Impact of chronic stress on the onset of anxiety disorders in the adult population: clinical implications in psychiatry

Abstract

Chronic stress is a key psychosocial factor affecting the mental health of the adult population, characterised by its persistence and its capacity to induce progressive alterations in emotional, neuroendocrine, and physiological regulatory systems. In contemporary contexts marked by intense work demands, socioeconomic insecurity, and rapid social changes, prolonged exposure to stressors is consistently associated with a significant increase in the prevalence, severity, and persistence of anxiety disorders, which constitute one of the leading causes of functional impairment and disability worldwide. Through a rigorous and systematic analysis of the available scientific evidence, following the PRISMA protocol, it was confirmed that sustained stress influences both the onset and clinical progression of these disorders via neurobiological alterations in the hypothalamic-pituitary-adrenal axis and brain circuits involved in emotional regulation. Nonetheless, clinical practice continues to face challenges in accurately and promptly identifying the specific impact of chronic stress, contributing to underdiagnosis and delayed interventions, thereby favouring the chronicity of anxious symptoms. The observed methodological heterogeneity highlights the need to develop integrative approaches that consider biological, cognitive, and social dimensions to promote more comprehensive and personalised assessments and treatments.