Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan

Results from the World Mental Health Surveys

Ymkje Anna De Vries, Ali Al-Hamzawi, Jordi Alonso, Guilherme Borges, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas-De-Almeida, Alfredo H. Cia, Giovanni De Girolamo, Rumyana V. Dinolova, Oluyomi Esan, Silvia Florescu, Oye Gureje, Josep Maria Haro, Chiyi Hu, Elie G. Karam, Aimee Karam, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety & 37 others Sing Lee, Zeina Mneimneh, Fernando Navarro-Mateu, Marina Piazza, Kate Scott, Margreet Ten Have, Yolanda Torres, Maria Carmen Viana, Ronald C. Kessler, Peter De Jonge, Sergio Aguilar-Gaxiola, Mohammed Salih Al-Kaisy, Laura Helena Andrade, Corina Benjet, Evelyn J. Bromet, Jose Miguel Caldas De Almeida, Graça Cardoso, Somnath Chatterji, Louisa Degenhardt, Koen Demyttenaere, Hristo Hinkov, Chi Yi Hu, Aimee Nasser Karam, Jean Pierre Lepine, Daphna Levinson, John McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Beth Ellen Pennell, Jose Posada-Villa, Kate M. Scott, Tim Slade, Juan Carlos Stagnaro, Dan J. Stein, Harvey Whiteford, David R. Williams, Bogdan Wojtyniak

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number101
JournalBMC Medicine
Volume17
Issue number1
DOIs
StatePublished - May 24 2019

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Health Surveys
Psychopathology
Mental Health
Comorbidity
Global Health
Specific Phobia
Interviews
Age of Onset
Suicide
Psychiatry
Linear Models
Cross-Sectional Studies
Logistic Models

Keywords

  • Comorbidity
  • Early markers
  • Internalizing disorders
  • Specific phobia
  • Suicidality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan : Results from the World Mental Health Surveys. / De Vries, Ymkje Anna; Al-Hamzawi, Ali; Alonso, Jordi; Borges, Guilherme; Bruffaerts, Ronny; Bunting, Brendan; Caldas-De-Almeida, José Miguel; Cia, Alfredo H.; De Girolamo, Giovanni; Dinolova, Rumyana V.; Esan, Oluyomi; Florescu, Silvia; Gureje, Oye; Haro, Josep Maria; Hu, Chiyi; Karam, Elie G.; Karam, Aimee; Kawakami, Norito; Kiejna, Andrzej; Kovess-Masfety, Viviane; Lee, Sing; Mneimneh, Zeina; Navarro-Mateu, Fernando; Piazza, Marina; Scott, Kate; Ten Have, Margreet; Torres, Yolanda; Viana, Maria Carmen; Kessler, Ronald C.; De Jonge, Peter; Aguilar-Gaxiola, Sergio; Al-Kaisy, Mohammed Salih; Andrade, Laura Helena; Benjet, Corina; Bromet, Evelyn J.; De Almeida, Jose Miguel Caldas; Cardoso, Graça; Chatterji, Somnath; Degenhardt, Louisa; Demyttenaere, Koen; Hinkov, Hristo; Hu, Chi Yi; Karam, Aimee Nasser; Lepine, Jean Pierre; Levinson, Daphna; McGrath, John; Medina-Mora, Maria Elena; Moskalewicz, Jacek; Pennell, Beth Ellen; Posada-Villa, Jose; Scott, Kate M.; Slade, Tim; Stagnaro, Juan Carlos; Stein, Dan J.; Whiteford, Harvey; Williams, David R.; Wojtyniak, Bogdan.

In: BMC Medicine, Vol. 17, No. 1, 101, 24.05.2019.

