Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T00:01:43.109Z Has data issue: false hasContentIssue false
  • English
  • Français

Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades

Published online by Cambridge University Press:  16 April 2020

R.G. Heimberg ,
M.B. Stein ,
E. Hiripi  and
R.C. Kessler
R.G. Heimberg
Affiliation:
Department of Psychology, Temple University,Philadelphia, PA, USA
M.B. Stein
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
E. Hiripi
Affiliation:
Department of Health Care Policy, Harvard Medical School,Boston, MA, USA
R.C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School,Boston, MA, USA
Get access

Summary

Previous analysis of data from the U.S. National Comorbidity Survey (NCS) suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

Keywords

anxietyepidemiologyprevalencesocial phobia
Type
Original article
Information
European Psychiatry , Volume 15 , Issue 1 , 2000 , pp. 29 - 37
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. revis 1987 Washington, DC: APAGoogle Scholar
Blazer, D.G.Kessler, R.C.McGonagle, K.A.Swartz, M.S.The prevalence and distribution of major depression in the National Comorbidity Survey. Am J Psychiatry 1994; 151: 979–986Google ScholarPubMed
Brown, E.J.Heimberg, R.G.Juster, H.R.Social phobia subtype and avoidant personality disorder: effect on severity of social phobia, impairment, and outcome of cognitive-behavioral treatment. Behav Ther 1995; 26: 467–486CrossRefGoogle Scholar
Chartier, M.J.Hazen, A.L.Stein, M.B.Lifetime patterns of social phobia: a retrospective study of the course of social phobia in a nonclinical population. Depression and Anxiety 1998; 7: 113–1213.0.CO;2-C>CrossRefGoogle Scholar
Davidson, J.R.T.Hughes, D.C.George, L.K.Blazer, D.G.The boundary of social phobia: exploring the threshold. Arch Gen Psychiatry 1994; 51: 975–983CrossRefGoogle ScholarPubMed
Davidson, J.R.T.Hughes, D.L.George, L.K.Blazer, D.G.The epidemiology of social phobia: findings from the Duke epidemiological catchment area study. Psychol M 1993; 23: 709–718CrossRefGoogle ScholarPubMed
Efron, B.Logistic regression, survival analysis, and the Kaplan-Meier Curve. J Am Soc Assoc 1988; 83: 414–425CrossRefGoogle Scholar
Gelernter, C.S.Stein, M.B.Tancer, M.E.Uhde, T.W.An examination of syndromal validity and diagnostic subtypes in social phobia and panic disorder. J Clin Psychiatry 1992; 53: 23–27Google ScholarPubMed
Giuffra, L.A.Risch Diminished recall and the cohort effect of major depression: A simulation study Psychol M 1994; 24: 375–383CrossRefGoogle ScholarPubMed
Heimberg, R.G.Fresco, D.M.Travers, J.Stein, M.B.Liebowitz, M.R.Social phobia or social anxiety disorder: What’s in a name? Arch Gen Psychiatry in pressGoogle Scholar
Heimberg, R.G.Holt, C.S.Schneier, F.R.Spitzer, R.E.Liebowitz, M.R.The issue of subtypes in the diagnosis of social phobia. J Anx Dis 1993; 7: 249–269CrossRefGoogle Scholar
Holt, C.S.Heimberg, R.G.Hope, D.A.Avoidant personality disorder and the generalized subtype in social phobia. J Abnormal Psychol 1992; 101: 318–325CrossRefGoogle ScholarPubMed
Holt, C.S.Heimberg, R.G.Hope, D.A.Liebowitz, M.R.Situational domains of social phobia. J Anx Dis 1992; 6: 63–7710.1016/0887-6185(92)90027-5CrossRefGoogle Scholar
Kaplan, E.L.Meier, P.Nonparametric estimation from incomplete observations. J Am Statistical Assoc 1958; 53: 281–284CrossRefGoogle Scholar
Kessler, R.C.The prevalence of psychiatric comorbidity.Wetzler, SSanderson, W.CTreatment strategies for patients with psychiatric comorbidity. 1997 New York: John Wiley & Sons 23–48Google Scholar
Kessler, R.C.Epidemiology of psychiatric comorbidity.Tsuang, M.TTohen, MZahner, G.E.PTextbook in psychiatric epidemiology. 1995 New York: John Wiley and Sons 179–197Google Scholar
Kessler, R.C.Crum, R.M.Warner, L.A.Nelson, C.B.Schulenberg, J.Anthony, J.C.The lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997; 54: 313–321CrossRefGoogle ScholarPubMed
