Functional impairment is independently associated with probable generalised anxiety disorder: a real-world outpatient study in Japan

Background Generalized anxiety disorder (GAD) is characterized by excessive and difficult-to-control worry and is associated with substantial functional impairment across multiple domains of daily life. Despite its clinical burden and impact on quality of life, GAD remains under-recognized and inadequately treated in routine clinical practice. Although validated instruments such as the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Athens Insomnia Scale, and Work Productivity and Activity Impairment (WPAI) questionnaire are widely used in both research and clinical settings, real-world evidence examining their relationships with sociodemographic characteristics and pharmacological treatment patterns remains limited. This study aimed to elucidate the clinical characteristics and associated factors of GAD in a real-world outpatient setting in Japan.

Methods We conducted a retrospective observational study of 59 outpatients attending a mental health clinic between December 2025 and April 2026. Data on sociodemographic variables (age, sex, occupation, marital status, and years of education), ICD-based psychiatric diagnoses, pharmacological treatments, and standardized clinical measures (GAD-7, PHQ-9, Athens Insomnia Scale, and WPAI) were extracted from medical records. Participants were classified into probable GAD (GAD-7 ≥10) and non-GAD groups. Group comparisons were performed using appropriate statistical methods. Multivariable logistic regression analyses were conducted to identify factors independently associated with probable GAD, adjusting for clinically relevant covariates including age, sex, depressive symptoms, and insomnia severity. This study was approved by the Nanyokai Institutional Ethics Committee. Informed consent was waived due to the retrospective design, and an opt-out approach was used in accordance with the Declaration of Helsinki.

Results The mean age of the participants was 42.7 ± 13.4 years, and 64.4% were female. Seventeen patients (28.8%) were classified as having probable GAD. Compared with the non-GAD group, individuals with probable GAD exhibited significantly higher levels of insomnia severity, depressive symptoms, and activity impairment (all p < 0.05). In addition, the use of anxiolytic and antipsychotic medications was significantly more frequent in the probable GAD group (p < 0.05).In multivariable logistic regression analyses, activity impairment (per 10% increase) was independently associated with probable GAD (OR = 1.66, 95% CI: 1.05–2.62, p < 0.05). Anxiolytic use was also independently associated with probable GAD (OR = 6.08, 95% CI: 1.21–30.62, p < 0.05).

Conclusion These findings indicate that a substantial proportion of outpatients may have probable GAD and that functional impairment is a key clinical correlate beyond symptom severity. The results also suggest that GAD remains under-recognized and suboptimally managed in routine outpatient care in Japan. Incorporating disorder-specific assessment tools and treatment strategies may contribute to improvements not only in symptom burden but also in functional outcomes in real-world clinical practice. These findings may also inform future research and contribute to the development of more effective clinical management strategies for GAD, and help improve early identification and intervention in routine clinical settings.

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