Identifying Japanese mothers of infants and toddlers at risk of parenting isolation: A validation study of cutoff scores and associated psychosocial measures.

Generalized anxiety disorder (GAD) is a pervasive mental health condition with a global prevalence of 3.7% [], and its prevalence has been increasing over time []. Individuals suffering from GAD are more likely to visit emergency medical services, experience prolonged hospitalizations, and incur significantly higher annual medical costs []. A recent meta-analysis reported that direct medical costs for the GAD population are 2.6 times greater than for those without GAD [], underscoring how its widespread prevalence places a massive financial burden on the overall national healthcare expenditure []. Furthermore, GAD is strongly associated with elevated risks of suicidal ideation and suicide attempts [, ]. Its symptoms adversely affect various aspects of individual health, including burden of comorbidity, productivity, and health-related quality of life (HRQOL) []. In the United States, a study focusing on older participants [] found that the scores of two quality of life measures, Quality of Life Inventory (QOLI) and Life Satisfaction Index-Z (LSI-Z), were negatively associated with anxiety disorders measured by the Spielberger State-Trait Anxiety Inventory (STAI). A European study focusing on the general population across five countries [] found that patients with GAD scored lower on the HRQOL measures, including Mental Component Summary (MCS) and Physical Component Summary (PCS), regardless of the presence of comorbidities. Similarly, a Canadian study that focused on the general population [] found that individuals with GAD had lower life satisfaction and perceptions of well-being. A study conducted in China that focused on patients at mental health centers [] has found that individuals with GAD scored lower on the quality of life measure, the World Health Organization Quality of Life-BREF (WHOQOL-BREF). While the negative association between GAD and HRQOL is well documented [–], existing literature shows significant knowledge gaps regarding this relationship across different geographic areas and methodologies. Most studies have been heavily skewed toward Western populations, and little is known about the potential moderators of this association. To our knowledge, only two studies have explored how GAD is linked to HRQOL within Asian contexts [, ]; however, the generalizability of these findings is constrained, as they selectively focused on localized urban populations or psychiatric outpatients. Although the clinical implications of GAD are increasingly complicated by multimorbidity—the coexistence of two or more chronic conditions within an individual—most studies have treated multimorbidity as a confounder. Diseases do not operate in isolation over the life course; rather, they interact in complex ways that can deteriorate an individual’s HRQOL and increase the burden of health management. In addition, a large share of the detrimental impacts of GAD and multimorbidity on HRQOL are profoundly shaped by structural socioeconomic inequalities. According to the intersectionality framework, health outcomes are not the sum of individual diseases and psychological distress; they are heavily moderated by economic circumstances such as employment status and household income. For instance, low-income individuals with psychological anxiety are likely to face the synergistic burden of chronic diseases and often experience a greater decline in their quality of life. Conversely, higher economic status may serve as a crucial buffering mechanism against adverse health outcomes caused by chronic diseases, preventing psychological distress from translating into severe problems that affect well-being. Despite the importance of comorbidity for understanding the mechanisms linking GAD and HRQOL, the complex intersectional dynamics among anxiety, comorbidity profiles, and the economic environment remain largely unexplored in nationally representative cohorts.