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Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population

Abstract

Background

There is a lack of data systematically describing subthreshold expressions of social anxiety disorder (SAD) with regard to prevalence, comorbidity, and impairment.

Methods

This analysis was based on data from the German Health Survey (GHS) and its Mental Health Supplement (GHS-MHS). Social anxiety disorder and its syndromes as well as other mental disorders were assessed with a standardized diagnostic interview (M-CIDI) in 4,174 adults.

Results

The 12-month prevalence rate for threshold SAD was 2.0%, subthreshold and symptomatic social anxiety (one DSM-IV criterion missing/two or more criteria missing) was found in 3.0 and 7.5% of the participants, respectively. As expected, threshold SAD was characterized by an elevated risk for comorbid disorders and associated with impairment in diverse areas of life. However, this was also true for the two subthreshold expressions of social anxiety, which were also significantly associated with higher comorbidity and greater impairment compared to the control group.

Conclusions

Our results suggest that social anxiety below the diagnostic threshold is clearly associated with adverse outcomes. Prospective designs should examine the exact temporal and possible causal pathways of this burden in order to inform prevention and early intervention programs.

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Acknowledgments

The authors thank Hans-Ulrich Wittchen as well as two anonymous reviewers for their helpful comments on earlier versions of the manuscript.

Reported data on mental disorders were assessed in the Mental Health Supplement of the German Health Survey (GHS-MHS), conducted by the Max-Planck-Institute of Psychiatry, Munich. Principal investigator was Hans-Ulrich Wittchen. Reported sociodemographic and somatic health status variables come from the Core Survey (GHS-CS), conducted by the Robert Koch-Institute, Berlin. Principal investigators of the GHS-CS were Dr. Bärbel-Maria Kurth and Dr Wolfgang Thefeld.

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Correspondence to Lydia Fehm.

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Fehm, L., Beesdo, K., Jacobi, F. et al. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Soc Psychiat Epidemiol 43, 257–265 (2008). https://doi.org/10.1007/s00127-007-0299-4

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  • DOI: https://doi.org/10.1007/s00127-007-0299-4

Key words

  • epidemiology
  • prevalence
  • social anxiety disorder
  • social anxiety-impairment