Social anxiety disorder: Current status of prevalence, comorbidity, and impairment

Yıl 2023, Cilt: 7 Sayı: 3, 448 - 467, 25.12.2023

Battal Göktürk Gök Müjgan İnözü

https://doi.org/10.5455/kpd.26024438m000101

Öz

Since the last quarter of the last century, knowledge about the epidemiology of social anxiety disorder (SAD) has continued to expand. Therefore, the present study aimed to present an up-to-date and holistic examination of the prevalence of SAD in the general population in various continents and regions worldwide. Epidemiological studies in databases since 2001 have been extensively searched and 43 community studies have been identified. Lifetime and 12-month prevalence estimates of SAD in community samples in all countries were 5.6% and 2.6%, respectively. In America, Europe, and Oceania countries with relatively high socioeconomic levels, the prevalence of SAD was the highest; in Asia, Africa, and Middle East countries, the prevalence rates were relatively the lowest. It was noteworthy that the age of onset of the disorder was quite early, and it was more common in females than males. At the same time, SAD was associated with worse mental health status and decreased quality of life in various fields—such as family, social relationships, and education. In addition, SAD stands out as a persistent and highly comorbid disorder. Although the prevalence of SAD varies in various epidemiological studies, it has been observed that it is one of the most common anxiety disorders in many studies. It was considered that understanding SAD and initiatives for treatment-seeking behavior will improve considerably with information obtained from the general population—such as the frequency of occurrence, age of onset, and the course of the disorder.

Anahtar Kelimeler

social anxiety disorder, epidemiology, prevalence, comorbidity, impairment, review

Etik Beyan

This does not require Committee approval.

Sosyal Kaygı Bozukluğu: Mevcut yaygınlık, eştanı ve bozulma durumu

Öz

Geçtiğimiz yüzyılın son çeyreğinden bu yana sosyal kaygı bozukluğu (SKB) epidemiyolojisiyle ilgili bilgi birikimi genişlemeye devam etmektedir. Bu nedenle bu çalışmada, dünyanın çeşitli kıta ve bölgelerinde, genel toplum popülasyonunda SKB epidemiyolojisinin güncel ve bütüncül bir incelemesinin sunulması amaçlanmıştır. Veri tabanlarında 2001 yılından günümüze kadar yapılan epidemiyolojik çalışmalar kapsamlı bir şekilde taranmış ve 43 çalışmaya ulaşılmıştır. SKB’nin tüm ülkelerde, toplum örneklemlerinde ortalama yaşam boyu ve 12 ay boyunca görülme sıklığı tahminleri sırasıyla %5.6 ve %2.6 olarak bulunmuştur. Yüksek sosyoekonomik düzeye sahip Amerika, Avrupa ve Okyanusya ülkelerinde bozukluğun görülme sıklığı oranlarının en yüksek düzeyde olduğu; Asya, Afrika ve Orta Doğu ülkelerinde ise oranların görece en az olduğu bulunmuştur. Dünya genelinde, başlangıç yaşının oldukça erken olması ve kadınlarda, erkeklere göre daha fazla görülmesi bir diğer önemli epidemiyolojik özelliktir. Bununla birlikte, SKB kötü seyreden ruhsal sağlık durumu ve çeşitli alanlarda (aile, sosyal ilişkiler, eğitim gibi) azalmış yaşam kalitesiyle ilişkilidir. Ayrıca, SKB ısrarcı ve yüksek düzeyde eştanılı seyreden bir bozukluk olarak ön plana çıkmaktadır. SKB’nin görülme sıklığı çeşitli epidemiyolojik çalışmalarda değişkenlik gösterse de birçok çalışmada en yaygın görülen kaygı bozukluğu türlerinden biri olduğu gözlenmiştir. Genel popülasyondan alınan örneklemlerle elde edilen görülme sıklığı, başlangıç yaşı, bozukluğun seyri ve cinsiyete göre dağılımı gibi bilgilerin, bir kaygı bozukluğu türü olarak SKB’ye yönelik anlayışı ve tedavi arama davranışını artırmaya yönelik girişimleri geliştireceği düşünülmektedir.