Research output: Contribution to journalArticle

De Vries, YA, Al-Hamzawi, A, Alonso, J, Borges, G, Bruffaerts, R, Bunting, B, Caldas-De-Almeida, JM, Cia, AH, De Girolamo, G, Dinolova, RV, Esan, O, Florescu, S, Gureje, O, Haro, JM, Hu, C, Karam, EG, Karam, A, Kawakami, N, Kiejna, A, Kovess-Masfety, V, Lee, S, Mneimneh, Z, Navarro-Mateu, F, Piazza, M, Scott, K, Ten Have, M, Torres, Y, Viana, MC, Kessler, RC, De Jonge, P, Aguilar-Gaxiola, S, Al-Kaisy, MS, Andrade, LH, Benjet, C, Bromet, EJ, De Almeida, JMC, Cardoso, G, Chatterji, S, Degenhardt, L, Demyttenaere, K, Hinkov, H, Hu, CY, Karam, AN, Lepine, JP, Levinson, D, McGrath, J, Medina-Mora, ME, Moskalewicz, J, Pennell, BE, Posada-Villa, J, Scott, KM, Slade, T, Stagnaro, JC, Stein, DJ, Whiteford, H, Williams, DR & Wojtyniak, B 2019, 'Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: Results from the World Mental Health Surveys', BMC Medicine, vol. 17, no. 1, 101. https://doi.org/10.1186/s12916-019-1328-3
De Vries, Ymkje Anna ; Al-Hamzawi, Ali ; Alonso, Jordi ; Borges, Guilherme ; Bruffaerts, Ronny ; Bunting, Brendan ; Caldas-De-Almeida, José Miguel ; Cia, Alfredo H. ; De Girolamo, Giovanni ; Dinolova, Rumyana V. ; Esan, Oluyomi ; Florescu, Silvia ; Gureje, Oye ; Haro, Josep Maria ; Hu, Chiyi ; Karam, Elie G. ; Karam, Aimee ; Kawakami, Norito ; Kiejna, Andrzej ; Kovess-Masfety, Viviane ; Lee, Sing ; Mneimneh, Zeina ; Navarro-Mateu, Fernando ; Piazza, Marina ; Scott, Kate ; Ten Have, Margreet ; Torres, Yolanda ; Viana, Maria Carmen ; Kessler, Ronald C. ; De Jonge, Peter ; Aguilar-Gaxiola, Sergio ; Al-Kaisy, Mohammed Salih ; Andrade, Laura Helena ; Benjet, Corina ; Bromet, Evelyn J. ; De Almeida, Jose Miguel Caldas ; Cardoso, Graça ; Chatterji, Somnath ; Degenhardt, Louisa ; Demyttenaere, Koen ; Hinkov, Hristo ; Hu, Chi Yi ; Karam, Aimee Nasser ; Lepine, Jean Pierre ; Levinson, Daphna ; McGrath, John ; Medina-Mora, Maria Elena ; Moskalewicz, Jacek ; Pennell, Beth Ellen ; Posada-Villa, Jose ; Scott, Kate M. ; Slade, Tim ; Stagnaro, Juan Carlos ; Stein, Dan J. ; Whiteford, Harvey ; Williams, David R. ; Wojtyniak, Bogdan. / Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan : Results from the World Mental Health Surveys. In: BMC Medicine. 2019 ; Vol. 17, No. 1.
@article{43fbda8a2fc142f2af31d721134e7f77,
title = "Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: Results from the World Mental Health Surveys",
abstract = "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.",
keywords = "Comorbidity, Early markers, Internalizing disorders, Specific phobia, Suicidality",
author = "{De Vries}, {Ymkje Anna} and Ali Al-Hamzawi and Jordi Alonso and Guilherme Borges and Ronny Bruffaerts and Brendan Bunting and Caldas-De-Almeida, {Jos{\'e} Miguel} and Cia, {Alfredo H.} and {De Girolamo}, Giovanni and Dinolova, {Rumyana V.} and Oluyomi Esan and Silvia Florescu and Oye Gureje and Haro, {Josep Maria} and Chiyi Hu and Karam, {Elie G.} and Aimee Karam and Norito Kawakami and Andrzej Kiejna and Viviane Kovess-Masfety and Sing Lee and Zeina Mneimneh and Fernando Navarro-Mateu and Marina Piazza and Kate Scott and {Ten Have}, Margreet and Yolanda Torres and Viana, {Maria Carmen} and Kessler, {Ronald C.} and {De Jonge}, Peter and Sergio Aguilar-Gaxiola and Al-Kaisy, {Mohammed Salih} and Andrade, {Laura Helena} and Corina Benjet and Bromet, {Evelyn J.} and {De Almeida}, {Jose Miguel Caldas} and Gra{\cc}a Cardoso and Somnath Chatterji and Louisa Degenhardt and Koen Demyttenaere and Hristo Hinkov and Hu, {Chi Yi} and Karam, {Aimee Nasser} and Lepine, {Jean Pierre} and Daphna Levinson and John McGrath and Medina-Mora, {Maria Elena} and Jacek Moskalewicz and Pennell, {Beth Ellen} and Jose Posada-Villa and Scott, {Kate M.} and Tim Slade and Stagnaro, {Juan Carlos} and Stein, {Dan J.} and Harvey Whiteford and Williams, {David R.} and Bogdan Wojtyniak",
year = "2019",
month = "5",
day = "24",
doi = "10.1186/s12916-019-1328-3",
language = "English (US)",
volume = "17",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",

}

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

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

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

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U2 - 10.1186/s12916-019-1328-3

DO - 10.1186/s12916-019-1328-3

M3 - Article

VL - 17

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 101

ER -