Is anxiety increasing in the United States? https://www.medicalnewstoday.com/articles/322877.

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By Tim Newman

According to some observers, anxiety is now snowballing in the United States. So, in
this Spotlight, we ask whether anxiety truly is becoming more prevalent in the West
and, if so, what may be causing it.

Anxious statue
The story of anxiety is deep and long.

For many, anxiety is an ever-present uninvited guest; in our circle of friends, among
family members, and in communities at large.

It seems to be rampaging through society like a noncontagious cognitive plague,

forming a low-level hum that hides in the corners of our collective minds.

In August 2018, Barnes & Noble — who are the largest book retailer in the United
States — announced a huge surge in the sales of books about anxiety; a 25 percent
jump on June 2017. "[W]e may be living in an anxious nation," one press release
dryly notes.

Does this surge in interest reflect a genuine spike in anxiety, or are people simply
more aware of it? In this article, we ask whether anxiety truly is increasing, if
wealthier nations are bearing the brunt, and why anxiety seems to be sitting in the
driving seat of modern society.

Many of us — a surprisingly high percentage, as we shall see — are all too familiar
with how anxiety feels. For those who have not experienced anxiety first-hand,
throughout the text, we have added excerpts from personal experiences.

Anxiety is a nebulous term that covers a great deal of psychological ground. At the
thinnest end of the wedge, before an exam or a job interview, we might feel anxious.
This is both understandable and normal; it is not a cause for concern.

Anxiety is only a problem when it extends beyond logical worry in an unreasonable,

unwarranted, uncontrollable way. Situations that should elicit no negative emotions
all of a sudden seem life-threatening or crushingly embarrassing.

At the widest end of the wedge, anxiety can arrive as a symptom of another mental
illness, such as panic disorders, post-traumatic stress disorder, phobias, or obsessive-
compulsive disorder (OCD).

When anxiety is a person's primary symptom, it may be referred to as generalized

anxiety disorder (GAD). The National Health Service (NHS) in the United Kingdom
summarize GAD neatly.

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"People with GAD," they explain, "feel anxious most days and often
struggle to remember the last time they felt relaxed. As soon as one
anxious thought is resolved, another may appear about a different
issue."

GAD affects around 6.8 million people in the U.S. — or more than 3 percent of the
country's adults.

Another common form of anxiety is social anxiety, which affects people more
specifically in social situations.

It might make someone very self-conscious, perhaps not wanting to eat or drink in
front of others, fearing that people are talking about them, or worrying about being
lost in a crowd. It comes in many forms.

Anxious woman biting nails

Anxiety disorders are more common than one might think.

Today, "anxiety disorders are the most common mental illness in the U.S.," affecting
around 40 million adults — almost 1 in 5 people.

Globally, the World Health Organization (WHO) say that almost 300 million people
have an anxiety disorder.

Anxiety disorders are not new, either. In fact, Robert Burton wrote this description in
The Anatomy of Melancholy (1621) referring to a patient of Hippocrates. It will
resonate with anyone who has ever experienced anxiety.

"He dare not come into company for fear he should be misused,
disgraced, overshoot himself in gestures or speeches, or be sick; he
thinks every man observeth him."

Interestingly, anxiety is not just a human experience, and evolution is ultimately to

blame (or thank); as with other animals, humanity's survival relies on our natural
ability to feel anxious about genuinely dangerous situations and to be on guard.

It is when this life-saving mechanism is triggered at inappropriate times or gets stuck

in the "on" position that it becomes a problem.

So, to the first big question: is anxiety really affecting us more now than it has in the
past? Is anxiety on the up in the West, or, in a modern society where good mental
health is a goal in itself, are we just more likely to notice and discuss it?

"When it's bad, it feels like an electric current building up inside of me

and like it's going to start shooting out of me, except it doesn't, which is
worse."

Anon.

A large study that was published in the journal JAMA Psychiatry in 2017 set out to
answer this exact question. In particular, the researchers looked at GAD.

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One might expect that, since mental illness tends to be more common in areas of the
U.S. that have a lower socioeconomic status, anxiety might also be more prevalent in
countries with a lower socioeconomic profile.

Additionally, in less wealthy countries, people can be under substantial stress;

finding food, water, or safety might be an issue in some regions.

However, it is important to remember that GAD is about feelings of anxiety that are
unreasonable. In a country where there is genuine struggle, higher levels of anxiety
might rightly be considered justifiable and therefore not a diagnosable condition.

The study, involving 147,261 adults from 26 countries, concluded:

"The disorder is especially common and impairing in high-income

countries despite a negative association between GAD and
socioeconomic status within countries."

