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Title: The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative
Authors: Stein, Dan J.
Lim, Carmen C.W.
Roest, Annelieke M.
de Jonge, Peter
Aguilar-Gaxiola, Sergio
Al-Hamzawi, Ali
Alonso, Jordi
Benjet, Corina
Bromet, Evelyn J.
Bruffaerts, Ronny
de Girolamo, Giovanni
Florescu, Silvia
Gureje, Oye
Haro, Josep Maria
Harris, Meredith G.
He, Yanling
Hinkov, Hristo
Horiguchi, Itsuko
Hu, Chiyi
Karam, Aimee
Karam, Elie G.
Lee, Sing
Lepine, Jean Pierre
Navarro-Mateu, Fernando
Pennell, Beth Ellen
Piazza, Marina
Posada-Villa, Jose
ten Have, Margreet
Torres, Yolanda
Viana, Maria Carmen
Wojtyniak, Bogdan
Xavier, Miguel
Kessler, Ronald C.
Scott, Kate M.
Al-Kaisy, Mohammed Salih
Andrade, Laura Helena
Borges, Guilherme
Bunting, Brendan
de Almeida, Jose Miguel Caldas
Cardoso, Graca
Cia, Alfredo H.
Chatterji, Somnath
Degenhardt, Louisa
Demyttenaere, Koen
Fayyad, John
Hu, Chi yi
Huang, Yueqin
Kawakami, Norito
Kiejna, Andrzej
Kovess-Masfety, Viviane
Levinson, Daphna
McGrath, John
Medina-Mora, Maria Elena
Moskalewicz, Jacek
Slade, Tim
Stagnaro, Juan Carlos
Taib, Nezar
Whiteford, Harvey
Williams, David R.
Affiliations: Faculty of Medicine 
Keywords: Cross-national epidemiology
Social anxiety disorder
Social phobia
World Mental Health Survey Initiative
Issue Date: 2017-01-31
Part of: BMC Medicine
Volume: 15
Issue: 1
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.
DOI: 10.1186/s12916-017-0889-2
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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