Abstract
Objective: Generalized anxiety disorder (GAD) is one of the most common mental health problems in adolescents, often resulting in significant academic and social challenges that can persist into adulthood. Identifying protective factors that can mitigate these negative outcomes is crucial. Prosocial behavior, which includes actions intended to benefit others, may serve as a protective factor. However, the relationship between prosocial behavior and anxiety in adolescents diagnosed with GAD has not been thoroughly investigated. The main objective of this study was to examine the relationship between prosocial behavior and anxiety levels in adolescents diagnosed with GAD. The second aim of the research was to explore psychosocial risk factors related to GAD.
Methods: The study included 80 adolescents diagnosed with GAD and 31 healthy controls (HCs) with no psychiatric disorders, aged between 13 and 18 years. Inclusion criteria for the GAD group included the first-time diagnosis of GAD, no other psychiatric diagnoses, and no prior psychotropic treatment. The control group consisted of healthy adolescents without any psychiatric history. Exclusion criteria for both groups included various chronic diseases as well as alcohol or substance abuse. Diagnoses were conducted using the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version DSM-5 (K-SADS-PL-DSM-5). Participants completed the Revised Child Anxiety and Depression Scale-Child Versions (RCADS-CV) and the Adolescent Prosociality Scale (APS).
Results: The mean age of the participants was 15.2 ± 1.5 years, with 67.6% being female. Female gender (odds ratio 4.74, p = 0.009), family history of psychiatric disorders (odds ratio 6.84, p = 0.007), and higher birth order (odds ratio 2.29, p = 0.006) were significantly associated with an increased risk of GAD. Conversely, higher APS scores were associated with a reduced risk of GAD (odds ratio 0.945, p = 0.016), indicating that each unit increase in APS score decreased the odds of GAD by 1.1. The case group showed significantly higher RCADS-CV scores than the HCs (p < 0.001), but APS scores did not significantly differ between the two groups. A weak negative correlation was found between APS total score and RCADS-CV total score (p = 0.024).
Conclusion: The findings suggest that prosocial behavior plays a role in reducing anxiety symptoms, independent of other risk factors, and highlights its importance as a protective factor against the occurrence of GAD. Promoting prosocial behavior in adolescents could be an effective strategy for reducing the risk of GAD and improving overall mental health. However, further longitudinal studies are needed to confirm these findings and explore the causal relationships.

Key words: Altruism; Anxiety; Mental health; Protective factors; Youth.