Advertisement

Social phobia and number of social fears, and their association with comorbidity, health-related quality of life and help seeking

A population-based study
  • C. AcarturkEmail author
  • Ron de Graaf
  • A. van Straten
  • M. ten Have
  • P. Cuijpers
ORIGINAL PAPER

Abstract

Objectives

Community based data were used to examine the association between social phobia and comorbidity, quality of life and service utilization. In addition, the correlations of the number of social fears with these domains were studied.

Method

Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) (N = 7,076). Social phobia was assessed according to DSM-III-R with the Composite International Diagnostic Interview (CIDI); quality of life was assessed according to the Short-Form-36 Health Survey (SF-36).

Results

The 12-month prevalence of social phobia was 4.8%. Being female, young, low educated, a single parent, living alone, not having a paid job and having a somatic disorder are associated with 12-month social phobia. Mean and median ages of onset of social phobia were 19.1 and 16.0 years, respectively, and mean and median duration were 16.8 and 14.0 years, respectively. 66% of respondents with social phobia had at least one comorbid condition. 12-month social phobia was significantly related to lower quality of life and higher service utilization. The mean number of feared social situations was 2.73 out of the 6 assessed. As the number of social fears increases, comorbidity and service utilization increases, and the quality of life decreases.

Conclusions

These findings suggest as the number of feared social situations increases, the burden of social phobia rises. In other words, like comorbidity or decreased quality of life, the number of social fears is also an important indicator of the severity of social phobia. We conclude that from a public health perspective, mental health care givers should pay attention to the number of social fears in order to check the severity of social phobia.

Key words

social phobia number of social fears help-seeking behaviour quality of life comorbidity 

