People who feel in control of their lives, and who find purpose and meaning in life, are less likely to experience anxiety disorders even when going through the toughest times, according to a study led by the University of Cambridge.

The study found that women who had these traits did not have anxiety, even if they were living in the most deprived circumstances, but women who did not feel that they were in control of their lives and who lacked purpose and meaning in life had high levels of anxiety when facing the hardships of living in deprivation. The finding could help researchers develop new ways of teaching women how to overcome anxiety.

Anxiety disorders are some of the most common mental health problems and their annual cost in the United States is estimated to be $42.3 billion. In the European Union, they affect over 60 million people in a given year.

Anxiety Disorders

Anxiety disorders can materialize as an inability to concentrate on work or school tasks, restlessness, fear, and difficulty in falling asleep at night.

In some cases, anxiety can arise out of the blue as in a panic attack, when sudden spikes of intense anxiety make the sufferer think they are having a heart attack, going insane, or even dying. In other cases, it is triggered by specific situations, such as being on a bus or at a social gathering, and symptoms such as sweating, chest pains, gastrointestinal discomfort, and dizziness may ensue.

Even though anxiety disorders are so common and costly, few studies have looked at what makes some people have anxiety when going through tough times, while others facing the exact same situations are able to maintain good mental health.

National Institute for Health Research (NIHR)-funded researchers from the Cambridge Institute of Public Health used data from over 10,000 British women who had responded to a structured health and lifestyle questionnaire. The questionnaire included a measure of Sense of Coherence, which is a personality disposition.

Sense of Coherence

Aaron Antonovsky, a professor of medical sociology, defined Sense of Coherence as:

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement."

(from Antonovsky, Aaron (1987). Unravelling the mystery of health. Josey Bass Publishers. p. 19. ISBN 1-55542-028-1)

In his formulation, the sense of coherence has three components:

Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.

Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.

Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His research demonstrated that the sense of coherence predicts positive health outcomes.

Inner Strengths

Women living in deprivation but who reported the following traits were less likely to have anxiety:

  • believing they were in control of their lives

  • believing their lives made sense

  • having a purpose and meaning in life.

Women living in deprivation but without these desirable traits had high levels of anxiety. In fact, women in deprived communities without these traits were almost twice as likely to have anxiety as women living in more affluent communities.

“This study sheds light on inner strengths or qualities that we may have which can protect us from anxiety when we’re exposed to hardships, such as living in deprivation. Fostering such strengths or traits may be useful for people who do not respond well to medication or other therapies for anxiety, and further research would be needed on this,”

first author and PhD candidate Olivia Remes said.


The researchers say that living in deprivation can lead to a sense of meaninglessness among individuals, and can give rise to poor mental health and suicide. In deprived communities, people are more fearful of their neighbours, assaults are more likely to happen, and it is difficult to form close relationships with others.

The total number of people living in deprivation worldwide is large; as such, the results of this study are particularly important.

“This study takes a different approach to mental health. Up until now, most studies have looked at what makes someone prone to disease, and the risk factors for ill health. But we have taken a different approach. Instead of looking at risk factors for disease, we are looking at traits or strengths that we have within us that can help us maintain good mental health and overcome adversity,"

said Professor Carol Brayne, Director of the Cambridge Institute of Public Health.

To carry out her research, Remes used data from the European Prospective Investigation of Cancer in Norfolk, one of the largest cohort studies looking at chronic diseases, mental health, and the way people live their lives.

She hopes her research will help inform prevention and intervention efforts directed to help those suffering from anxiety, but also that it will lead to greater awareness of the condition.

The work was supported by the Medical Research Council UK and Cancer Research UK.

Remes O, Wainwright NWJ, Surtees P, et al A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study BMJ Open 2018;8:e018501. doi: 10.1136/bmjopen-2017-018501

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