Graves disease (GD) is an autoimmune thyroid disease and is the most common cause of hyperthyroidism in developed countries. Research suggests that patients with GD experience high levels of anxiety and depression. Until recently, this increased prevalence hasbeen attributed largely to Graves-induced hyperthyroidism, however even after achieving euthyroidism, many patients continue to suffer from neuropsychiatric symptoms. This suggests that the mood symptoms present in these individuals may be associated with the autoimmune inflammatory processes underlying GD. This relationship has yet to be fully understood, highlighting the need for an evaluation of the current literature. This systematic review aimed to assess the prevalence of anxiety and depression in GD patients and to identify associated risk factors.

The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024611942). EMBASE, MEDLINE, PsycINFO and the Cochrane Library were searched up to 31 October 2024. Papers were included providing the participants were diagnosed with GD and satisfied the diagnostic criteria for anxiety, depression or both; or provided symptomatology measures. Studies were quality assessed using Hawker’s tool. 29 studies were included and underwent data extraction. Studies using a case-control design were summarised separately.

Symptoms of anxiety and depression were consistently higher in the GD group versus healthy controls. GD patients displayed a higher baseline degree of anxiety and depression, compared with patients with other causes of hyperthyroidism. Depression and anxiety were more prevalent in relapsed hyperthyroid GD patients, compared with remitted euthyroid GD patients. Risk factors included body mass index (BMI), physical activity, gender, stress and smoking. A limitation of the review was the high study heterogeneity resulting from the variety of study designs included.

These findings highlight a population that may benefit from early psychiatric assessment. The higher prevalence of anxiety and depression observed in GD patients, including those who are euthyroid, reflects the complex interplay between autoimmune, endocrine and psychological processes underpinning the relationship between GD and mental health conditions. This pattern emphasises the need for a multidisciplinary, integrated and holistic approach when managing and treating GD patients. Future research establishing the mechanisms responsible for this increased prevalence could facilitate the development of targeted interventions and preventative treatments.

Funding: None.

Background: Growing evidence from observational studies indicates a high prevalence of anxiety in asthma. However, prevalence rates of coexisting anxiety symptoms and comorbid anxiety disorders vary widely across studies. We aimed to evaluate the associations between anxiety and asthma and provide more precise comorbidity estimates.

We systematically reviewed the literature from case-controlled studies and conducted a meta-analysis to evaluate the pooled prevalence estimates and risks of anxiety symptoms and anxiety disorders in asthma individuals. Screening, data extraction, and quality assessment were undertaken following PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. A random-effects model was used to calculate pooled prevalence rates. Meta-analysis was conducted using Review Manager 5.3. Multiple databases including PubMed, ScienceDirect, PsychINFO, and PsycARTICLES were searched for publications before 1 December 2019. The review protocol was registered on PROSPERO (ref: CRD42020176028).

In total, 19 studies involving 106813 participants were included. The pooled prevalence of anxiety symptoms and anxiety disorders in individuals with asthma was 0.32 (95% CI 0.22–0.43) and 0.24 (95% CI 0.13–0.41), respectively. The risks of coexisting anxiety symptoms and comorbid anxiety disorders were significantly higher in asthma patients than in non-asthma controls indicated by OR 1.89 (95% CI 1.42–2.52; Z = 4.37; p < 0.001) and OR 2.08 (95% CI 1.70–2.56; Z = 6.97; p < 0.001), respectively. Anxiety symptoms and anxiety disorders occur at increased frequency among patients with asthma.

Our findings highlight the need for appropriate assessments for these comorbid conditions, which may help to identify a subgroup of patients who might benefit from interventions designed to reduce anxiety and enhance the quality of life.