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

Dan J. Stein, Carmen C.W. Lim, Annelieke M. Roest, Peter de Jonge, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Corina Benjet, Evelyn J. Bromet, Ronny Bruffaerts, Giovanni de Girolamo, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G. Harris, Yanling He, Hristo Hinkov, Itsuko Horiguchi, Chiyi Hu, Aimee KaramElie G. Karam, Sing Lee, Jean Pierre Lepine, Fernando Navarro-Mateu, Beth Ellen Pennell, Marina Piazza, Jose Posada-Villa, Margreet ten Have, Yolanda Torres, Maria Carmen Viana, Bogdan Wojtyniak, Miguel Xavier, Ronald C. Kessler, Kate M. Scott, Mohammed Salih Al-Kaisy, Jordi Alonso, Laura Helena Andrade, Guilherme Borges, Brendan Bunting, José M Caldas-de-Almeida, Graca Cardoso, Alfredo H. Cia, Somnath Chatterji, Louisa Degenhardt, Koen Demyttenaere, John Fayyad, Chi yi Hu, Yueqin Huang, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety, Daphna Levinson, John McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Beth Ellen Pennell, Tim Slade, Juan Carlos Stagnaro, Nezar Taib, Harvey Whiteford, David R. Williams

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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.

Original languageEnglish
Article number143
Pages (from-to)Online
Number of pages21
JournalBMC Medicine
Issue number1
Publication statusPublished - 31 Jul 2017


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


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