Abstract
Social phobia commonly co-occurs with substance use disorders and depression; however, the prevalence and correlates of social phobia among individuals with both of these disorders remain unknown. Interviews were conducted with 120 individuals entering residential rehabilitation for substance use treatment, who endorsed criteria for major depression and were recruited to a randomised controlled trial. Nearly three quarters (72.5%) of the sample met diagnostic criteria for social phobia. These individuals were more likely to report problematic drinking, more severe anxiety and depressive rumination, and lower distress tolerance, compared to individuals without social phobia. When examining the impact of applying diagnostic exclusion rules for social phobia among this cohort, results indicate that one third (32.2%) of those with social phobia specified their fear was related to a co-occurring mental health and/or substance use disorder. This group—who would not have met diagnostic criteria for social phobia if exclusion rules were strictly followed—experienced more severe depression, anxiety, depressive rumination, and repetitive negative thinking than those who did not make such attributions. The high prevalence and burden associated with social phobia among depressed substance users highlight the importance of screening for, assessing, and treating the disorder upon entry to treatment, irrespective of whether symptoms are related to other conditions.
References
Althouse, A. D. (2016). Adjust for multiple comparisons? It’s not that simple. The Annals of Thoracic Surgery, 101(5), 1644–1645. https://doi.org/10.1016/j.athoracsur.2015.11.024.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.
Aragona, M. (2009). The role of comorbidity in the crisis of the current psychiatric classification system. Philosophy, Psychiatry, and Psychology, 16(1), 1–11. https://doi.org/10.1353/ppp.0.0211.
Baillie, A., Stapinski, L., Sannibale, C., Teesson, M. R., Rapee, R., & Haber, P. S. (2013). RCT of combined CBT for alcohol use and social anxiety disorders (Abstract). Alcoholism: Clinical and Experimental Research, 37(Supplement 2), 200A–200A.
Bakken, K., Landheim, A. S., & Vaglum, P. (2005). Substance-dependent patients with and without social anxiety disorder: occurrence and clinical differences. Drug and Alcohol Dependence, 80(3), 321–328. https://doi.org/10.1016/j.drugalcdep.2005.04.011.
Barrett, E. L., Mills, K. L., & Teesson, M. (2013). Mental health correlates of anger in the general population: findings from the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 47(5), 470–476. https://doi.org/10.1177/0004867413476752.
Beck, A. T., Steer, R. A., & Brown, B. K. (1996). Beck depression inventory manual (2nd ed.). San Antonio: Psychological Corporation.
Beesdo, K., Pine, D. S., Lieb, R., & Wittchen, H.-U. (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder categorization of generalized anxiety disorder. JAMA Psychiatry, 67(1), 47–57. https://doi.org/10.1001/archgenpsychiatry.2009.177.
Blumenthal, H., Leen-Feldner, E. W., Frala, J. L., Badour, C. L., & Ham, L. S. (2010). Social anxiety and motives for alcohol use among adolescents. Psychology of Addictive Behaviors, 24(3), 529–534. https://doi.org/10.1037/a0019794.
Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211. https://doi.org/10.1002/cphy.c110025.
Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment. Psychological Assessment, 21(3), 256–271. https://doi.org/10.1037/a0016608.
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599. https://doi.org/10.1037/0021-843X.110.4.585.
Buckner, J. D., Keough, M. E., & Schmidt, N. B. (2007). Problematic alcohol and cannabis use among young adults: the roles of depression and discomfort and distress tolerance. Addictive Behaviors, 32(9), 1957–1963. https://doi.org/10.1016/j.addbeh.2006.12.019.
Carter, S. A., & Wu, K. D. (2010). Relations among symptoms of social phobia subtypes, avoidant personality disorder, panic, and depression. Behavior Therapy, 41(1), 2–13. https://doi.org/10.1016/j.beth.2008.10.002.
Chartrand, H., Cox, B., El-Gabalawy, R., & Clara, I. (2011). Social anxiety disorder subtypes and their mental health correlates in a nationally representative Canadian sample. Canadian Journal of Behavioural Science, 43, 89–98. https://doi.org/10.1037/a0022435.
Clark, L. A., Cuthbert, B., Lewis-Fernández, R., Narrow, W. E., & Reed, G. M. (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychological Science in the Public Interest, 18(2), 72–145. https://doi.org/10.1177/1529100617727266.
