Eight of the nine Colleges at the University and the Graduate and Professional Student Association sent the recruitment email to all currently enrolled undergraduate and graduate/professional students in September 2020. The number of students who received the recruitment email was not documented; however, 1,367 students started the survey. Of those, 17 (1.2%) were excluded based on responses to the two screening questions and an additional 107 (7.8%) were excluded for not completing the GAD-7. Thus, 1243 (90.9%) participants were included in the final analysis.
Table 1
Demographic characteristics of study participants (n = 1243)
Demographicsa | n | % |
Age (years) | | |
18–20 | 353 | 29.5 |
21–24 | 326 | 27.2 |
25–30 | 205 | 17.1 |
>30 | 314 | 26.2 |
Gender | | |
Female | 909 | 73.1 |
Male | 281 | 22.6 |
Non-cisgender | 53 | 4.3 |
Race/Ethnicity | | |
American Indian or Alaskan Native | 60 | 4.9 |
Asian | 99 | 8.0 |
Black or African American | 27 | 2.2 |
Hispanic/Latino | 239 | 19.3 |
White | 732 | 59.2 |
More than one race/ethnicity or other | 79 | 6.4 |
Student Status | | |
Undergraduate | 702 | 57.0 |
Graduate/Professional | 530 | 43.0 |
Anxiety Severity (GAD-7 score) | | |
No Anxiety (< 5) | 238 | 19.2 |
Mild Anxiety (5–9) | 360 | 29.0 |
Moderate Anxiety (10–14) | 339 | 27.3 |
Severe Anxiety (≥ 15) | 306 | 24.6 |
aAge missing for 45 participants; race/ethnicity missing for 7 participants; student status missing for 11 participants |
Demographic characteristics of the study sample are presented in Table 1. The mean age of participants was 26.5 ± 9.2 years (range 18–82). The majority were female (n = 909; 73.1%), white (n = 732; 59.2%) or Hispanic/Latino (n = 239; 19.3%), and undergraduate students (n = 702; 57%). The study sample differed from the general population of the University in fall 2020, with an overrepresentation of females (73.1% versus 57.4%) and white students (59.2% versus 33.3%) and an underrepresentation of undergraduate students (57% versus 70.9%). The study sample did, however, accurately represent the University’s composition of American Indian/Alaskan Native and Black/African American students. Mean age in this study (26.5 years) was comparable to the University’s overall average of 25.7 years, reflecting the large population of non-traditional students.
In the full sample, the mean GAD-7 score was 10.1 ± 5.6. GAD-7 score was not normally distributed (p < 0.05). Over half of participants (n = 645; 51.9%) experienced anxiety in the past two weeks based on a GAD-7 score of 10 or more. In the full sample, 29% had mild anxiety, 27.3% had moderate anxiety, and 24.6% had severe anxiety. Nearly 90% of participants indicated symptoms of anxiety made it somewhat difficult (54.9%), very difficult (22.2%), or extremely difficult (10.9%) to do work, take care of things at home, or get along with other people. The prevalence of anxiety differed significantly by age category, gender, and level of education (p < 0.01) but not by race/ethnicity (p = 0.13) (Table 2). The youngest age category (18–20 years of age) had the highest prevalence of anxiety (62%) including moderate anxiety (33.7%) and severe anxiety (28.3%) compared to older age groups. The oldest age category (> 30 years of age) had the lowest prevalence anxiety (39.8%) including moderate anxiety (20.4%) and severe anxiety (19.4%). Non-cisgender participants, including transgender, gender fluid, non-binary, and other-gendered participants, had the highest prevalence of anxiety (73.6%) including moderate (34%) and severe anxiety (39.6%) compared to females and males. Male participants had the lowest prevalence of anxiety (n = 111; 39.5%).
Table 2
Prevalence of anxiety by severity in university students by demographic characteristics
| Anxiety (GAD-7 ≥ 10) | Mild Anxiety (GAD-7 score 5–9) | Moderate Anxiety (GAD-7 score 10–14) | Severe Anxiety (GAD-7 score ≥ 15) | |
| N | % | N | % | n | % | n | % | pa |
Full Sample | 645 | 51.9 | 360 | 29.0 | 339 | 27.3 | 306 | 24.6 | |
Age (years) | | | | | | | | | < 0.01 |
18–20 | 219 | 62.0 | 82 | 23.2 | 119 | 33.7 | 100 | 28.3 | |
21–24 | 174 | 53.4 | 102 | 31.3 | 91 | 27.9 | 83 | 25.5 | |
25–30 | 105 | 51.2 | 62 | 30.2 | 56 | 27.3 | 49 | 23.9 | |
>30 | 125 | 39.8 | 101 | 32.2 | 64 | 20.4 | 61 | 19.4 | |
Gender | | | | | | | | | < 0.01 |
Female | 495 | 54.5 | 269 | 29.6 | 260 | 28.6 | 235 | 25.9 | |
Male | 111 | 39.5 | 80 | 28.5 | 61 | 21.7 | 50 | 17.8 | |
Non-cisgender | 39 | 73.6 | 11 | 20.8 | 18 | 34.0 | 21 | 39.6 | |
Student Status | | | | | | | | | < 0.01 |
Undergraduate | 426 | 60.7 | 178 | 25.4 | 223 | 31.8 | 203 | 28.9 | |
Graduate/ Professional | 212 | 40.0 | 178 | 33.6 | 112 | 21.1 | 100 | 18.9 | |
Race/Ethnicity | | | | | | | | | 0.13 |
American Indian/ Alaskan Native | 33 | 55.0 | 19 | 31.7 | 17 | 28.3 | 16 | 26.7 | |
Asian | 37 | 37.4 | 32 | 32.3 | 20 | 20.2 | 17 | 17.2 | |
Black/African American | 15 | 55.6 | 6 | 22.2 | 7 | 25.9 | 8 | 29.6 | |
Hispanic/Latino | 138 | 57.7 | 70 | 29.3 | 69 | 28.9 | 69 | 28.9 | |
White | 376 | 51.4 | 207 | 28.3 | 202 | 27.6 | 174 | 23.8 | |
>1 Race/Other | 44 | 55.7 | 22 | 27.9 | 24 | 30.4 | 20 | 25.3 | |
aChi-square test for difference in prevalence of anxiety severity (no anxiety, mild anxiety, moderate anxiety, severe anxiety) within demographic groups; p < 0.05 indicates statistical significance |
Undergraduate students had a significantly higher prevalence of GAD-7 scores indicating anxiety (60.7%) compared to graduate students (40.0%) (p < 0.01). While anxiety severity was not significantly different by race/ethnicity (p = 0.13), Asian participants had the lowest prevalence of anxiety (37.4%) compared to all other race/ethnicity groups (> 50%). Hispanic/Latino participants had the highest prevalence of anxiety (57.7%), followed by students reporting other or more than one race/ethnicity (55.7%). The prevalence of severe anxiety, however, was highest in Black/African American students (29.6%), followed by Hispanic/Latino students (28.9%).
