The impact of anxiety on cognitive functioning among a cohort of adolescents living in KwaZulu-Natal, South Africa.

Abstract

Anxiety symptoms can affect cognitive functioning, yet little is known about this relationship in low- and middle-income countries. This study aimed to examine the prevalence of anxiety and explore whether anxiety symptoms are associated with reduced cognitive performance among a cohort of adolescents in KwaZulu-Natal, South Africa, drawing on Attentional Control Theory (ACT). The study employed secondary analysis from a longitudinal study. Wave Three data of this study was used, which comprised 945 adolescents aged 13 to 19 years. Anxiety symptoms were assessed using the Generalised Anxiety Disorder 7 (GAD-7) scale. Cognitive functioning was assessed using six of the Kaufman Assessment Battery for Children - Second Edition (KABC-II) domains, which measured sequential processing, simultaneous processing, planning, and learning. Descriptive statistics estimated prevalence, and chisquared analysis examined the association between anxiety severity and cognitive performance. Data were collected in peri-urban areas of eThekwini District, KwaZulu-Natal, South Africa, through face-to-face interviews and standardised assessments conducted in participants' home language. The study employed a cross-sectional design using Wave Three data from a longitudinal cohort study. The results indicated that 32.8% of participants presented with mild anxiety and 4.4% with severe anxiety, with no significant differences by age or gender. There were no significant associations between mild anxiety symptoms and cognitive performance across any of the subtests. Severe anxiety showed no significant associations after the Bonferroni correction was applied, although Pattern Reasoning (timed) demonstrated a trend towards enhanced performance among participants with severe anxiety symptoms. These results suggest a relatively high prevalence of mild anxiety and an expected level of severe anxiety within this population. Contrary to theoretical predictions, anxiety symptoms were not associated with reduced cognitive functioning in this population. The minimal cognitive impact may suggest that environmental factors moderate this association, which is not fully captured by Western-derived theories. The negatively skewed cognitive performance across anxiety groups may indicate that socio-economic factors may exert a more substantial influence on cognitive functioning than anxiety symptoms. These findings highlight a need for a culturally grounded theoretical framework and community-level intervention addressing structural determinants of adolescent mental health.