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. 2017 Jul 31;15(1):143.
doi: 10.1186/s12916-017-0889-2.

The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative

Dan J Stein  1 , Carmen C W Lim  2   3   4 , Annelieke M Roest  5 , Peter de Jonge  5   6 , Sergio Aguilar-Gaxiola  7 , Ali Al-Hamzawi  8 , Jordi Alonso  9   10   11 , Corina Benjet  12 , Evelyn J Bromet  13 , Ronny Bruffaerts  14 , Giovanni de Girolamo  15 , Silvia Florescu  16 , Oye Gureje  17 , Josep Maria Haro  18 , Meredith G Harris  4   19 , Yanling He  20 , Hristo Hinkov  21 , Itsuko Horiguchi  22 , Chiyi Hu  23 , Aimee Karam  24 , Elie G Karam  24   25   26 , Sing Lee  27 , Jean-Pierre Lepine  28 , Fernando Navarro-Mateu  29 , Beth-Ellen Pennell  30 , Marina Piazza  31   32 , Jose Posada-Villa  33 , Margreet Ten Have  34   35 , Yolanda Torres  36 , Maria Carmen Viana  37 , Bogdan Wojtyniak  38 , Miguel Xavier  39 , Ronald C Kessler  40 , Kate M Scott  2 ; WHO World Mental Health Survey Collaborators
Affiliations

The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative

Dan J Stein et al. BMC Med. .

Abstract

Background: There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis.

Methods: Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates.

Results: SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries.

Conclusions: While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.

Keywords: Cross-national epidemiology; Social anxiety disorder; Social phobia; World Mental Health Survey Initiative.

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Figures

Fig. 1
Fig. 1
Age of onset of SAD by country income level
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