Abstract
Background
Anxiety is the most common mental health problem in young people and sex/gender differences have been consistently reported, with girls and young women experiencing twice the chance of anxiety compared to boys and young men. There is a limited understanding, however, of the underlying causes of these differences. This systematic review aims to synthesise research identifying modifiable sex/gender-specific risk and protective factors for anxiety among young people aged 16–24 in high income countries.
Methods
A systematic literature search was conducted on 29th February 2024 and updated on 4th July 2025 across MEDLINE (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Scopus, Sociological abstracts, and Web of Science. Observational studies reporting estimates of sex/gender-specific associations between modifiable risk and protective factors and anxiety according to DSM-5 categories were included. Results were summarised using narrative synthesis.
Results
85 studies were included. Modifiable factors were grouped into levels: individual; interpersonal relationships; local community; and wider environment and society levels. The review identified conflicting results for sex/gender differences, demonstrating the methodological limitations of the evidence base and the complexity of the modifiable risk and protective factors implicated in the explanations for sex/differences in anxiety among young people aged 16–24 years. Potential sex/gender-specific risk factors emerged; early alcohol use initiation, parental overprotection and social media may be more anxiety-inducing in females than in males.
Conclusions
This review indicates that sex/gender differences may exist in the associations between modifiable risk and protective factors and anxiety. Future longitudinal studies are crucial to understanding how these pathways differ by sex/gender. Studies are needed which explore whether sex/gender influences the relationship between anxiety and gender discrimination, peer relationships, school/college context, the workplace and the school-to-work transition. Such evidence has the potential to guide the development of effective sex/gender-specific mental health interventions.
PROSPERO protocol registration
CRD42024518279.
Clinical trial number
Not applicable.
Anxiety is the most common mental health problem in young people and sex/gender differences have been consistently reported, with girls and young women experiencing twice the chance of anxiety compared to boys and young men. There is a limited understanding, however, of the underlying causes of these differences. This systematic review aims to synthesise research identifying modifiable sex/gender-specific risk and protective factors for anxiety among young people aged 16–24 in high income countries.
Methods
A systematic literature search was conducted on 29th February 2024 and updated on 4th July 2025 across MEDLINE (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Scopus, Sociological abstracts, and Web of Science. Observational studies reporting estimates of sex/gender-specific associations between modifiable risk and protective factors and anxiety according to DSM-5 categories were included. Results were summarised using narrative synthesis.
Results
85 studies were included. Modifiable factors were grouped into levels: individual; interpersonal relationships; local community; and wider environment and society levels. The review identified conflicting results for sex/gender differences, demonstrating the methodological limitations of the evidence base and the complexity of the modifiable risk and protective factors implicated in the explanations for sex/differences in anxiety among young people aged 16–24 years. Potential sex/gender-specific risk factors emerged; early alcohol use initiation, parental overprotection and social media may be more anxiety-inducing in females than in males.
Conclusions
This review indicates that sex/gender differences may exist in the associations between modifiable risk and protective factors and anxiety. Future longitudinal studies are crucial to understanding how these pathways differ by sex/gender. Studies are needed which explore whether sex/gender influences the relationship between anxiety and gender discrimination, peer relationships, school/college context, the workplace and the school-to-work transition. Such evidence has the potential to guide the development of effective sex/gender-specific mental health interventions.
PROSPERO protocol registration
CRD42024518279.
Clinical trial number
Not applicable.
| Original language | English |
|---|---|
| Article number | 1292 |
| Number of pages | 22 |
| Journal | BMC Public Health |
| Volume | 26 |
| Issue number | 1 |
| Early online date | 18 Feb 2026 |
| DOIs | |
| Publication status | E-pub ahead of print - 18 Feb 2026 |
Bibliographical note
Publisher Copyright:© The Author(s) 2026.
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
-
SDG 3 Good Health and Well-being -
SDG 5 Gender Equality
Keywords
- Anxiety
- Young people
- Mental health
- Gender differences
- Adolescence
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