Table 3
Mean AEBQ scores in participants by anxiety status
| All Participants (n = 1243) | No Anxiety (n = 598) | Anxiety* (n = 645) | |
AEBQ Indicators | Mean | SD | Mean | SD | Mean | SD | pa |
Food approach subscales | | | | | | | |
Hunger | 3.10 | 0.75 | 2.98 | 0.74 | 3.21 | 0.75 | < 0.01 |
Food responsiveness | 3.18 | 0.75 | 3.08 | 0.73 | 3.27 | 0.75 | < 0.01 |
Emotional over-eating | 2.85 | 1.01 | 2.69 | 0.93 | 2.99 | 1.05 | < 0.01 |
Enjoyment of food | 4.14 | 0.80 | 4.24 | 0.71 | 4.04 | 0.86 | < 0.01 |
Food avoidance subscales | | | | | | | |
Satiety responsiveness | 2.74 | 0.82 | 2.66 | 0.77 | 2.81 | 0.86 | < 0.01 |
Emotional under-eating | 3.11 | 0.96 | 3.03 | 0.89 | 3.18 | 1.02 | < 0.01 |
Food fussiness | 2.03 | 0.84 | 1.95 | 0.79 | 2.11 | 0.88 | < 0.01 |
Slowness in eating | 2.71 | 1.01 | 2.66 | 0.94 | 2.75 | 1.06 | 0.23 |
*Anxiety defined as GAD-7 score ≥ 10; aMann-Whitney U test comparing mean subscale score by anxiety status; p < 0.05 indicates statistical significance |
Table 3 shows mean AEBQ subscale scores in the full sample and by anxiety status. Subscale scores were not normally distributed (p < 0.05). Mean scores for food approach subscales (hunger, food responsiveness, emotional over-eating) were significantly higher in those with anxiety, except enjoyment of food which was significantly lower (p < 0.01). Mean scores for three of four food avoidance subscales (satiety responsiveness, emotional under-eating, and food fussiness) were significantly higher in those with anxiety compared to those without anxiety (p < 0.01).
Table 4
Unadjusted and adjusted associations between GAD-7 score and AEBQ indicators
| GAD-7 score correlationa | Multivariate Regressionb |
AEBQ Indicators | r-square | p | β | p |
Food approach subscales | | | | |
Hunger | 0.24 | < 0.01 | 0.027 | < 0.01 |
Food responsiveness | 0.14 | < 0.01 | 0.014 | < 0.01 |
Emotional over-eating | 0.18 | < 0.01 | 0.034 | < 0.01 |
Enjoyment of food | -0.11 | < 0.01 | -0.014 | < 0.01 |
Food avoidance subscales | | | | |
Satiety responsiveness | 0.13 | < 0.01 | 0.012 | < 0.01 |
Emotional under-eating | 0.07 | 0.01 | 0.003 | 0.50 |
Food fussiness | 0.08 | < 0.01 | 0.011 | 0.01 |
Slowness in eating | 0.03 | 0.29 | 0.000 | 0.07 |
aSpearman’s correlation coefficients; bGAD-7 score as predictor, adjusted for age, gender, race/ethnicity, and student status |
In the full sample, seven of the eight AEBQ indicators were significantly correlated with GAD-7 score based on Spearman’s correlation coefficients (Table 4). Six of the eight indicators were positively correlated with GAD-7 score; hunger and emotional over-eating had the strongest correlations (r-square = 0.24 and 0.18, respectively; p < 0.01). Enjoyment of food was significantly negatively correlated with GAD-7 score (r-square=-0.11; p < 0.01) and slowness in eating was not correlated with GAD-7 score (p = 0.29). In multivariate linear regression adjusting for age, gender, race/ethnicity, and student status, associations between GAD-7 score and AEBQ indicators remained significant, except for emotional under-eating (p = 0.50) and slowness in eating (p = 0.07).