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BMC Med. 2017 Jul 31;15(1):143. doi: 10.1186/s12916-017-0889-2.

The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative.

Author information

1
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa. dan.stein@uct.ac.za.
2
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
3
Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.
4
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia.
5
Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, Groningen, Netherlands.
6
Department of Developmental Psychology, University of Groningen, Groningen, Netherlands.
7
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA.
8
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq.
9
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
10
Pompeu Fabra University (UPF), Barcelona, Spain.
11
CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
12
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
13
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA.
14
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
15
IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
16
National School of Public Health, Management and Professional Development, Bucharest, Romania.
17
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
18
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain.
19
School of Public Health, The University of Queensland, Herston, Queensland, Australia.
20
Shanghai Mental Health Center, Shanghai, China.
21
National Center for Public Health and Analyses, Sofia, Bulgaria.
22
Center for Public Relations Strategy, Nagasaki University (Tokyo Office), Tokyo, Japan.
23
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China.
24
Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon.
25
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.
26
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
27
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
28
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes, Paris, France.
29
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain.
30
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
31
Universidad Cayetano Heredia, Lima, Peru.
32
National Institute of Health, Lima, Peru.
33
Colegio Mayor de Cundinamarca University, Bogota, Colombia.
34
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
35
Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
36
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
37
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil.
38
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
39
Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
40
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis.

METHODS:

Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates.

RESULTS:

SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries.

CONCLUSIONS:

While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.

KEYWORDS:

Cross-national epidemiology; Social anxiety disorder; Social phobia; World Mental Health Survey Initiative

PMID:
28756776
PMCID:
PMC5535284
DOI:
10.1186/s12916-017-0889-2
[Indexed for MEDLINE]
Free PMC Article

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