Anxiety Symptoms Assessed by the Goldberg Anxiety and Depression Scale, Lifestyle Habits, and Cardiometabolic Risk in Spanish Workers

Abstract

Background: Anxiety has been increasingly recognized as a relevant contributor to cardiometabolic dysfunction through neuroendocrine, inflammatory, and behavioral mechanisms. However, evidence evaluating the relationship between anxiety symptoms, lifestyle habits, and cardiometabolic risk in large occupational populations remains limited. This study aimed to analyze the association between Goldberg Anxiety and Depression Scale (GADS) scores, lifestyle behaviors, and cardiometabolic risk factors in a large cohort of Spanish workers.

Methods: A cross-sectional observational study was conducted in 119,336 Spanish workers undergoing routine occupational health examinations between 2021 and 2023. Anxiety symptoms were assessed using the GADS. Lifestyle variables included smoking status, physical activity assessed with the International Physical Activity Questionnaire (IPAQ), and adherence to the Mediterranean diet evaluated through the Prevention with Mediterranean Diet (PREDIMED) questionnaire. Anthropometric measurements, blood pressure, lipid profile, fasting glucose, obesity, abdominal obesity, and metabolic syndrome were analyzed. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) for cardiometabolic abnormalities according to anxiety status and lifestyle factors. 

Results: Elevated GADS scores were significantly associated with worse cardiometabolic profiles in both sexes, including higher blood pressure, triglycerides, fasting glucose, body mass index, waist circumference, and lower high-density lipoprotein cholesterol concentrations. Workers with elevated anxiety presented markedly higher prevalences of hypertension, hypertriglyceridemia, impaired fasting glucose, abdominal obesity, and metabolic syndrome (all p < 0.001). After multivariable adjustment, elevated anxiety remained independently associated with hypertension (OR 6.48; 95% confidence interval (CI) 5.89– 7.09), hypertriglyceridemia (OR 5.31; 95% CI 4.60–6.02), and impaired fasting glucose (OR 5.23; 95% CI 4.64–5.83). Physical inactivity and low adherence to the Mediterranean diet were associated with a less favorable cardiometabolic profile among participants with elevated anxiety scores. Elevated GADS scores were independently associated with all major cardiometabolic outcomes after multivariable adjustment, with the strongest associations observed for hypertension, hypertriglyceridemia, and impaired fasting glucose.

Conclusions: Elevated GADS scores are strongly associated with adverse cardiometabolic profiles in Spanish workers, particularly when combined with unhealthy lifestyle behaviors. These findings support the integration of mental health assessment and lifestyle interventions into occupational cardiometabolic prevention strategies.