TY - JOUR
T1 - The cross-national epidemiology of social anxiety disorder
T2 - Data from the World Mental Health Survey Initiative
AU - Stein, Dan J.
AU - Lim, Carmen C.W.
AU - Roest, Annelieke M.
AU - de Jonge, Peter
AU - Aguilar-Gaxiola, Sergio
AU - Al-Hamzawi, Ali
AU - Alonso, Jordi
AU - Benjet, Corina
AU - Bromet, Evelyn J.
AU - Bruffaerts, Ronny
AU - de Girolamo, Giovanni
AU - Florescu, Silvia
AU - Gureje, Oye
AU - Haro, Josep Maria
AU - Harris, Meredith G.
AU - He, Yanling
AU - Hinkov, Hristo
AU - Horiguchi, Itsuko
AU - Hu, Chiyi
AU - Karam, Aimee
AU - Karam, Elie G.
AU - Lee, Sing
AU - Lepine, Jean Pierre
AU - Navarro-Mateu, Fernando
AU - Pennell, Beth Ellen
AU - Piazza, Marina
AU - Posada-Villa, Jose
AU - ten Have, Margreet
AU - Torres, Yolanda
AU - Viana, Maria Carmen
AU - Wojtyniak, Bogdan
AU - Xavier, Miguel
AU - Kessler, Ronald C.
AU - Scott, Kate M.
AU - Al-Kaisy, Mohammed Salih
AU - Alonso, Jordi
AU - Andrade, Laura Helena
AU - Borges, Guilherme
AU - Bunting, Brendan
AU - Caldas-de-Almeida, José M
AU - Cardoso, Graca
AU - Cia, Alfredo H.
AU - Chatterji, Somnath
AU - Degenhardt, Louisa
AU - Demyttenaere, Koen
AU - Fayyad, John
AU - Hu, Chi yi
AU - Huang, Yueqin
AU - Kawakami, Norito
AU - Kiejna, Andrzej
AU - Kovess-Masfety, Viviane
AU - Levinson, Daphna
AU - McGrath, John
AU - Medina-Mora, Maria Elena
AU - Moskalewicz, Jacek
AU - Pennell, Beth Ellen
AU - Slade, Tim
AU - Stagnaro, Juan Carlos
AU - Taib, Nezar
AU - Whiteford, Harvey
AU - Williams, David R.
PY - 2017/7/31
Y1 - 2017/7/31
N2 - 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.
AB - 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.
KW - Cross-national epidemiology
KW - Social anxiety disorder
KW - Social phobia
KW - World Mental Health Survey Initiative
UR - http://www.scopus.com/inward/record.url?scp=85026466440&partnerID=8YFLogxK
U2 - 10.1186/s12916-017-0889-2
DO - 10.1186/s12916-017-0889-2
M3 - Article
C2 - 28756776
AN - SCOPUS:85026466440
VL - 15
SP - Online
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 143
ER -