Longitudinal changes in generalised anxiety disorder symptoms, severity and associated factors among Australian men: insights from the Ten to Men study

While Australian men exhibit lower prevalence rates of anxiety disorders than women, these conditions contribute to higher suicide rates among men. Existing studies of men’s anxiety are predominantly cross-sectional and provide limited insights into the trajectories of anxiety symptoms and associated risk factors over time. This study aimed to investigate longitudinal changes in self-reported anxiety symptoms and severity among Australian men, identify associated factors, and examine their time-varying effects. Data were obtained from three waves (2020–2025) of the Ten to Men cohort study, using 18,592 observations from men aged 18 years and older. Ten to Men is a nationally representative longitudinal cohort study of Australian males, established in 2011 to build the evidence base on male health, using a stratified multi-stage cluster random sampling design. Anxiety symptoms were measured using the Generalised Anxiety Disorder (GAD-7) instrument. Two-part hurdle mixed-effects models were used to examine factors associated with both the presence and severity of self-reported anxiety symptoms and to assess the time-varying effects of these factors over time. Both the prevalence of reporting at least one self-reported anxiety symptom and the mean GAD-7 score decreased slightly over the study period (from 71.7% to 70.4% and from 3.65 +/- 4.36 to 3.61 +/- 4.25, respectively). Several factors, including younger age, non-Culturally and Linguistically Diverse (CALD) background, financial hardship, being married or in a de facto relationship, harmful alcohol use, gambling, lower subjective well-being, lower perceived social support, sexual difficulties, adverse life events, and living with a disability, were associated with a higher likelihood and/or greater severity of self-reported anxiety symptoms. Furthermore, increases in illicit drug use, high-risk alcohol consumption, and adverse life stress events over time were associated with a greater anxiety symptom severity. Illicit drug use, high-risk alcohol consumption, adverse life events, and financial hardship are modifiable factors whose associations with self-reported anxiety symptoms and their severity changed over time among Australian men and could be the primary focus of intervention programs. Moreover, this study provides valuable insights into other modifiable factors such as subjective well-being and social support to consider for developing timely, targeted and evidence-based interventions to address men’s anxiety symptoms and severity. However, these time-varying findings were based on borderline interaction effects among multiple tests and should be interpreted as exploratory and requiring replication in future studies. Not applicable.