In other words, within each country, GAD is more prevalent in less wealthy regions.
However, as a whole, it is the residents of wealthier countries who are more likely to
experience GAD, and their lives are more significantly impacted by it.

Breaking down the statistics, the scientists found that lifetime estimates for GAD
were as follows:

low-income countries: 1.6 percent

middle-income countries: 2.8 percent
high-income countries: 5.0 percent

This is in line with other research that found a higher prevalence of anxiety in
wealthier economies.

In the WHO's Depression and Other Common Mental Disorders Global Health
Estimates report that was released in 2017, they compare prevalence estimates of
mental disorders across global regions.

When they compare the levels of depression, no single area has significantly higher
rates. When it comes to anxiety disorders, however, it's a different story; the
Americas are head and shoulders above all other regions, including Africa and
Europe.

Interestingly, though the U.S. and the West in general do seem to be taking the lead
in the anxiety stakes, it may not stay this way for long; the very same report explains
that common mental health disorders are increasing in lower-income countries
"because the population is growing and more people are living to the age when
depression and anxiety most commonly occurs."

Added to this, anxiety tends to be less common in older adults. Also, because the
average age of U.S. individuals is slowly rising, the percentage of people with anxiety
disorders may gradually decline.

To conclude this section, although other countries might be catching up, it does seem
that anxiety is more common in wealthier nations and perhaps the U.S. in particular
— but is it getting worse?

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"Anxiety is mysterious. It can feel like an invisible cage that keeps you
prisoner on your sofa, unable to move for fear of something that you can't
quite identify."

Anon.

Much debate surrounds this question. Is anxiety on the rise, or are we simply more
inclined to think and speak about it these days? This is a tough question to pick
apart, but we must try.

The American Psychiatric Association ran a poll on 1,000 U.S. residents in 2017, and
they found that nearly two thirds were "extremely or somewhat anxious about health
and safety for themselves and their families and more than a third are more anxious
overall than last year."

Anxious face in the shadows

Anxiety in the U.S. may be impacting millennials most.

They also noted that millennials were the most anxious generation.

In 2018, the same poll was repeated. Anxiety was shown to have risen again by
another 5 percent.

Millennials were revealed to still be the most anxious generation.

It is crucial to remember, though, that increasing feelings of anxiety do not equate to

a diagnosis of anxiety disorder.

Naturally, it is possible to feel more anxious than you previously did without it being
classified as a mental condition.

Looking at the broader picture, several studies have charted the rise of mental health
issues in the West.

For instance, a meta-analysis published in 2010 took data from studies that included
over 77,000 young people; the scientists found generational increases in mental
health issues in 1938–2007.

Another report, using data from four surveys completed by almost 7 million people in
the U.S., concluded that "Americans reported substantially higher levels of
depressive symptoms, particularly somatic symptoms, in the 2000s–2010s
compared to the 1980s–1990s."

Outside of the U.S., the U.K. Council for Psychotherapy published a report in 2017
that assessed the mental health of full- and part-time employees. Their figures show
that "workers reporting anxiety and depression have risen by nearly a third in the last
4 years."

As for Europe at large, a huge analysis that was published in 2011 concluded that
almost one third of adults had some type of mental health issue, with anxiety
disorders being the most frequent.

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However, this study was a follow-up to a similar pan-European review conducted in

2005, and the authors note that there were no significant increases between these
years.

"I have a list of possible problems in my head. If all the real problems are
solved, I turn another one into a problem so that I can worry about it.
These are constant facts of life. It is not increasing. It has always been like
this."

Anon.

The authors believe that the perception of a new wave of mental health issues may be
an illusion, concluding that "the true size and burden of disorders of the brain in the
[European Union] was significantly underestimated in the past."

Another paper concludes that "it is difficult to find reliable evidence for a change in
prevalence rates for anxiety disorders. Epidemiologic data obtained before the
introduction of psychiatric classification systems [...] are too imprecise to be
comparable with modern studies."

The study authors note that "the rate of treatment-seeking individuals increased,
which may be the reason for the general impression that these disorders are more
frequent."

To add to the already complicated mix, anxiety disorders have a genetic factor.
Researchers think that 30–50 percent of the variation in anxiety disorders within a
population is down to our genes.

Levels of a condition that has a heritable component are likely to be more stable,
since the prevalence of those genes won't change much across a few decades or even
centuries.

Whether the upward trend is real or imagined, there is no question that anxiety is
dominant in the U.S. population; so, the next question is...

