Journal
BMC MEDICINE
Volume 15, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12916-017-0889-2
Keywords
Social anxiety disorder; Social phobia; Cross-national epidemiology; World Mental Health Survey Initiative
Categories
Funding
- National Institute of Mental Health (NIMH) [R01 MH070884, U01-MH60220]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- US Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly and Company
- Ortho-McNeil Pharmaceutical
- GlaxoSmithKline
- Bristol-Myers Squibb
- Australian Government Department of Health and Ageing
- State of Sao Paulo Research Foundation (FAPESP) Thematic Project Grant [03/00204-3]
- Ministry of Health
- National Center for Public Health Protection
- Shenzhen Bureau of Health
- Shenzhen Bureau of Science, Technology, and Information
- Ministry of Social Protection
- Center for Excellence on Research in Mental Health (CES University)
- Secretary of Health of Medellin
- European Commission [QLG5-1999-01042, SANCO 2004123, EAHC 20081308]
- Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain [FIS 00/0028]
- Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]
- Departament de Salut, Generalitat de Catalunya, Spain
- Instituto de Salud Carlos III [CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP]
- Grant for Research on Psychiatric and Neurological Diseases and Mental Health from Japan Ministry of Health, Labour and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]
- Lebanese Ministry of Public Health
- WHO (Lebanon)
- National Institute of Health/Fogarty International Center [R03 TW006481-01]
- Algorithm
- AstraZeneca
- Benta
- Bella Pharma
- Eli Lilly
- Lundbeck
- Novartis
- OmniPharma
- Pfizer
- Phenicia
- Servier
- UPO
- National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]
- National Council on Science and Technology [CONACyT-G30544-H]
- Pan American Health Organization (PAHO)
- (Mexican) National Council of Science and Technology grant [CB-2010-01-155221]
- New Zealand Ministry of Health
- Alcohol Advisory Council
- Health Research Council
- WHO (Geneva)
- WHO (Nigeria)
- Federal Ministry of Health, Abuja, Nigeria
- Health AMP
- Social Care Research AMP
- Development Division of the Public Health Agency
- National Institute of Health of the Ministry of Health of Peru
- EEA Financial Mechanism [PL 0256]
- Norwegian Financial Mechanism
- Polish Ministry of Health
- Champalimaud Foundation
- Gulbenkian Foundation
- Foundation for Science and Technology (FCT)
- Ministry of Public Health
- Eli Lilly Romania SRL
- US National Institute of Mental Health [R01-MH059575, RO1-MH61905]
- National Institute of Drug Abuse
- South African Department of Health
- University of Michigan
- South African Medical Research Council (MRC)
- Regional Health Authorities of Murcia (Servicio Murciano de Salud)
- Regional Health Authorities of Murcia (Consejeria de Sanidad y Politica Social)
- Fundacion para la Formacion e Investigacion Sanitarias (FFIS) of Murcia
- National Institute of Drug Abuse (NIDA)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Robert Wood Johnson Foundation (RWJF) [044708]
- John W. Alden Trust
Ask authors/readers for more resources
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.
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