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Disability and quality of life in pure and comorbid social phobia – Findings from a controlled study

Published online by Cambridge University Press:  16 April 2020

HU Wittchen ,
M Fuetsch ,
H Sonntag ,
N Müller  and
M Liebowitz
HU Wittchen
Affiliation:
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology, München, Germany
M Fuetsch
Affiliation:
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology, München, Germany
H Sonntag
Affiliation:
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology, München, Germany
N Müller
Affiliation:
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology, München, Germany
M Liebowitz
Affiliation:
New York State Psychiatric Institute, New York, USA
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Summary

Social phobia is increasingly recognized as a prevalent and socially impairing mental disorder. However, little data is available regarding the general and disease-specific impairments and disabilities associated with social phobia. Furthermore, most studies have not controlled for the confounding effects of comorbid conditions.

This study investigates: (a) the generic quality of life; (b) work productivity; and, (c) various other disorder-specific social impairments in current cases with pure (n = 65), comorbid (n = 51) and subthreshold (n = 34) DSM-IIIR social phobia as compared to controls with no social phobia (subjects with a history of herpes infections).

Social phobia cases reported a mean illness duration of 22.9 years with onset in childhood or adolescence. Current quality of life, as assessed by the SF-36, was significantly reduced in all social phobia groups, particularly in the scales measuring vitality, general health, mental health, role limitations due to emotional health, and social functioning. Comorbid cases revealed more severe reductions than pure and subthreshold social phobics. Findings from the Liebowitz self-rated disability scale indicated that: (a) social phobia affects most areas of life, but in particular education, career, and romantic relationship; (b) the presence of past and current comorbid conditions increases the frequency of disease-specific impairments; and, (c) subthreshold social phobia revealed slightly lower overall impairments than comorbid social phobics. Past week work productivity of social phobics was significantly diminished as indicated by: (a) a three-fold higher rate of unemployed cases; (b) elevated rates of work hours missed due to social phobia problems; and, (c) a reduced work performance.

Overall, these findings underline that social phobia in our sample of adults, whether comorbid, subthreshold, or pure was a persisting and impairing condition, resulting in considerable subjective suffering and negative impact on work performance and social relationships. The current disabilities and impairments were usually less pronounced than in the past, presumably due to adaptive behaviors in life style of the respondents. Data also confirmed that social phobia is poorly recognized and rarely treated by the mental health system.

Keywords

social phobiacomorbidsocial phobiasocial anxiety disorder
Type
Original Articles
Information
European Psychiatry , Volume 14 , Issue 3 , June 1999 , pp. 118 - 131
Copyright
Copyright © European Psychiatric Association 1999