Anahtar Kelimeler

sosyal kaygı bozukluğu, epidemiyoloji, görülme sıklığı, eştanı, bozulma, gözden geçirme

Etik Beyan

Etik Kurul onayı gerektiren bir çalışma değildir.

Kaynakça

• Alhasnawi, S., Sadik, S., Rasheed, M., Baban, A., Al-Alak, M. M., Othman, A. Y., ... & Kessler, R. C. (2009). The prevalence and correlates of DSM-IV disorders in the Iraq Mental Health Survey (IMHS). World Psychiatry, 8(2), 97-109.
• Altwaijri, Y. A., Al‐Habeeb, A., Al‐Subaie, A. S., Bilal, L., Al‐Desouki, M., Shahab, M. K., ... & Kessler, R. C. (2020a). Twelve‐month prevalence and severity of mental disorders in the Saudi National Mental Health Survey. International Journal of Methods in Psychiatric Research, 29(3), e1831.
• Altwaijri, Y. A., Al‐Subaie, A. S., Al‐Habeeb, A., Bilal, L., Al‐Desouki, M., Aradati, M., ... & Kessler, R. C. (2020b). Lifetime prevalence and age‐of‐onset distributions of mental disorders in the Saudi National Mental Health Survey. International Journal of Methods in Psychiatric Research, 29(3), e1836.
• American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (Fifth ed.) [text revision]. American Psychiatric Association.
• Andrade, L., Walters, E. E., Gentil, V., & Laurenti, R. (2002). Prevalence of ICD-10 mental disorders in a catchment area in the city of São Paulo, Brazil. Social psychiatry and Psychiatric Epidemiology, 37(7), 316-325.
• Angst, J., Gamma, A., Neuenschwander, M., Ajdacic-Gross, V., Eich, D., Rössler, W., & Merikangas, K. R. (2005). Prevalence of mental disorders in the Zurich Cohort Study: A twenty year prospective study. Epidemiology and Psychiatric Sciences, 14(2), 68-76.
• Angst, J., Paksarian, D., Cui, L., Merikangas, K. R., Hengartner, M. P., Ajdacic-Gross, V., & Rössler, W. (2015). The epidemiology of common mental disorders from age 20 to 50: Results from the prospective Zurich cohort Study. Epidemiology and Psychiatric Sciences, 25(1), 24-32.
• Arch, J. J., Twohig, M. P., Deacon, B. J., Landy, L. N., & Bluett, E. J. (2015). The credibility of exposure therapy: Does the theoretical rationale matter?. Behaviour Research and Therapy, 72, 81-92.
• Asnaani, A., Richey, J. A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. The Journal of Nervous and Mental Disease, 198(8), 551-555.
• Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Höfler, M., Lieb, R., & Wittchen, H. U. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64(8), 903-912.
• Bromet, E. J., Gluzman, S. F., Paniotto, V. I., Webb, C. P., Tintle, N. L., Zakhozha, V., ... & Schwartz, J. E. (2005). Epidemiology of psychiatric and alcohol disorders in Ukraine. Social Psychiatry and Psychiatric Epidemiology, 40(9), 681-690.
• Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., ... & Keller, M. B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162(6), 1179-1187.
• Bujang, M. A., Sa’at, N., & Bakar, T. M. I. T. A. (2017). Determination of minimum sample size requirement for multiple linear regression and analysis of covariance based on experimental and non-experimental studies. Epidemiology, Biostatistics, and Public Health, 14(3), 1-9.
• Bunting, B. P., Murphy, S. D., O'neill, S. M., & Ferry, F. R. (2012). Lifetime prevalence of mental health disorders and delay in treatment following initial onset: Evidence from the Northern Ireland Study of Health and Stress. Psychological Medicine, 42(8), 1727-1739.
• Bunting, B., Murphy, S., O’Neill, S., & Ferry, F. (2013). Prevalence and treatment of 12-month DSM-IV disorders in the Northern Ireland study of health and stress. Social Psychiatry and Psychiatric Epidemiology, 48(1), 81-93.
• Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample. Journal of Affective Disorders, 80(2-3), 163-171.
• Cho, M. J., Chang, S. M., Lee, Y. M., Bae, A., Ahn, J. H., Son, J., ... & Park, J. I. (2010). Prevalence of DSM-IV major mental disorders among Korean adults: A 2006 National Epidemiologic Survey (KECA-R). Asian Journal of Psychiatry, 3(1), 26-30.
• Cho, M. J., Kim, J. K., Jeon, H. J., Suh, T., Chung, I. W., Hong, J. P., ... & Lee, C. K. (2007). Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults. The Journal of Nervous and Mental Disease, 195(3), 203-210.
• Cía, A. H., Stagnaro, J. C., Aguilar Gaxiola, S., Vommaro, H., Loera, G., Medina-Mora, M. E., ... & Kessler, R. C. (2018). Lifetime prevalence and age-of-onset of mental disorders in adults from the Argentinean Study of Mental Health Epidemiology. Social Psychiatry and Psychiatric Epidemiology, 53(4), 341-350.
• Dalrymple, K. L., & Zimmerman, M. (2011a). Age of onset of social anxiety disorder in depressed outpatients. Journal of Anxiety Disorders, 25(1), 131-137.
• Dalrymple, K. L., & Zimmerman, M. (2011b). Treatment-seeking for social anxiety disorder in a general outpatient psychiatry setting. Psychiatry Research, 187(3), 375-381.
• De Girolamo, G., Polidori, G., Morosini, P., Scarpino, V., Reda, V., Serra, G., ... & Falsirollo, F. (2006). Prevalence of common mental disorders in Italy. Social Psychiatry and Psychiatric Epidemiology, 41(11), 853-861.
• De Graaf, R., Ten Have, M., van Gool, C., & van Dorsselaer, S. (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology, 47(2), 203-213.
• De Lijster, J. M., Dieleman, G. C., Utens, E. M., Dierckx, B., Wierenga, M., Verhulst, F. C., & Legerstee, J. S. (2018). Social and academic functioning in adolescents with anxiety disorders: A systematic review. Journal of Affective Disorders, 230, 108-117.
• Faravelli, C., Abrardi, L., Bartolozzi, D., Cecchi, C., Cosci, F., D’Adamo, D., ... & Prodi, P. M. R. (2004a). The Sesto Fiorentino study: Point and one-year prevalences of psychiatric disorders in an Italian community sample using clinical interviewers. Psychotherapy and Psychosomatics, 73(4), 226-234.
• Faravelli, C., Abrardi, L., Bartolozzi, D., Cecchi, C., Cosci, F., D’Adamo, D., ... & Rosi, S. (2004b). The Sesto Fiorentino Study: Background, methods and preliminary results. Psychotherapy and Psychosomatics, 73(4), 216-225.
• Faravelli, C., Zucchi, T., Viviani, B., Salmoria, R., Perone, A., Paionni, A., ... & Bartolozzi, D. (2000). Epidemiology of social phobia: a clinical approach. European Psychiatry, 15(1), 17-24.
• Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257-265.
• Gilbert, P. (2001). Evolution and social anxiety: The role of attraction, social competition, and social hierarchies. Psychiatric Clinics, 24(4), 723-751.
• Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., Goldstein, R. B., . . . Huang, B. (2005). The Epidemiology of Social Anxiety Disorder in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 66(11), 1351-1361.
• Gureje, O., Lasebikan, V. O., Kola, L., & Makanjuola, V. A. (2006). Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. The British Journal of Psychiatry, 188(5), 465-471.
• Heimberg, R. G., Hofmann, S. G., Liebowitz, M. R., Schneier, F. R., Smits, J. A., Stein, M. B., Hinton, D. E., & Craske, M. G. (2014). Social anxiety disorder in DSM-5. Depression and Anxiety, 31(6), 472–479.
• Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45(2), 91-113.