Before we dive into the next section, we must make clear that there is no definitive
answer to this question. Many people have offered insight, be it backed up by
evidence or not. The answer is likely to be complex in the extreme and a mishmash of
all facets of modern life and societal pressures.

Anxious man in window

Anxiety is complex — as are its origins.

No two people are the same; no two people's experiences are the same; no two
people's experience of anxiety is the same.

Therefore, it is highly unlikely that there will be an answer that fits all sizes.

That said, there is a range of theories that attempt to explain why anxiety might be
creeping steadily into the foreground.

As we have seen, the number of people in wealthier societies who have an anxiety

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disorder is surprisingly high.

However, it's worth noting that many people who experience daily anxiety may not
meet the criteria for an anxiety disorder but are still affected.

These people are harder to quantify; they fly under the radar, not enduring enough
psychological discomfort to join the GAD ranks but still feeling its force.

"If someone overtakes me on my way home, anxiety convinces me that it's

my fault for going too slow. If a family member or friend gets into an
accident, anxiety convinces me it's my fault for not wishing them a safe
journey."

Anon.

Below are a few theories that have been kicked around by people interested in how
anxiety might develop.

A shift in society
Some say that humans in Western societies are becoming more psychologically
sensitive because there is less pressure on us to survive now that food and water are
so abundant. They believe that our gaze has moved away from survival and shifted
inward.

They argue that we now focus on extrinsic desires, such as a new car and a big house,
rather than intrinsic desires, including the joy of family and friends, and meeting
with others in the community.

This all sounds like it may be difficult to pin down with research, but some scientists
have come to similar conclusions.

One study published in the 1990s found that people who pursued money, looks, and
status were more likely to feel anxious and depressed.

A study looking at changes in freshman attitudes over a 40-year period found that
the number of students who place importance on financial gains has almost doubled
since the 1960s, whereas "developing a meaningful philosophy for life" has dropped
in importance dramatically.

A meta-analysis that investigated increased psychopathology in U.S. youths over

time concluded that "[t]he results best fit a model citing cultural shifts toward
extrinsic goals, such as materialism and status and away from intrinsic goals, such as
community, meaning in life, and affiliation."

Motivations are drifting away from the community and onto the individual.
Materialism is paramount in modern society. It's impossible to draw a straight line
between these shifts in culture and anxiety, but some are tempted to do so.

"The worst part is not being able focus — anxiety induces a thick brain
fog, making it really difficult to concentrate at work. Not being able to
concentrate at work, in turn, makes me feel anxious about other people's
perception of my performance and feeds the cycle."

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Anon.

Living alone
People today are much more likely to live alone than they were 50 years ago. In the
U.S. in 1960, under 7 percent of adults lived alone; by 2017, that figure had soared to
well over one third of adults.

Could this be playing a part? Of course, many people are incredibly happy to live
alone — others, however, are not.

Loneliness has received a great deal of interest over recent years and has been
discussed as a potential risk factor for depression and Alzheimer's, among other
conditions.

Although depression and anxiety disorders are separate conditions, individuals with
depression commonly experience similar symptoms, such as nervousness. Social
anxiety disorder often appears in tandem with major depression.

Lonely man
Could loneliness help explain anxiety in the West?

In fact, those who go on to develop depression often develop an anxiety disorder

earlier on in their life.

Anxiety also sometimes occurs as a part of the mood changes that take place in the
early and middle stages of Alzheimer's.

Loneliness can also worsen symptoms for those with chronic pain, a condition that
often brings anxiety in tow.

Similarly, being in a state of high anxiety can increase the level of perceived pain,
thereby creating a vicious cycle; if someone is in pain, they feel anxious, and anxiety
drives the pain.

It seems that social isolatation could potentially increase anxiety through a number
of pathways.

To muddy the waters further, some people who experience high levels of anxiety
choose to live alone. So, the higher number of people living alone may be part of the
cause and effect of an increase in anxiety levels in the West.

A chemical world

Perhaps there's something in the water? That sounds a little conspiratorial, but we
shouldn't dismiss it out of hand. There certainly is an unwieldy range of chemicals in
the environment we inhabit.

A literature review — published in 2013 — assessed the evidence that chemicals in

the environment might influence the developing brain while we are in the womb.

Poring over existing research, the scientists investigated chemicals well-known to be

poisonous (such as lead), chemicals that have been considered dangerous only in
recent decades (such as methylmercury), and compounds that are only now being

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studied for potential toxicity (including certain ingredients in plastics).