Conner, K. R., Gamble, S. A., Bagge, C. L., He, H., Swogger, M. T., Watts, A., & Houston, R. J. (2014). Substance-induced depression and independent depression in proximal risk for suicidal behavior. Journal of Studies on Alcohol and Drugs, 75(4), 567–572. https://doi.org/10.15288/jsad.2014.75.567.
Cox, B. J., Borger, S. C., Taylor, S., Fuentes, K., & Ross, L. M. (1999). Anxiety sensitivity and the five-factor model of personality. Behavior Research and Therapy, 37(7), 633–641. https://doi.org/10.1016/S0005-7967(98)00174-0.
Cox, B. J., Turnbull, D. L., Robinson, J. A., Grant, B. F., & Stein, M. B. (2011). The effect of avoidant personality disorder on the persistence of generalized social anxiety disorder in the general population: Results from a longitudinal, nationally representative mental health survey. Depression and Anxiety, 28(3), 250–255
Crome, E., Grove, R., Baillie, A. J., Sunderland, M., Teesson, M., & Slade, T. (2014). DSM-IV and DSM-5 social anxiety disorder in the Australian community. Australian and New Zealand Journal of Psychiatry, 49(3), 227–235. https://doi.org/10.1177/0004867414546699.
Dalrymple, K. L., & Zimmerman, M. (2007). Does comorbid social anxiety disorder impact the clinical presentation of principal major depressive disorder? Journal of Affective Disorders, 100(1–3), 241–247. https://doi.org/10.1016/j.jad.2006.10.014.
Daughters, S. B., Lejuez, C. W., Bornovalova, M. A., Kahler, C. W., Strong, D. R., & Brown, R. A. (2005a). Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. Journal of Abnormal Psychology, 114(4), 729–734. https://doi.org/10.1037/0021-843x.114.4.729.
Daughters, S. B., Lejuez, C. W., Kahler, C. W., Strong, D. R., & Brown, R. A. (2005b). Psychological distress tolerance and duration of most recent abstinence attempt among residential treatment-seeking substance abusers. Psychology of Addictive Behaviors, 19(2), 208–211. https://doi.org/10.1037/0893-164x.19.2.208.
Dilsaver, S. C., Qamar, A. B., & Del Medico, V. J. (1992). Secondary social phobia in patients with major depression. Psychiatry Research, 44(1), 33–40. https://doi.org/10.1016/0165-1781(92)90067-D.
Eaton, N. R., Rodriguez-Seijas, C., Carragher, N., & Krueger, R. F. (2015). Transdiagnostic factors of psychopathology and substance use disorders: a review. Social Psychiatry and Psychiatric Epidemiology, 50(2), 171–182. https://doi.org/10.1007/s00127-014-1001-2.
Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192.
Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Perseverative Thinking Questionnaire (PTQ): validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry, 42, 225–232. https://doi.org/10.1016/j.jbtep.2010.12.003.
Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire. JAMA, 252(14), 1905–1907. https://doi.org/10.1001/jama.252.14.1905.
Goes, F. S., McCusker, M. G., Bienvenu, O. J., Mackinnon, D. F., Mondimore, F. M., Schweizer, B., . . . Potash, J. B. (2012). Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder. Psychological Medicine, 42(7), 1449–1459. https://doi.org/10.1017/s0033291711002637.
Grant, B., Stinson, F., Dawson, D., Chou, P., Dufour, M., Compton, W., . . . Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61, 807–816. https://doi.org/10.1001/archpsyc.61.8.807.
Guillem, E., Pelissolo, A., Vorspan, F., Bouchez-Arbabzadeh, S., & Lepine, J. P. (2009). Sociodemographic profiles, addictive and mental comorbidity in cannabis users in an outpatient specific setting. Encephale, 35(3), 226–233. https://doi.org/10.1016/j.encep.2008.03.010.
Hasin, D., Liu, X., Nunes, E., McCloud, S., Samet, S., & Endicott, J. (2002). Effects of major depression on remission and relapse of substance dependence. Archives of General Psychiatry, 59(4), 375–380. https://doi.org/10.1001/archpsyc.59.4.375.
Hopko, D., Robertson, S., & Lejuez, C. (2006). Behavioral activation for anxiety disorders. The Behavior Analyst Today, 7(2), 212–233.
IBM Corp. (2015). IBM SPSS statistics for Windows (version 23.0). Armonk: IBM Corp.
Kaufman, E. A., & Baucom, K. J. W. (2014). Treating comorbid social anxiety and major depression: the challenge of diagnostic overshadowing. Clinical Case Studies, 13(3), 265–281. https://doi.org/10.1177/1534650113508220.