References

  1. 1.
    Akiskal HS, Benazzi F (2006) The DSM-IV and ICD-10 categories of recurrent [major] depressieve and bipolar II disorders: evidence that they lie on a dimensional spectrum. J Affect Disord 92:45–54PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn (revised). APA, WashingtonGoogle Scholar
  3. 3.
    Bijl RV, de Graaf R, Ravelli A, Smit F, Vollebergh WAM (2002) Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population: results from the Netherlands mental health survey and incidence study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 37(8):372–379PubMedCrossRefGoogle Scholar
  4. 4.
    Bijl RV, Ravelli A, van Zessen G (1998) Prevalence of psychiatric disorder in the general population: results of The Netherlands mental health survey and incidence study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 33:587–595PubMedCrossRefGoogle Scholar
  5. 5.
    Bijl RV, van Zessen G, Ravelli A, de Rijk C, Langendoen Y (1998) The Netherlands mental health survey and incidence study (NEMESIS): objectives and design. Soc Psychiatry Psychiatr Epidemiol 33:581–586PubMedCrossRefGoogle Scholar
  6. 6.
    Chaleby K (1987) Social phobia in Saudis. Soc Psychiatry Psychiatr Epidemiol 22:167–170Google Scholar
  7. 7.
    Chartier MJ, Walker JR, Stein MB (2003) Considering comorbidity in social phobia. Soc Psychiatry Psychiatr Epidemiol 38(12):728–734PubMedCrossRefGoogle Scholar
  8. 8.
    Davidson JRT, Hughes DL, George LK, Blazer DG (1993) The epidemiology of social phobia: findings from the Duke epidemiological catchment area study. Psychol Med 23:709–718PubMedCrossRefGoogle Scholar
  9. 9.
    Fehm L, Pelissolo A, Furmark T, Wittchen HU (2005) Size and burden of social phobia in Europe. Eur Neuropsychopharmacol 15:453–462PubMedCrossRefGoogle Scholar
  10. 10.
    Furmark T (2002) Social phobia: overview of community surveys. Acta Psychiatr Scand 105:84–93PubMedCrossRefGoogle Scholar
  11. 11.
    Furmark T, Tillforts M, Everz PO, Marteinsdottir I, Gefvert O, Fredrikson M (1999) Social phobia in the general population: prevalence and sociodemographic profile. Soc Psychiatry Psychiatr Epidemiol 34:416–424PubMedCrossRefGoogle Scholar
  12. 12.
    Furmark T, Tillfors M, Stattin H, Ekselius L, Fredrikson M (2000) Social phobia subtypes in the general population revealed by cluster analysis. Psychol Med 30:1335–1344PubMedCrossRefGoogle Scholar
  13. 13.
    Grant BF, Hasin DS, Blanco C et al. (2005) The epidemiology of social anxiety disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 66:1351–1361PubMedCrossRefGoogle Scholar
  14. 14.
    Hankin BL, Fraley RC, Lahey BB, Waldman ID (2005) Is depression best viewed as a continuum or discrete category? A taxometric analysis of childhood and adolescent depression in a population-based sample. J Abnorm Psychol 114(1):96–110PubMedCrossRefGoogle Scholar
  15. 15.
    Heimberg RG, Stein MB, Hiripi E, Kessler RC (2000) Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades. Eur Psychiatry 15:29–37PubMedCrossRefGoogle Scholar
  16. 16.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–768PubMedCrossRefGoogle Scholar
  17. 17.
    Kessler RC, McGonagle KA, Zhao S et al. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51:8–19PubMedGoogle Scholar
  18. 18.
    Kessler RC, Stang P, Wittchen HU, Stein M, Walters EE (1999) Lifetime co-morbidities between social phobia and mood disorders in the US national comorbidity survey. Psychol Med 29:555–567PubMedCrossRefGoogle Scholar
  19. 19.
    Kessler RC, Stein MB, Berglund P (1998) Social phobia subtypes in the national comorbidity survey. Am J Psychiatry 155:5 613–619Google Scholar
  20. 20.
    Kringlen E, Torgersen S, Cramer V (2006) Mental illness in a rural area: A Norwegian psychiatric epidemiological study. Soc Psychiatry Psychiatr Epidemiol 41:713–719PubMedCrossRefGoogle Scholar
  21. 21.
    Kringlen E, Torgersen S, Cramer V (2001) A Norwegian psychiatric epidemiological study. Am J Psychiatry 158:71091–71098CrossRefGoogle Scholar
  22. 22.
    Lepine JP, Lellouch J (1995) Classification and epidemiology of social phobia. Eur Arch Psychiatry Clin Neurosci 244:290–296PubMedCrossRefGoogle Scholar
  23. 23.
    Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC (1996) Agoraphobia, simple phobia, and social phobia in the national comorbidity survey. Arch Gen Psychiatry 53:159–168PubMedGoogle Scholar
  24. 24.
    Offord DR, Boyle MH, Campbell D et al. (1996) One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age. Can J Psychiatry 41:559–561PubMedGoogle Scholar
  25. 25.
    Patel A, Knapp M, Henderson J, Baldwin D (2002) The economic consequences of social phobia. J Affect Disord 68:221–233PubMedCrossRefGoogle Scholar
  26. 26.
    Robins LN, Wing J, Wittchen H-U et al. (1988) The composite international diagnostic interview: an epidemiologic instrument suitable for use in conjuction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077PubMedGoogle Scholar
  27. 27.
    Safren SA, Heimberg RG, Brown EJ, Holle C (1996) Quality of life in social phobia. Depress Anxiety 4:126–133PubMedCrossRefGoogle Scholar
  28. 28.
    Schneier FR, Johnson J, Hornig CD, Liebowitz MR, Weissman MM (1992) Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 49:282–288PubMedGoogle Scholar
  29. 29.
    Skodol AE, Oldham JM, Bender DS, Dyck IR, Stout RL, Morey LC, Shea MT, Zanarini MC, Sanislow CA, Grilo LM, McGlashan TH, Gunderson JG (2005) Dimensional representations of DSM-IV personality disorders: relationships to functional impairment. Am J Psychiatry 162:1919–1925PubMedCrossRefGoogle Scholar
  30. 30.
    Smeets RMW, Dingemans PMAJ (1993) Composite international diagnostic interview (CIDI), Version 1.1. World Health Organization, AmsterdamGoogle Scholar
  31. 31.
    Spitzer RL, Williams JBW, Gibbon M, First MB (1992) The structured clinical interview for DSM-III-R (SCID) I: history, rationale, and description. Arch Gen Psychiatry 49:624–629PubMedGoogle Scholar
  32. 32.
    Stein MB, Deutsch R (2003) Brief Report: in search of social phobia subtypes: similarity of feared social situations. Depress Anxiety 17:94–97PubMedCrossRefGoogle Scholar
  33. 33.
    Stein MB, Kean YM (2000) Disability and quality of life in social phobia: Epidemiological findings. Am J Psychiatry 157:1606–1613PubMedCrossRefGoogle Scholar
  34. 34.
    Stein MB, Torgrud LJ, Walker JR (2000) Social phobia symptoms, subtypes, and severity. findings from a community survey. Arch Gen Psychiatry 57:1046–1052PubMedCrossRefGoogle Scholar
  35. 35.
    Vriends N, Becker ES, Meyer A, Michael T, Margraf J (2007) Subtypes of social phobia: are they of any use? J Anxiety Disord 21:59–75PubMedCrossRefGoogle Scholar
  36. 36.
    Ware JE, Sherbourne CD (1992) The MOS 36 item short-form health survey (SF36): I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  37. 37.
    Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey, manual & interpretation guide. The Health Institute, New England Medical Center, BostonGoogle Scholar
  38. 38.
    Weissman MM, Bland RC, Canino GJ, Greenwald S, Lee CK, Newman SC, Rubio-Stipec M, Wickramaratne PJ (1996) The cross-national epidemiology of social phobia: a preliminary report. Int Clin Psychopharmacol 11(suppl 3):9–14PubMedCrossRefGoogle Scholar
  39. 39.
    Wittchen HU, Fuetsch M, Sonntag H, Muller N, Liebowitz (2000) Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. Eur Psychiatry 15:46–58Google Scholar
  40. 40.
    Wittchen H-U, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier DA, Participants in the multicentre WHO/ADAMHA field trials (1991) Cross-cultural feasibility, reliability and sources of variance in the CIDI. Br J Psychiatry 159:645–653PubMedGoogle Scholar
  41. 41.
    World Health Organization (1990) Composite international diagnostic interview (CIDI), Version 1.0. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • C. Acarturk
    • 1
    Email author
  • Ron de Graaf
    • 2
  • A. van Straten
    • 1
  • M. ten Have
    • 2
  • P. Cuijpers
    • 1
    • 2
  1. 1.FPP, Dept. Clinical PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
  2. 2.Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands

Personalised recommendations