The Relationship Between Anxiety and Employment Status in a German Working-Age Population: Findings on Sex-Specific Prevalence Rates and Associated Factors of Anxiety From the LIFE-Adult-Study

Introduction: Anxiety disorders are among the most prevalent mental illnesses worldwide, with a 12-month prevalence rate of 14%-15.3%. Prior research has demonstrated a correlation between unemployment and impaired mental health. The primary objective of this study is to examine the relationship between anxiety and employment status in Germany. Methods: The sample consisted of 4885 working-age participants (18-65 years) from the baseline survey of a population-based cohort study. Anxiety was assessed using the General Anxiety Disorder Scale-7 (GAD-7). Employment status was divided into four groups: full-time employment (FTE group), part-time employment (PTE group), ALG I (ALG I group, being unemployed receiving entitlement-based benefits), and ALG II (ALG II group, being unemployed receiving means-tested benefits). Negative binomial regressions were conducted to examine the association between anxiety, employment status, sociodemographic variables (age, sex, marital status, and education), and social resources (Lubben Social Network Scale 6 [LSNS-6]). Results: The prevalence of anxiety symptoms (FTE group: 5.0%, PTE group: 4.8%, ALG I group: 2.7%, and ALG II group: 17.6%) differed between employment status groups. The ALG II group exhibited a markedly elevated prevalence compared to all other groups (p < 0.001). The prevalence of anxiety symptoms was higher among females in the FTE group (7.6%) compared to males (2.9%) in the same category (p < 0.001). The initial regression model indicated a statistically significant association between anxiety symptoms and the ALG II group (p < 0.001) and the PTE group (p = 0.006). After including additional variables, this effect maintained its statistical significance. Factors associated with a higher risk of anxiety symptoms were female sex (p < 0.001), low educational level (p = 0.007), and less social resources (p < 0.001). Conclusion: Unemployed individuals who receive ALG II are at the highest risk of developing anxiety symptoms among those who are able to work. These findings suggest the need for targeted psychosocial and occupational support for unemployed individuals receiving ALG II.