Kay-Lambkin, F. J., Baker, A. L., Lewin, T. J., & Carr, V. J. (2009). Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction, 104(3), 378–388. https://doi.org/10.1111/j.1360-0443.2008.02444.x.
Kelly, K. M., & Mezuk, B. (2017). Predictors of remission from generalized anxiety disorder and major depressive disorder. Journal of Affective Disorders, 208, 467–474. https://doi.org/10.1016/j.jad.2016.10.042.
Kessler, R. C., & Ustün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121. https://doi.org/10.1002/mpr.168.
Kingston, R., Marel, C., & Mills, K. (2016). A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug and Alcohol Review, Advance online publication, 36, 527–539. https://doi.org/10.1111/dar.12448.
Laposa, J. M., Collimore, K. C., Hawley, L. L., & Rector, N. A. (2015). Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of Anxiety Disorders, 33, 8–14. https://doi.org/10.1016/j.janxdis.2015.04.003.
Lawrence, A., & Brown, T. (2008). Classification and boundaries among anxiety-related problems. In M. Anthony & M. Stein (Eds.), Oxford handbook of anxiety and related disorders. New York: Oxford University Press.
Lawrence, A., Liverant, G., Rosellini, A., & Brown, T. (2009). Generalized anxiety disorder within the course of major depressive disorder: examining the utility of the DSM-IV hierarchy rule. Depression and Anxiety, 26(10), 909–916. https://doi.org/10.1002/da.20607.
Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters, S. B., & Pagoto, S. L. (2011). Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behavior Modification, 35(2), 111–161. https://doi.org/10.1177/0145445510390929.
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600. https://doi.org/10.1037/a0019712.
Loewenthal, K. M. (2004). An introduction to psychological tests and scales (2nd ed.). Hove: Psychology Press.
Magidson, J. F., Wang, S., Lejuez, C. W., Iza, M., & Blanco, C. (2013). Prospective study of substance-induced and independent major depressive disorder among individuals with substance use disorders in a nationally representative sample. Depression and Anxiety, 30(6), 538–545. https://doi.org/10.1002/da.22122.
Manos, R. C., Kanter, J. W., & Luo, W. (2011). The behavioral activation for depression scale-short form: development and validation. Behavior Therapy, 42(4), 726–739. https://doi.org/10.1016/j.beth.2011.04.004.
Marquenie, L. A., Schadé, A., Van Balkom, A. J. L. M., Koeter, M., Frenken, S., Van Den Brink, W., & Van Dyck, R. (2006). Comorbid phobic disorders do not influence outcome of alcohol dependence treatment. Results of a naturalistic follow-up study. Alcohol and Alcoholism, 41(2), 168–173. https://doi.org/10.1093/alcalc/agh252.
McEvoy, P. M., Grove, R., & Slade, T. (2011). Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45(11), 957–967. https://doi.org/10.3109/00048674.2011.624083.
McKetin, R., Lubman, D., Lee, N., Ross, J., & Slade, T. (2011). Major depression among methamphetamine users entering drug treatment programs. The Medical Journal of Australia, 195(3), s51–s55.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6.
Michalak, J., Hölz, A., & Teismann, T. (2011). Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression. Psychology and Psychotherapy: Theory, Research and Practice, 84(2), 230–236. https://doi.org/10.1348/147608310X520166.
Mills, K. L., Deady, M., Proudfoot, H., Sannibale, C., Teesson, M., Mattick, R. P., & Burns, L. A. (2009). Guidelines on the management co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: National Drug and Alcohol Research Centre, University of New South Wales.
Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S., Sannibale, C., Barrett, E. L., Merz, S., Rosenfeld, J., & Ewer, P. L. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial. JAMA, 308(7), 690–699. https://doi.org/10.1001/jama.2012.9071.
Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., & Poulton, R. (2007). Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry, 64(6), 651–660. https://doi.org/10.1001/archpsyc.64.6.651.
Myrick, H., & Brady, K. (1997). Social phobia in cocaine-dependent individuals. The American Journal on Addictions, 6(2), 99–104. https://doi.org/10.1111/j.1521-0391.1997.tb00558.x.
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3), 504–511. https://doi.org/10.1037//0021-843X.109.3.504.
Nolen-Hoeksema, S., & Harrell, Z. A. (2002). Rumination, depression, and alcohol use: tests of gender differences. Journal of Cognitive Psychotherapy, 16(4), 391–403. https://doi.org/10.1891/jcop.16.4.391.52526.
