The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta‐analysis

Megan E. Renna

Mia S. O’Toole

Phillip E. Spaeth

Mats Lekander

Douglas S. Mennin

First published: 10 September 2018



Anxiety is characterized by prolonged preparation for real or perceived threat. This may manifest both as psychological and physiological activation, ultimately leading to greater risk for poor health. Chronic inflammation may play an integral role in this relationship, given the influential role that it has in chronic illness. The aim of this meta‐analysis is to examine levels of chronic inflammation, measured by inflammatory cytokines and C‐reactive protein, in people with anxiety disorders, PTSD (posttraumatic stress disorder), or obsessive–compulsive disorder compared to healthy controls. Several moderating variables, including specific diagnosis and depression comorbidity, were also assessed.


Seventy six full‐text articles were screened for eligibility with 41 studies ultimately included in analysis.


Results demonstrated a significant overall difference between healthy controls (HCs) and people with anxiety disorders in pro‐inflammatory cytokines (P = 0.013, Hedge’s g = –0.39), which appears to be largely driven by interleukin‐1β (IL‐1β; P = 0.009, Hedge’s g = –0.50), IL‐6 (P < 0.001, Hedge’s g = –0.93), and tumor necrosis factor‐α (P = 0.030, Hedge’s g = –0.56). Moderation analyses revealed a moderating effect of diagnosis (P = 0.050), as only individuals with PTSD demonstrated differences in inflammation between HCs (P = 0.004, Hedge’s g = –0.68).


These data demonstrate the association between inflammatory dysregulation and diagnoses associated with chronic, impactful, and severe anxiety and provides insight into the way that anxiety, and in particular PTSD, is related to certain inflammatory markers. In doing so, these findings may provide an initial step in disentangling the relationship between anxiety and basic health processes.

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About S. R. Zelenz 119 Articles
S.R. Zelenz has worked in education for 20 years. Working with students from all walks of life, cultures, races, and social diversity, Zelenz’s research in Educational Leadership led to finding a better way to approach learning for students with trauma histories. Many were juvenile offenders, gang members, diagnosed with varying behavioral disorders, or had family histories of violence, murder, or narcissistic parenting. This research could not be effectively accomplished without further understanding: how epigenetic trauma inheritance may be impacting these students; how brain development from trauma may be impacting their behavioral and emotional development; as well as deep understanding of psychology and its varying classifications for behavioral and personality disorders. The goal is to find solutions for changing the conversation and making a real difference for these students. She has also worked with nonprofits of varying focus areas for the last 25 years. Her undergraduate degree in Arts Administration and Music prepared her for managing nonprofits of any size as well as procuring funding so that they can achieve their goals. Pairing her nonprofit background with her education background, she has been able to make a difference for over 200 nonprofits worldwide, written curriculum for schools across the globe, and assisted many arts organizations through performance and management.