The most likely source of her anxiety and depression is precisely her change of life to a new city and her new jo. All the changes a situation like that can bring to someone can be a factor of distress that can affect a person's life.
Explanation:
People that experence anxiety and depression are most likley to aggravate whenever a big change happends, or a particular difficult situation presents. Jo developed these symptoms after she moved into the new city, which is a life changing experience. This situation can be a factor of distress.
Issuing Licences are a State/Provicinal Power. Like a marriage licence or drivers licences or gun licences. Those are only relating to the state they were issued in.
