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Subtyping social anxiety disorder in developed and developing countries


Stein, DJ and Ruscio, AM and Lee, S and Petukhova, M and Alonso, J and Andrade, LHSG and Benjet, C and Bromet, E and Demyttenaere, K and Florescu, S and de Girolamo, G and de Graaf, R and Gureje, O and He, YL and Hinkov, H and Hu, CH and Iwata, N and Karam, EG and Lepine, JP and Matschinger, H and Browne, MO and Posada-Villa, J and Sagar, R and Williams, DR and Kessler, RC, Subtyping social anxiety disorder in developed and developing countries, Depression and Anxiety, 27, (4) pp. 390-403. ISSN 1091-4269 (2010) [Refereed Article]

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DOI: doi:10.1002/da.20639


Background: Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose–response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful. Methods: The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. Results: Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose–response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. Conclusion: No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.

Item Details

Item Type:Refereed Article
Keywords:social anxiety disorder;social phobia;epidemiology;subtype
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Mental health services
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Mental health
UTAS Author:Browne, MO (Professor Mark Oakley Browne)
ID Code:65325
Year Published:2010
Web of Science® Times Cited:39
Deposited By:Medicine
Deposited On:2010-11-03
Last Modified:2014-12-18

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