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

Q: What are the key findings of this study?

Elevated Goldberg Anxiety and Depression Scale scores were independently associated with increased odds of hypertension (OR 6.48, 95% CI 5.89-7.09), hypertriglyceridemia (OR 5.31), and impaired fasting glucose (OR 5.23) in Spanish workers.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiometabolic risk in occupational workers (n=119336). Intervention: Elevated anxiety symptoms (Goldberg Anxiety and Depression Scale score ≥4) vs. Low anxiety symptoms (Goldberg Anxiety and Depression Scale score <4). Primary outcome: Hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or antihypertensive treatment) (OR 6.48, 95% CI 5.89-7.09, p=<0.001).

Q: What does this research mean for the field?

Elevated anxiety symptoms assessed by the Goldberg Anxiety and Depression Scale are independently associated with adverse cardiometabolic risk profiles, particularly increased odds of hypertension, hypertriglyceridemia, and impaired fasting glucose in workers. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the relationship between anxiety symptoms measured by the Goldberg Anxiety and Depression Scale, lifestyle behaviors, and cardiometabolic risk factors among Spanish workers.

Lucía Garrido Sepúlveda; Pedro Juan Tárraga López; María Teófila Vicente-Herrero; Jose Alberto Garrido; Ángel Arturo López‐González; José Ignacio Ramírez‐Manent

doi:10.62641/aep.2356

October 15, 2026Actas Españolas de PsiquiatríaOpen Access

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

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Key result

Elevated anxiety and depression scores linked to ~6.5-fold higher odds of hypertension.

OR 6.48
95% CI 5.89-7.09
P<0.001
n=119,336

Why the study?

Anxiety contributes to cardiometabolic dysfunction, yet evidence evaluating the relationship between anxiety symptoms, lifestyle habits, and cardiometabolic risk in large occupational populations remains limited.

Are elevated anxiety symptoms on the Goldberg Anxiety and Depression Scale and unhealthy lifestyle habits associated with increased cardiometabolic risk factors in Spanish workers?

Key Points

To examine the relationship between anxiety symptoms measured by the Goldberg Anxiety and Depression Scale, lifestyle behaviors, and cardiometabolic risk factors among Spanish workers.
Cross-sectional observational study of 119,336 Spanish workers (71,787 men and 47,549 women; mean age 39.6 ± 10.3 years) undergoing routine occupational health examinations between 2021 and 2023.
Anxiety symptoms were evaluated with the Goldberg Anxiety and Depression Scale (GADS score ≥4 classified as high anxiety), physical activity was assessed with the IPAQ, and diet was evaluated using the PREDIMED questionnaire.
Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) for blood pressure, lipid abnormalities, fasting glucose, obesity, and metabolic syndrome.
After multivariable adjustment, elevated anxiety remained independently associated with hypertension (OR 6.48; 95% 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).
In men, high anxiety scores corresponded to higher prevalences of hypertension (36.9% vs 6.9%), hypertriglyceridemia (41.3% vs 7.9%), and impaired fasting glucose (28.0% vs 4.9%) compared to low anxiety scores (all p < 0.001).
Physical inactivity and low adherence to the Mediterranean diet were associated with less favorable cardiometabolic profiles among individuals with elevated anxiety scores.

Study Design

Type

Cross-Sectional (n=119,336)

Multicenter

Yes

Structured PICO

Are elevated anxiety symptoms on the Goldberg Anxiety and Depression Scale and unhealthy lifestyle habits associated with increased cardiometabolic risk factors in Spanish workers?

P

Population

119,336 Spanish workers (mean age 39.6 years, 39.8% female) aged 20-69 years undergoing routine occupational health examinations between 2021 and 2023.

E

Exposure

Elevated anxiety symptoms assessed via the self-administered Goldberg Anxiety and Depression Scale (GADS anxiety subscale score ≥4 points) alongside lifestyle behaviors (smoking status, physical activity via IPAQ-SF, and Mediterranean diet adherence via 14-item PREDIMED questionnaire).

C

Comparator

Low anxiety symptoms (Goldberg Anxiety and Depression Scale anxiety subscale score <4 points) and healthy lifestyle behaviors.

O

Outcome

Cardiometabolic alterations including hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg or antihypertensive treatment), hypertriglyceridemia (≥150 mg/dL), impaired fasting glucose (100-125 mg/dL or antidiabetic treatment), hypercholesterolemia (≥200 mg/dL), elevated LDL-c (≥130 mg/dL), low HDL-c (<40 mg/dL in men, <50 mg/dL in women), general obesity (BMI ≥30 kg/m²), abdominal obesity (waist circumference ≥102 cm in men, ≥88 cm in women), and metabolic syndrome (harmonized international criteria).surrogate

Main Result

Odds Ratio: 6.48 (95% CI 5.89–7.09)

p-value: p=<0.001

Elevated anxiety symptoms on the Goldberg Anxiety and Depression Scale are strongly and independently associated with hypertension, hypertriglyceridemia, and impaired fasting glucose in working adults, supporting mental health integration into occupational cardiovascular prevention.

Limitations

Former smokers were included in the non-smoker category due to the absence of standardized information regarding smoking cessation duration.
Former smokers were categorized as non-smokers due to lack of standardized data on smoking cessation duration

Implication

May inform occupational screening; leaves open causality and whether anxiety treatment reduces cardiometabolic risk.

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. 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.

Discussion

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Cite This Study

Sepúlveda et al. (2026) conducted a cross-sectional in Cardiometabolic risk in occupational workers (n=119,336). Elevated anxiety symptoms (Goldberg Anxiety and Depression Scale score ≥4) vs. Low anxiety symptoms (Goldberg Anxiety and Depression Scale score <4) was evaluated on Hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or antihypertensive treatment) (OR 6.48, 95% CI 5.89-7.09, p=<0.001). Elevated Goldberg Anxiety and Depression Scale scores were independently associated with increased odds of hypertension (OR 6.48, 95% CI 5.89-7.09), hypertriglyceridemia (OR 5.31), and impaired fasting glucose (OR 5.23) in Spanish workers.

synapsesocial.com/papers/6ae13cba043bfbd6353324cb https://doi.org/10.62641/aep.2356

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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