TY - JOUR
T1 - Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan
T2 - Results from the World Mental Health Surveys
AU - De Vries, Ymkje Anna
AU - Al-Hamzawi, Ali
AU - Alonso, Jordi
AU - Borges, Guilherme
AU - Bruffaerts, Ronny
AU - Bunting, Brendan
AU - Caldas-De-Almeida, José Miguel
AU - Cia, Alfredo H.
AU - De Girolamo, Giovanni
AU - Dinolova, Rumyana V.
AU - Esan, Oluyomi
AU - Florescu, Silvia
AU - Gureje, Oye
AU - Haro, Josep Maria
AU - Hu, Chiyi
AU - Karam, Elie G.
AU - Karam, Aimee Nasser
AU - Kawakami, Norito
AU - Kiejna, Andrzej
AU - Kovess-Masfety, Viviane
AU - Lee, Sing
AU - Mneimneh, Zeina
AU - Navarro-Mateu, Fernando
AU - Piazza, Marina
AU - Scott, Kate M.
AU - Ten Have, Margreet
AU - Torres, Yolanda
AU - Viana, Maria Carmen
AU - Kessler, Ronald C.
AU - De Jonge, Peter
AU - Aguilar-Gaxiola, Sergio
AU - Al-Kaisy, Mohammed Salih
AU - Andrade, Laura Helena
AU - Benjet, Corina
AU - Bromet, Evelyn J.
AU - De Almeida, Jose Miguel Caldas
AU - Cardoso, Graça
AU - Chatterji, Somnath
AU - Degenhardt, Louisa
AU - Demyttenaere, Koen
AU - Hinkov, Hristo
AU - Hu, Chi Yi
AU - Karam, Aimee Nasser
AU - Lepine, Jean Pierre
AU - Levinson, Daphna
AU - McGrath, John
AU - Medina-Mora, Maria Elena
AU - Moskalewicz, Jacek
AU - Pennell, Beth Ellen
AU - Posada-Villa, Jose
AU - Scott, Kate M.
AU - Slade, Tim
AU - Stagnaro, Juan Carlos
AU - Stein, Dan J.
AU - Whiteford, Harvey
AU - Williams, David R.
AU - Wojtyniak, Bogdan
PY - 2019/5/24
Y1 - 2019/5/24
N2 - Background: Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. Methods: We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. Results: Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3-2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4-1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7-1.8, p < 0.001). Conclusions: This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
AB - Background: Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. Methods: We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. Results: Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3-2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4-1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7-1.8, p < 0.001). Conclusions: This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
KW - Comorbidity
KW - Early markers
KW - Internalizing disorders
KW - Specific phobia
KW - Suicidality
UR - http://www.scopus.com/inward/record.url?scp=85066396682&partnerID=8YFLogxK
U2 - 10.1186/s12916-019-1328-3
DO - 10.1186/s12916-019-1328-3
M3 - Article
C2 - 31122269
AN - SCOPUS:85066396682
VL - 17
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 101
ER -