Anxiety Severity among Pakistani Adults: Implications for Positive Psychological Interventions and Mental Health Promotions

Abstract

Anxiety is among the most widespread forms of psychological distress in Pakistan, yet the national evidence base remains predominantly deficit-oriented, quantifying pathology without mapping the subclinical distress and psychological strength across which promotion and prevention efforts must operate. This study characterised the full severity distribution of generalized anxiety symptoms among Pakistani adults, examined its gender patterning, and interpreted both through a positive psychological lens. A cross-sectional survey was conducted with 356 adults (195 men, 161 women) aged 18 to 60 years, recruited from all four provinces using convenience and snowball sampling. Participants completed the Urdu Generalized Anxiety Disorder Scale (GAD-7), which showed good internal consistency (α = .87). The sample mean was 7.57 (SD = 5.87). Severity was graded rather than dichotomous: 36.5% minimal, 28.1% mild, 19.7% moderate, and 15.7% severe, with 35.4% (95% CI [30.4, 40.4]) at or above the clinical threshold. Women scored higher than men, t(354) = 3.99, p < .001, d = 0.43, and were displaced upward across the entire distribution, χ²(3, N = 356) = 14.15, p = .003, Cramér's V = .20, being 1.61 times as likely to score in the moderate-to-severe range. A substantial clinical burden therefore coexists with a subclinical majority that threshold-based services cannot reach. These findings support a tiered, dual-continua public mental health strategy for Pakistan in which brief, culturally grounded interventions that build psychological strength operate alongside clinical care rather than in place of it.