Scoping Review of Risk Factors of Anxiety Disorders and Post-Traumatic Stress Disorder: A Public Health Perspective

Objective: To identify risk factors for Anxiety Disorders and Post-Traumatic Stress Disorder (PTSD) in the general population. Knowledge of risk factors is useful for identifying at-risk populations, guiding the development of prevention programs, and improving early detection of these disorders. Method: A scoping review of English and French language articles published between 2003 and 2015 was conducted. Longitudinal studies of risk factors in the general population using definitions of anxiety disorders and PTSD as per the DSM-IV nomenclature were included. Associations between risk factors and anxiety disorders or PTSD were summarized and compared. Synthesis: Twenty-two longitudinal studies focusing on anxiety (N=17) and PTSD (N=5) were retained. The bulk of evidence came from ten large, population-based, longitudinal prospective studies. Six categories of risk factors emerged: 1) genetic/biological, 2) neurodevelopmental, 3) environmental, 4) temperamental, 5) behavioral, and 6) stress-related. Conclusion: Risk factors for anxiety disorders are multifactorial and often mutually interactive. Childhood is a critical period. Children of parents with psychopathology, who demonstrate behavioral inhibition, who demonstrate antisocial behavior, who have low IQ, or who live in chronically adverse conditions such as poverty, are at risk of developing anxiety disorders. A history of juvenile disorders, severe maltreatment, poor quality of parental care, as well as symptoms of PTSD themselves, can increase the likelihood of PTSD. PTSD symptoms may develop in response to traumatic/life threatening events as well to accumulation of stressful, but non-traumatic events. Successful prevention of anxiety disorders and PTSD should focus on modifiable behavioural, environmental, and stress-related risk factors.