• Huang, Y., Wang, Y., Wang, H., Liu, Z., Yu, X., Yan, J., ... & Wang, Z. (2019). Prevalence of mental disorders in China: A cross-sectional epidemiological study. The Lancet Psychiatry, 6(3), 211-224.
• Ishikawa, H., Kawakami, N., Kessler, R. C., & World Mental Health Japan Survey Collaborators. (2016). Lifetime and 12-month prevalence, severity and unmet need for treatment of common mental disorders in Japan: Results from the final dataset of World Mental Health Japan Survey. Epidemiology and Psychiatric Sciences, 25(3), 217-229.
• Karam, E. G., Mneimneh, Z. N., Dimassi, H., Fayyad, J. A., Karam, A. N., Nasser, S. C., ... & Kessler, R. C. (2008). Lifetime prevalence of mental disorders in Lebanon: First onset, treatment, and exposure to war. PLoS Med, 5(4), e61.
• Karam, E. G., Mneimneh, Z. N., Karam, A. N., Fayyad, J. A., Nasser, S. C., Chatterji, S., & Kessler, R. C. (2006). Prevalence and treatment of mental disorders in Lebanon: A national epidemiological survey. The Lancet, 367(9515), 1000-1006.
• Kawakami, N., Takeshima, T., Ono, Y., Uda, H., Hata, Y., Nakane, Y., ... & Kikkawa, T. (2005). Twelve‐month prevalence, severity, and treatment of common mental disorders in communities in Japan: Preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry and Clinical Neurosciences, 59(4), 441-452.
• Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
• Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.
• Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169-184.
• Kiejna, A., Piotrowski, P., Adamowski, T., Moskalewicz, J., Wciorka, J., Stokwiszewski, J., … & Kessler, R. C. (2015). The prevalence of common mental disorders in the population of adult Poles by sex and age structure – an EZOP Poland study. Psychiatra Polska, 49(1), 15-27.
• Kringlen, E., Torgersen, S., & Cramer, V. (2001). A Norwegian psychiatric epidemiological study. American Journal of Psychiatry, 158(7), 1091-1098.
• Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317-325.
• MacKenzie, M. B., & Fowler, K. F. (2013). Social anxiety disorder in the Canadian population: Exploring gender differences in sociodemographic profile. Journal of Anxiety Disorders, 27(4), 427-434.
• Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.
• Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., ... & Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of General Psychiatry, 68(3), 241-251.
• McEvoy, P. M., Grove, R., & Slade, T. (2011). Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 45(11), 957-967.
• McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027-1035.
• Medina-Mora, M. E., Borges, G., Lara, C., Benjet, C., Blanco, J., Fleiz, C., ... & Zambrano, J. (2005). Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: Results from the Mexican National Comorbidity Survey. Psychological Medicine, 35(12), 1773-1783.
• Merikangas, K. R., Avenevoli, S., Acharyya, S., Zhang, H., & Angst, J. (2002). The spectrum of social phobia in the Zurich cohort study of young adults. Biological Psychiatry, 51(1), 81-91.
• Oakley Browne, M. A., Elisabeth Wells, J., Scott, K. M., Mcgee, M. A., & New Zealand Mental Health Survey Research Team. (2006). Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Rau Hinengaro: The New Zealand Mental Health Survey. Australian & New Zealand Journal of Psychiatry, 40(10), 865-874.
• Pelissolo, A., Abou Kassm, S., & Delhay, L. (2019). Therapeutic strategies for social anxiety disorder: where are we now?. Expert Review of Neurotherapeutics, 19(12), 1179-1189.