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116(1), 198–207. https://doi.org/10.1037/0021-843x.116.1.198.
Nunes, E. V., Liu, X., Samet, S., Matseoane, K., & Hasin, D. (2006). Independent versus substance-induced major depressive disorder in substance-dependent patients: observational study of course during follow-up. The Journal of Clinical Psychiatry, 67(10), 1561–1567. https://doi.org/10.4088/JCP.v67n1010.
Ohayon, M. M., & Schatzberg, A. F. (2010). Social phobia and depression: prevalence and comorbidity. Journal of Psychosomatic Research, 68(3), 235–243. https://doi.org/10.1016/j.jpsychores.2009.07.018.
Pagano, M. E., Wang, A. R., Rowles, B. M., Lee, M. T., & Johnson, B. R. (2015). Social anxiety and peer helping in adolescent addiction treatment. Alcoholism, Clinical and Experimental Research, 39(5), 887–895. https://doi.org/10.1111/acer.12691.
Pincus, H. A., Tew, J. D., & First, M. B. (2004). Psychiatric comorbidity: is more less? World Psychiatry, 3(1), 18–23.
Prior, K., Mills, K., Ross, J., & Teesson, M. (2016). Substance use disorders comorbid with mood and anxiety disorders in the Australian general population. Drug and Alcohol Review, 36(3), 317–324. https://doi.org/10.1111/dar.12419.
Raes, F. (2012). Repetitive negative thinking predicts depressed mood at 3-year follow-up in students. Journal of Psychopathology and Behavioral Assessment, 34(4), 497–501. https://doi.org/10.1007/s10862-012-9295-4.
Raj, S., Yasin, M., Othman, Z., & Othman, A. (2016). Drinking motives as mediator between social anxiety and alcohol use among private university students in Klang Valley. Procedia - Social and Behavioral Sciences, 219, 614–619. https://doi.org/10.1016/j.sbspro.2016.05.041.
Randall, C. L., Thomas, S., & Thevos, A. K. (2001). Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcoholism: Clinical and Experimental Research, 25(2), 210–220. https://doi.org/10.1111/j.1530-0277.2001.tb02201.x.
Ross, J., Teesson, M., Darke, S., Lynskey, M., Ali, R., Ritter, A., & Cooke, R. (2005). The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS). Drug and Alcohol Review, 24(5), 411–418. https://doi.org/10.1080/09595230500286039.
Ross, J., Teesson, M., Lejuez, C., Mills, K., Kaye, S., Brady, K., Dore, G., Prior, K., Larkin, X., Cassar, J., Ewer, P., Memedovic, S., Kihas, I., & Masters, S. (2016). The efficacy of behavioural activation treatment for co-occurring depression and substance use disorder (the Activate Study): a randomized controlled trial protocol. BioMed Central Psychiatry, 16, 221. https://doi.org/10.1186/s12888-016-0943-1.
Samet, S., Fenton, M. C., Nunes, E., Greenstein, E., Aharonovich, E., & Hasin, D. (2013). Effects of independent and substance-induced major depressive disorder on remission and relapse of alcohol, cocaine and heroin dependence. Addiction, 108(1), 115–123. https://doi.org/10.1111/j.1360-0443.2012.04010.x.
Schadé, A., Marquenie, L. A., Van Balkom, A. J., Koeter, M. W., De Beurs, E., Van Den Brink, W., & Van Dyck, R. (2004). Alcohol-dependent patients with comorbid phobic disorders: a comparison between comorbid patients, pure alcohol-dependent and pure phobic patients. Alcohol and Alcoholism, 39(3), 241–246. https://doi.org/10.1093/alcalc/agh039.
Schneier, F. R., Foose, T. E., Hasin, D. S., Heimberg, R. G., Liu, S. M., Grant, B. F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 40(6), 977–988.
Schuckit, M. A., Smith, T. L., Danko, G. P., Pierson, J., Trim, R., Nurnberger, J. I., . . . Hesselbrock, V. (2007). A comparison of factors associated with substance-induced versus independent depressions. Journal of Studies on Alcohol and Drugs, 68(6), 805–812. https://doi.org/10.15288/jsad.2007.68.805.
Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: development and validation of a self-report measure. Motivation and Emotion, 29(2), 83–102. https://doi.org/10.1007/s11031-005-7955-3.
Smits, J. A. J., Minhajuddin, A., & Jarrett, R. B. (2009). Cognitive therapy for depressed adults with comorbid social phobia. Journal of Affective Disorders, 114, 271–278. https://doi.org/10.1016/j.jad.2008.08.008.