Kessler, R.C.Little, R.J.A.Groves, R.M.Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiol Rev 1995; 17: 192–204CrossRefGoogle ScholarPubMed
Kessler, R.C.McGonagle, K.A.Nelson, C.B.Hughes, M.Swartz, M.Blazer, D.G.Sex and depression in the National Comorbidity Survey: II. cohort effects. J Affect Disord 1994; 30: 15–26CrossRefGoogle ScholarPubMed
Kessler, R.C.McGonagle, K.A.Zhao, S.Nelson, C.B.Hughes, M.Eshleman, S. et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8–19CrossRefGoogle ScholarPubMed
Kessler, R.C.Stein, M.B.Berglund, P.Social phobia subtypes in the National Comorbidity Survey. Am J Psychiatry 1998; 155: 613–619CrossRefGoogle ScholarPubMed
Kish, L.Frankel, M.D.Inferences from complex samples. J Am Stat Assoc 1970; 65: 1071–1094CrossRefGoogle Scholar
Lazarsfeld, P.R.Henry, N.W.Latent structure analysis. 1968 Boston: Houghton-MifflinGoogle Scholar
Magee, W.J.Eaton, W.W.Wittchen, H.U.McGonagle, K.A.Kessler, R.C.Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53: 159–16810.1001/archpsyc.1996.01830020077009CrossRefGoogle ScholarPubMed
Mannuzza, S.Schneier, F.R.Chapman, T.F.Liebowitz, M.R.Klein, D.F.Fyer, A.J.Generalized social phobia: reliability and validity. Arch Gen Psychiatry 1995; 52: 230–237CrossRefGoogle ScholarPubMed
McCutcheon, A.L.Latent class analysis. 1987 Newbury Park, CA: Sage PublicationsCrossRefGoogle Scholar
Reich, J.Goldenberg, I.Goisman, R.Vasile, R.Keller, M.A prospective follow-along study of the course of social phobia: II. Testing for basic predictors of course. J Nerv Ment Dis 1994; 182: 297–301CrossRefGoogle Scholar
Reich, J.Goldenberg, I.Vasile, R.Goisman, R.Keller, M.A prospective follow-along study of the course of social phobia. Psychiatry Res 1994; 54: 249–258CrossRefGoogle ScholarPubMed
Safren, S.A.Heimberg, R.G.Brown, E.J.Holle, C.Quality of life in social phobia. Depress Anx 1997; 4: 126–13310.1002/(SICI)1520-6394(1996)4:3<126::AID-DA5>3.0.CO;2-E3.0.CO;2-E>CrossRefGoogle Scholar
Schneier, F.R.Heckelman, L.R.Garfinkel, R.Campeas, R.Fallon, B.A.Gitow, A. et al. Functional impairment in social phobia. J Clin Psychiatry 1994; 55: 322–331Google ScholarPubMed
Schneier, F.R.Johnson, J.Hornig, C.Liebowitz, M.Weissman, M.Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 1992; 49: 282–288CrossRefGoogle Scholar
Spitzer, R.L.Williams, J.B.W.Gibbon, M.First, M.B.The Structured Clinical Interview for DSM-III-R (SCID). I. history, rationale, and description. Arch Gen Psychiatry 1992; 49: 624–629CrossRefGoogle ScholarPubMed
Stein, M.B.Walker, J.R.Forde, D.R.Public speaking fears in a community sample: prevalence, impact on functioning, and diagnostic classification. Arch Gen Psychiatry 1996; 53: 169–174CrossRefGoogle Scholar
Stein, M.B.Walker, J.R.Forde, D.R.Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety. Am J Psychiatry 1994; 151: 408–412Google ScholarPubMed
Turner, S.M.Beidel, D.C.Townsley, R.M.Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder. J Abnorm Psychol 1992; 101: 326–331CrossRefGoogle ScholarPubMed
Warner, L.A.Kessler, R.C.Hughes, M.Anthony, J.C.Nelson, C.B.Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52: 219–229CrossRefGoogle ScholarPubMed
Weissman, M.M.Klerman, G.L.Depression: current understanding and changing trends. Annu Rev Public Health 1992; 13: 319–33910.1146/annurev.pu.13.050192.001535CrossRefGoogle ScholarPubMed
Wittchen, H.U.Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 1994; 28: 57–84CrossRefGoogle ScholarPubMed
Wittchen, H.U.Kessler, R.C.Zhao, S.Abelson, J.Reliablity and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder. J Psychiatric Res 1995; 29: 95–110CrossRefGoogle Scholar
Wittchen, H.U.Zhao, S.Abelson, J.M.Abelson, J.L.Kessler, R.C.Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders. Psychol M 1996; 26: 1169–1177CrossRefGoogle ScholarPubMed
World Health Organization Composite International Diagnostic Interview (CIDI, Version 1.0.). 1990 Geneva, Switzerland: World Health OrganizationGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.