• Pirkola, S. P., Isometsä, E., Suvisaari, J., Aro, H., Joukamaa, M., Poikolainen, K., ... & Lönnqvist, J. K. (2005). DSM-IV mood-, anxiety-and alcohol use disorders and their comorbidity in the Finnish general population. Social Psychiatry and Psychiatric Epidemiology, 40(1), 1-10.
• Scaini, S., Belotti, R., & Ogliari, A. (2014). Genetic and environmental contributions to social anxiety across different ages: A meta-analytic approach to twin data. Journal of Anxiety Disorders, 28(7), 650-656.
• Schneier, F. R., Foose, T. E., Hasin, D. S., Heimberg, R. G., Liu, S. M., Grant, B. F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder comorbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 40(6), 977-988.
• Sharifi, V., Amin-Esmaeili, M., Hajebi, A., Motevalian, A., Radgoodarzi, R., Hefazi, M., & Rahimi-Movaghar, A. (2015). Twelve-month prevalence and correlates of psychiatric disorders in Iran: The Iranian Mental Health Survey, 2011. Archives of Iranian Medicine, 18(2), 76-84.
• Shen, Y. C., Zhang, M. Y., Huang, Y. Q., He, Y. L., Liu, Z. R., Cheng, H., ... & Kessler, R. C. (2006). Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychological Medicine, 36(2), 257-267.
• Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. The Canadian Journal of Psychiatry, 51(2), 100-113.
• Stagnaro, J. C., Cía, A. H., Aguilar Gaxiola, S., Vázquez, N., Sustas, S., Benjet, C., & Kessler, R. C. (2018). Twelve-month prevalence rates of mental disorders and service use in the Argentinean Study of Mental Health Epidemiology. Social Psychiatry and Psychiatric Epidemiology, 53(2), 121-129.
• Stein, D. J., Lim, C. C., Roest, A. M., De Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., ... & De Girolamo, G. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15(1), 143.
• Stein, M. B., Fuetsch, M., Müller, N., Höfler, M., Lieb, R., & Wittchen, H. U. (2001). Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults. Archives of General Psychiatry, 58(3), 251-256.
• Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371(9618), 1115-1125.
• Tobias, M. R., Landy, L. N., Levin, M. E., & Arch, J. J. (2021). A Randomized Trial of Brief Online Interventions to Facilitate Treatment Seeking for Social Anxiety. Behavior Modification, 1-30.
• Vicente, B., Kohn, R., Rioseco, P., Saldivia, S., Levav, I., & Torres, S. (2006). Lifetime and 12-month prevalence of DSM-III-R disorders in the Chile psychiatric prevalence study. American Journal of Psychiatry, 163(8), 1362-1370.
• Vorcaro, C. M. R., Rocha, F. L., Uchoa, E., & Lima-Costa, M. F. (2004). The burden of social phobia in a Brazilian community and its relationship with socioeconomic circumstances, health status and use of health services: the Bambui study. International Journal of Social Psychiatry, 50(3), 216-226.
• Wells, J. E., Oakley Browne, M. A., Scott, K. M., McGee, M. A., Baxter, J., & Kokaua, J. (2006). Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: The New Zealand Mental Health Survey. Australian & New Zealand Journal of Psychiatry, 40(10), 845-854.
• Williams, D. R., Herman, A., Stein, D. J., Heeringa, S. G., Jackson, P. B., Moomal, H., & Kessler, R. C. (2008). Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychological Medicine, 38(2), 211-220.
• Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., … Steinhausen, H. C. (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21(9), 655–679.
• Wong, Q. J., & Rapee, R. M. (2016). The aetiology and maintenance of social anxiety disorder: A synthesis of complementary theoretical models and formulation of a new integrated model. Journal of Affective Disorders, 203, 84-100.