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Subtyping social anxiety disorder in developed and developing countries
Author(s) -
Stein Dan J.,
Ruscio Ayelet Meron,
Lee Sing,
Petukhova Maria,
Alonso Jordi,
Andrade Laura Helena S.G.,
Benjet Corina,
Bromet Evelyn,
Demyttenaere Koen,
Florescu Silvia,
de Girolamo Giovanni,
de Graaf Ron,
Gureje Oye,
He Yanling,
Hinkov Hristo,
Hu Chiyi,
Iwata Noboru,
Karam Elie G.,
Lepine JeanPierre,
Matschinger Herbert,
Oakley Browne Mark,
PosadaVilla Jose,
Sagar Rajesh,
Williams David R.,
Kessler Ronald C.
Publication year - 2010
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.20639
Subject(s) - library science , psychiatry , medicine , sociology , computer science
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. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.