TY - JOUR
T1 - Subtyping social anxiety disorder in developed and developing countries
AU - Stein, Dan J.
AU - Ruscio, Ayelet Meron
AU - Lee, Sing
AU - Petukhova, Maria
AU - Alonso, Jordi
AU - Andrade, Laura Helena S.G.
AU - Benjet, Corina
AU - Bromet, Evelyn
AU - Demyttenaere, Koen
AU - Florescu, Silvia
AU - De Girolamo, Giovanni
AU - De Graaf, Ron
AU - Gureje, Oye
AU - He, Yanling
AU - Hinkov, Hristo
AU - Hu, Chiyi
AU - Iwata, Noboru
AU - Karam, Elie G.
AU - Lepine, Jean Pierre
AU - Matschinger, Herbert
AU - Browne, Mark Oakley
AU - Posada-Villa, Jose
AU - Sagar, Rajesh
AU - Williams, David R.
AU - Kessler, Ronald C.
PY - 2010/4
Y1 - 2010/4
N2 - Background: Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful. Methods: The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. Results: Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. Conclusion: No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.
AB - Background: Although social anxiety disorder (SAD) is classified in the fourth edition of The Diagnostic and Statistical Manual (DSM-IV) into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful. Methods: The World Health Organization's World Mental Health Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries, using the Composite International Diagnostic Interview to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. Results: Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. Conclusion: No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.
KW - Epidemiology
KW - Social anxiety disorder
KW - Social phobia
KW - Subtype
UR - http://www.scopus.com/inward/record.url?scp=77953606301&partnerID=8YFLogxK
U2 - 10.1002/da.20639
DO - 10.1002/da.20639
M3 - Article
C2 - 20037919
AN - SCOPUS:77953606301
SN - 1091-4269
VL - 27
SP - 390
EP - 403
JO - Depression and Anxiety
JF - Depression and Anxiety
IS - 4
ER -