Of the chemicals they tested, only two were linked with anxiety, specifically. These
were phthalates and bisphenol-A, both of which are used in the production of
plastics. However, the findings were inconclusive, and the relevant studies that they
analyzed produced contradictory results.

A large BMJ study involving more than 70,000 female nurses drew links between air
pollution and anxiety.

To reach this conclusion, the researchers estimated long-term pollution exposure

and compared it with data from an anxiety questionnaire. They found that those who
had higher levels of exposure were more likely to report symptoms of anxiety.

This area of research is notoriously difficult to unpick; humans are never exposed to
just one single chemical. We are all bathed in a cocktail of varying composition; a
cocktail whose ingredients change across the days, months, and years.

It will be a long time before even semisolid conclusions can be made about
environmental chemicals and anxiety.

"My anxiety is usually a bit like white noise in the background — I get on
with life, but it always feels like there's something I'm missing, something
I haven't attended to, or that there's something I've done horribly wrong."

Anon.

Can we blame social media?

Some others have looked to the impact of social media on mental health. After all,
social media has flooded society so thoroughly in such a short space of time, it is
highly unlikely to have had no impact at all.

Woman holding phone

What role does social media play in anxiety today?

Facebook was founded in 2004; today, almost 1.5 billion people use it at least once
per day.

So one, singular, standalone website is now perused by around 1 in 5 people globally.

That's incredible, and Facebook is only one of the many social media giants.

Studies looking at the link between social media and anxiety are relatively easy to
find.

For instance, one that investigated social media use, sleep, and mental health in over
400 Scottish adolescents revealed that those who used social media the most,
particularly at night-time, had lower self-esteem and higher levels of anxiety and
depression.

Another investigation surveyed more than 1,700 young U.S. adults. The researchers
compared the number of social platforms used with levels of anxiety and depression.

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People who frequented higher numbers of social platforms reported higher levels of
depression and anxiety. Another study on 18–22-year-olds came to similar
conclusions.

Before we throw Facebook and their staff to the lions, we need to remember that
cause and effect cannot be established in the vast majority of these studies.

It is possible that an anxious person seeks solace in social media. Perhaps it's not that
social media causes anxiety, but that social media is attractive to those who are
already anxious. Maybe anxiety drives the user to engage with social media more
often.

Because social media is so ubiquitous, it is difficult to run a study with a control

group of adults who have not been introduced to it.

"For me, having OCD-related anxiety means that nothing — not even the
most banal everyday activity — can be experienced without guilt and fear.
And that's why it's draining. I'm constantly on the lookout for the harm I
might involuntarily cause."

Anon.

Is life just more stressful now?

Are jobs more stressful? Is commuting to blame? When we tell kids that they can
"achieve anything if they try hard enough," are we setting them up to fail? Not every
kid can be the president (or Beyoncé), after all.

News media
'Fake news' is everywhere.

Is our self image being driven into the floor by the constant bombardment on our
senses of perfectly filtered, digitally altered models?

Has capitalism shifted the attention from kindly social pursuits to vastly
unobtainable personal desires, leaving us with a gaping chasm we know we can never
fill?

Can we lay some of the blame at the feet of the modern media, the perpetual, brightly
lit news cabaret telling us that the world is broken, we broke it, and it can't be fixed,
and that everything gives us cancer?

Indeed, John S. Price, a former practicing psychiatrist, when introducing a paper on

the evolution of social anxiety, writes that "as a practicing clinician, I advise all my
anxious patients to avoid watching TV news."

Climate change, nuclear apocalypse, Ebola, flesh-eating viruses, antibiotic resistance,

ever-growing economic inequality, fake news...the list is endless.

Anxiety might be prevalent because the society we live in is more stressful than it was
5, 10, or 50 years ago.

However, assessing how stressful a society is compared with any other is bordering
on impossible.

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Perhaps anxiety is prevalent in the U.S. because of all or none of the above. After all,
everyone is different, and anxiety may have a myriad of causes in each individual.

Unraveling the ins and outs of mental health is not a simple task; conditions overlap,
symptoms vary, and cause and effect are blurred.

Is anxiety a spectrum that we all inhabit? Is humanity a naturally anxious species? Its
severity and prevalence might fluctuate with the social conditions of the time, but
perhaps it is within us all.

Maybe anxiety is poised and ready to pounce when we let down our guard, or when
our guard is reduced by external forces.

This article has posed many more questions than it has answered, but at the very
least, it shows how complex the issue of anxiety is. Perhaps most importantly, it
shows you that if you are personally affected by anxiety, you are not alone.

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