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

WHO World Mental Health Survey Collaborators

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

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 (US)
Article number143
JournalBMC Medicine
Volume15
Issue number1
DOIs
StatePublished - Jul 31 2017

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Health Surveys
Mental Health
Epidemiology
Comorbidity
Age of Onset
Demography
Survival Analysis
Global Health
Social Phobia
Mediterranean Region
Geographic Locations
Eastern Africa
Mental Disorders
Psychiatry
Therapeutics
Public Health
Logistic Models
Regression Analysis

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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

In: BMC Medicine, Vol. 15, No. 1, 143, 31.07.2017.

Research output: Contribution to journalArticle

@article{7fe9aa655d8b42b28fa2daf4770bde57,
title = "The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative",
abstract = "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.",
keywords = "Cross-national epidemiology, Social anxiety disorder, Social phobia, World Mental Health Survey Initiative",
author = "{WHO World Mental Health Survey Collaborators} and Stein, {Dan J.} and Lim, {Carmen C.W.} and Roest, {Annelieke M.} and {de Jonge}, Peter and Sergio Aguilar-Gaxiola and Ali Al-Hamzawi and Jordi Alonso and Corina Benjet and Bromet, {Evelyn J.} and Ronny Bruffaerts and {de Girolamo}, Giovanni and Silvia Florescu and Oye Gureje and Haro, {Josep Maria} and Harris, {Meredith G.} and Yanling He and Hristo Hinkov and Itsuko Horiguchi and Chiyi Hu and Aimee Karam and Karam, {Elie G.} and Sing Lee and Lepine, {Jean Pierre} and Fernando Navarro-Mateu and Pennell, {Beth Ellen} and Marina Piazza and Jose Posada-Villa and {ten Have}, Margreet and Yolanda Torres and Viana, {Maria Carmen} and Bogdan Wojtyniak and Miguel Xavier and Kessler, {Ronald C.} and Scott, {Kate M.} and Al-Kaisy, {Mohammed Salih} and Jordi Alonso and Andrade, {Laura Helena} and Guilherme Borges and Brendan Bunting and {de Almeida}, {Jose Miguel Caldas} and Graca Cardoso and Cia, {Alfredo H.} and Somnath Chatterji and Louisa Degenhardt and Koen Demyttenaere and John Fayyad and Hu, {Chi yi} and Yueqin Huang and Norito Kawakami and Andrzej Kiejna",
year = "2017",
month = "7",
day = "31",
doi = "10.1186/s12916-017-0889-2",
language = "English (US)",
volume = "15",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",

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TY - JOUR

T1 - The cross-national epidemiology of social anxiety disorder

T2 - Data from the World Mental Health Survey Initiative

AU - WHO World Mental Health Survey Collaborators

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 - de Almeida, Jose Miguel Caldas

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

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

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U2 - 10.1186/s12916-017-0889-2

DO - 10.1186/s12916-017-0889-2

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VL - 15

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

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