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-MasfetySing 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, Graça Cardoso, Somnath Chatterji, Louisa Degenhardt, Koen Demyttenaere, Hristo Hinkov, Aimee Nasser Karam, Jean Pierre Lepine, Daphna Levinson, John McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Beth Ellen Pennell, Jose Posada-Villa, Tim Slade, Juan Carlos Stagnaro, Dan J. Stein, Harvey Whiteford, David R. Williams, Bogdan Wojtyniak

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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
Article number101
JournalBMC Medicine
Issue number1
StatePublished - 24 May 2019


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


Dive into the research topics of 'Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: Results from the World Mental Health Surveys'. Together they form a unique fingerprint.

Cite this