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References

Wittchen, HU, Stein, HB, Kessler, RCSocial fears and social phobia in a community sample of adolescents and young adults: prelavence, risk factors, and comorbidity. Psychol Med 1999 ; 29 : 309–323.CrossRefGoogle Scholar
Angst, J, Vollrath, M, Merikangas, KR, Ernst, CComorbidity of anxiety and depression in the Zurich cohort study of young adults In: Maser, JD, Cloninger, CR eds. Comorbidity of mood and anxiety disorders 1990 Washington DC: Am Psychiatr Press 123–153.Google Scholar
Wittchen, HU, Essau, CA, Zerssen, D, vonKrieg, CJ, Zaudig, MLifetime and six-month prevalence of mental disorders in the Munich follow-up study. Eur Arch Psychiatry Clin Neurosci 1992 ; 241 : 247–258.CrossRefGoogle ScholarPubMed
Wacker, HR, Müllejans, R, Klein, KH, Battegay, RIdentification of cases of anxiety disorders and affective disorders in the community according to ICD-10 and DSM-III-R by using the composite international diagnostic interview (CIDI). Int J Meth Psychiatr Res 1992 ; 2 : 91–100.Google Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HULifetime 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 : 8–19.CrossRefGoogle ScholarPubMed
Magee, WJ, Eaton, WW, Wittchen, HU, McGonagle, KA, Kessler, RCAgoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996 ; 53 : 159–168.CrossRefGoogle ScholarPubMed
Davidson, JR, Hughes, DC, George, LK, Blazer, DGThe boundary of social phobia Exploring the threshold. Arch Gen Psychiatry 1994 ; 51 : 975–983.CrossRefGoogle ScholarPubMed
Liebowitz, MR, Gorman, JM, Fyer, AJ, Klein, DFSocial phobia: review of a neglected anxiety disorder. Arch Gen Psychiatry 1985 ; 42 : 729–736.CrossRefGoogle ScholarPubMed
Mullaney, JA, Trippet, CJAlcohol dependence and phobias: clinical description and relevance. Br J Psychiatry 1979 ; 135 : 565–573.CrossRefGoogle ScholarPubMed
Borden, KHSocial phobia: an overview of treatment strategies. J Clin Psychiatry 1993 ; 54 : 165–171.Google Scholar
Merikangas, K, Angst, J, Eaton, W, Canino, G, Rubio-Stipec, M, Wacker, HComorbidity and boundaries of affective disorders with anxiety disorders and substance abuse: results of an international task force. Br J Psychiatry 1996 ; 168 Suppl 30 : 49–58.CrossRefGoogle Scholar
World Health Organization Composite international diagnostic interview (CIDI): a) CIDI-interview (version 1 0), b) CIDI-user manual, c) CIDI-training manual, d) CIDI-computer programs 1990 Geneva: World Health OrganizationGoogle Scholar
Wittchen, HU, Semler, GComposite international diagnostic interview (CIDI, version 1 0) 1990 Weinheim: Beltz VerlagGoogle Scholar
Semler, G, Wittchen, HU, Joschke, K, Zaudig, M, Geiso, T, Kaiser, STest-retest reliability of a standardized psychiatric interview (DIS/CIDI). Eur Arch Psychiatry Neuro Sci 1987 ; 236 : 214–222.CrossRefGoogle Scholar
Wittchen, HU, Robins, LN, Cottler, L, Sartorius, N, Burke, J, Regier, DCross-cultural feasibility, reliability and sources of variance of the composite international diagnostic interview (CIDI) Results of the multicenter WHO/ADAMHA field trials (wave I). Br J Psychiatry 1991 ; 159 : 645–653.CrossRefGoogle Scholar
Wittchen, HUReliability and validity studies of the WHO-composite international diagnostic interview (CIDI): a critical review. J Psychiatr Res 1994 ; 28 : 57–84.CrossRefGoogle ScholarPubMed
Wittchen, HU, Zhao, S, Abelson, JM, Abelson, JL, Kessler, RCReliability and procedural validity of CIDI DSM-III-R phobic disorders. Psychol M 1999in pressGoogle Scholar
Ware, JE, Sherbourne, CDThe MOS 36-item short form health survey (SF-36) I Conceptual framework and item selection. Med Care 1992 ; 30 : 473–483.CrossRefGoogle ScholarPubMed
McHorney, CA, Ware, JE, Raczek, AEThe MOS 36-item short form health survey (SF-36): II Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993 ; 31 : 247–263.CrossRefGoogle ScholarPubMed
Brazier, JE, Harper, R, Jones, NM, O'Cathain, A, Thomas, KJ, Usherwood, TValidating the SF-36 health survey questionnaire: new outcome measure for primary care. Br Med J 1992 ; 305 : 160–164.CrossRefGoogle ScholarPubMed
McHorney, CA, Ware, JE, Rogers, W, Raczek, AE, Lu, JFThe validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts Results from the medical outcomes study. Med Care 1992 ; 30 5 Suppl : 253–265.CrossRefGoogle Scholar
Bullinger M, Kirchberger I, Ware J The German SF-36 health survey Translation and psychometric testing of a generic instrument for the assessment of health-related quality of life, unpublishedGoogle Scholar
Schneier, FR, Heckelman, LR, Garfinkel, R, Campeas, R, Fallon, BA, Gitow, AFunctional impairment of social phobia. J Clin Psychiatry 1994 ; 55 : 322–331.Google ScholarPubMed
Reilly, MC, Zbrozek, AS, Dukes, EMThe validity and reproducibility of a work productivity and impairment instrument. PharmacoEconomics 1993 ; 4 : 353–365.CrossRefGoogle ScholarPubMed
Tarlov, AR, Ware, JE, Greenfield, SThe medical outcomes study: an application of methods for monitoring the results of medical care. JAMA 1989 ; 262 : 925–930.CrossRefGoogle ScholarPubMed
Jugend-Gesundheit, Schwerpunktbericht im Rahmen der Gesundheitsberichterstattung des Gesundheitsreferates der Landeshauptstadt München 1997 MünchenGoogle Scholar
Weiller, I, Bisserbe, JC, Bauer, P, Lepine, JP, Lecrubier, YSocial phobia in general health care An unrecognized, untreated disabiliting disorder. Br J Psychiatry 1996 ; 168 : 169–174.CrossRefGoogle Scholar
Safren, SA, Heimberg, RG, Brown, EJ, Holle, CQuality of life in social phobia. Depression Anxiety 1997 ; 4 : 126–133.3.0.CO;2-E>CrossRefGoogle Scholar
Kessler, RC, Stang, P, Wittchen, HU, Stein, M, Walters, EELifetime comorbidities between social phobia and mood disorders in the US national comorbidity survey. Psychol M 1999in pressCrossRefGoogle ScholarPubMed
Wittchen, HU, Beloch, EThe impact of social phobia on quality of life. Ont Clin Psychopharmacol 1996 ; 11 Suppl 3 : 15–23.CrossRefGoogle ScholarPubMed
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