OBJECTIVE Studies have shown that area-level deprivation measured by factors, such as, non-home ownership, non-car ownership, and household overcrowding, can increase the risk for mental disorders over and above individual-level circumstances, such as, education and social class. Whether area-level deprivation is associated with generalised anxiety disorder independent of personal circumstances, and whether this association is different between British women and men is unknown.

DESIGN Large, population study.

SETTING UK population-based cohort.

PARTICIPANTS 30,445 people from the general population aged 40 years and older and living in England consented to participate at study baseline, and of these, 21,000 participants completed a structured health and lifestyle questionnaire used to capture generalised anxiety disorder. Area deprivation was measured in 1991 using Census data, and generalised anxiety disorder was assessed in 1996-2000. 10,275 women and 8,219 men had complete data on all covariates.

MAIN OUTCOME MEASURE Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

RESULTS In this study, 2.5% (261/10,275) of women and 1.8% (145/8,219) of men had generalised anxiety disorder. Women living in the most deprived areas were over 60% more likely to develop anxiety than those living in areas that were not deprived (OR=1.63, 95%CI: 1.21 to 2.21; p=0.001), but this association between deprivation and generalised anxiety disorder was not apparent in men (OR=1.13, 95% CI: 0.72 to 1.77; p=0.598).

CONCLUSION
The absolute numbers of people living in deprived conditions are large worldwide. This, combined with a growing mental health burden means that the findings obtained in this study remain highly relevant. The World Health Organisation has emphasised the need to reduce social and health inequalities. Our findings provide a strong evidence base to this call, showing that the environment needs to be taken into account when developing mental health policy; gender is clearly an important factor when it comes to assessing the impacts of the environment, and promoting good mental health.