OBJECTIVES: Generalized anxiety disorder (GAD) is a prevalent mental health condition that interferes with performing daily activities, and its impact on health-related quality of life (HRQoL) has been underexplored. This study aimed to quantify the association of GAD with HRQoL, overall, and by symptom severity.

METHODS: This cross-sectional study analyzed data from the 2022 US National Health and Wellness Survey, a nationally-representative, online-based survey. Adults (aged ≥18 years) diagnosed with GAD were categorized by symptom severity using the GAD-7 screening tool: no GAD symptoms (n=872, 0-4); mild (n=1,381, 5-9); moderate (n=1,100, 10-14); and severe (n=1,080, ≥15). Controls were defined as reporting no diagnosis of GAD and having a negative screen (n=36,505, GAD-7<10). Outcomes included 5-Level EQ-5D (EQ-5D-5L) index and RAND-36 (Global Health Composite [GHC], Physical Health Composite [PHC], Mental Health Composite [MHC]); higher scores indicate better HRQoL. Groups were compared on confounder-adjusted outcomes using generalized linear models (normal distribution, identity link).

RESULTS: Adjusted EQ-5D index scores were significantly lower among mild (0.80, 95% confidence interval [CI]: 0.79-0.81), moderate (0.75, 95%CI: 0.74-0.76), and severe GAD (0.66, 95%CI: 0.65-0.67) than controls (0.84, 95%CI: 0.84-0.84), with scores decreasing as severity worsened. Compared with controls (45.3, 95%CI: 45.2-45.4), adjusted GHC scores were significantly lower among mild (41.5, 95%CI: 41.0-42.0), moderate (38.3, 95%CI: 37.8-38.9), and severe GAD (35.0, 95%CI: 34.4-35.6), with scores decreasing as severity worsened, and significantly higher among diagnosed patients with no GAD symptoms (46.8, 95%CI: 46.1-47.4). A similar trend was observed for MHC and PHC scores, but the magnitude of difference for PHC was smaller, suggesting a greater impact of GAD symptom severity on mental health functioning than physical health functioning. For all comparisons, p<0.001.

CONCLUSIONS: Higher HRQoL burden was observed for greater GAD symptom severity. Findings highlight the need to reduce GAD symptom severity to potentially alleviate this HRQoL burden.