Spitzer, R., Kroenke, K., & Williams, J. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. Journal of the American Medical Association, 282, 1737–1744. https://doi.org/10.1001/jama.282.18.1737.
Steer, R. A., & Beck, A. T. (1997). Beck anxiety inventory. In C. P. Z. R. J. Wood (Ed.), Evaluating stress: a book of resources (pp. 23–40). Lanham: Scarecrow Education.
Sunderland, M., Slade, T., Anderson, T. M., & Peters, L. (2008). Impact of substance-induced and general medical condition exclusion criteria on the prevalence of common mental disorders as defined by the CIDI, Australian and New Zealand Journal of Psychiatry., 42(10), 898–904. https://doi.org/10.1080/00048670802345508.
Teesson, M., Slade, T., & Mills, K. (2009). Comorbidity in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 43(7), 606–614. https://doi.org/10.1080/00048670902970908.
Terra, M. B., Barros, H. M., Stein, A. T., Figueira, I., Athayde, L. D., Spanemberg, L., . . . da Silveira, D. X. (2006). Does co-occurring social phobia interfere with alcoholism treatment adherence and relapse? Journal of Substance Abuse Treatment, 31(4), 403–409. doi:https://doi.org/10.1016/j.jsat.2006.05.013.
Thomas, S. E., Thevos, A. K., & Randall, C. L. (1999). Alcoholics with and without social phobia: a comparison of substance use and psychiatric variables. Journal of Studies on Alcohol, 60(4), 472–479. https://doi.org/10.15288/jsa.1999.60.472.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: a psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259. https://doi.org/10.1023/A:1023910315561.
Vujanovic, A. A., Meyer, T. D., Heads, A. M., Stotts, A. L., Villarreal, Y. R., & Schmitz, J. M. (2017). Cognitive-behavioral therapies for depression and substance use disorders: an overview of traditional, third-wave, and transdiagnostic approaches. The American Journal of Drug and Alcohol Abuse, 43(4), 402–415. https://doi.org/10.1080/00952990.2016.1199697.
Watson, D., & O'Hara, M. (2017). Understanding the emotional disorders: a symptom-level approach based on the IDAS-II. New York: Oxford University Press.
Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). PTSD checklist - civilian version. Boston: National Centre for PTSD: Behavioral Science Division.
Williams, A. D., Thompson, J., & Andrews, G. (2013). The impact of psychological distress tolerance in the treatment of depression. Behaviour Research and Therapy, 51(8), 469–475. https://doi.org/10.1016/j.brat.2013.05.005.
World Health Organization. (1997). Composite International Diagnostic Interview (CIDI) Core Version 2.1. Geneva: World Health Organization.
World Health Organization. (2004). ICD-10 : international statistical classification of diseases and related health problems. Geneva: World Health Organization.
Zimmerman, M., & Chelminski, I. (2003). Generalized anxiety disorder in patients with major depression: is DSM-IV’s hierarchy correct? American Journal of Psychiatry, 160(3), 504–512. https://doi.org/10.1176/appi.ajp.160.3.504.
Acknowledgements
The authors would like to thank all those who participated in the Activate Study, funded by the National Health and Medical Research Council (NHMRC; APP10444625). The funding for this study came from Australian Rotary Health, the Australian Federal Government (an Australian Postgraduate Award), and the Centre for Research Excellence in Mental Health and Substance Use (funded by the NHMRC). Mills and Teesson were funded by fellowships provided by NHMRC. The authors alone are responsible for the content and writing of the paper and report no financial relationships with commercial interests.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
Ethics Approval
Ethics approval was obtained from the Human Research Ethics Committee (HREC) of the University of New South Wales (HC13155). The study has been prospectively registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12613000876796, 7/08/13).
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Highlights
• Nearly three quarters of depressed substance users met diagnostic criteria for current social phobia.
• A diagnosis of social phobia was associated with a more severe clinical profile.
• Those who related their social phobia to comorbid substance use and/or mental disorders experienced greater impairment.
• Important to assess for social phobia even if symptoms are perceived to be related to co-occurring conditions.
Rights and permissions
About this article
Cite this article
Prior, K., Ross, J., Mills, K. et al. Social Phobia Among Depressed Individuals Entering Residential Rehabilitation Programmes: Prevalence and Correlates. Int J Ment Health Addiction 18, 1148–1167 (2020). https://doi.org/10.1007/s11469-019-00131-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-019-00131-z