Open Access Highly Accessed Research article

Physical inactivity is strongly associated with anxiety and depression in Iraqi immigrants to Sweden: a cross-sectional study

Faiza Siddiqui13, Ulf Lindblad2 and Louise Bennet1345*

Author Affiliations

1 Center for Primary Health Care Research, Region Skåne and Lund University, Malmo, Sweden

2 Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

3 Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden

4 Genetic and Molecular Epidemiology, Lund University, Malmö, Sweden

5 Center for Primary Health Care Research, Clinical Research Centre, Lund University, Skåne University Hospital, Building 60, Floor 12, Jan Waldenströms gata 37, 205 02 Malmö, Sweden

For all author emails, please log on.

BMC Public Health 2014, 14:502  doi:10.1186/1471-2458-14-502

Published: 25 May 2014



Increasing evidence on associations between mental health and chronic diseases like cardio-vascular disease and diabetes together with the fact that little is known about the prevalence of anxiety/depression and associated risk factors among Iraqi immigrants to Sweden, warrants a study in this group. The aim was to study the prevalence of anxiety and depression in immigrants from Iraq compared to native Swedes and compare socioeconomic and lifestyle-related factors associated with these conditions.


A population-based, cross-sectional study of residents of Malmö, Sweden, aged 30–75 years, born in Iraq or Sweden. The overall response rate was 49% for Iraqis and 32% for Swedes. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Associations were studied using multivariate logistic regression models. The outcome was odds of depression and/or anxiety.


Compared to Swedes (n = 634), anxiety was three times as prevalent (52.6 vs. 16.3%, p < 0.001) and depression five times as prevalent (16.3 vs. 3.1%, p < 0.001) in Iraqi immigrants (n = 1255). Iraqis were three times more likely to be anxious and/or depressed compared to Swedes (odds ratio (OR) 3.02, 95% confidence interval (CI) 2.06-4.41). Among Iraqis, physical inactivity (<150 min/week) (OR 2.00, 95% CI 1.49-2.69), economic insecurity (OR 2.16, 95% CI 1.56-3.01), inability to trust people (OR 1.75, 95% CI 1.28-2.39) and smoking (OR 1.43, 95% CI 1.02-2.01), were strongly associated with anxiety/depression. Among Swedes, living alone (OR 2.10, 95% CI 1.36-3.25) and economic insecurity (OR 2.38, 95% CI 1.38-4.12) showed the strongest associations with anxiety/depression. Country of birth modified the effect of physical inactivity (Pinteraction =0.058) as well as of marital status (Pinteraction =0.001).


Our study indicates that economic insecurity has a major impact on poor mental health irrespective of ethnic background but that physical inactivity may be more strongly associated with anxiety/depression in immigrants from the Middle East compared to native Swedes. Preventive actions emphasizing increased physical activity may reduce the risk of poor mental health in immigrants from the Middle East, however intervention studies are warranted to test this hypothesis.

Anxiety; Depression; Physical activity; Immigrants; Middle East; Sweden