هراس اجتماعی و افسردگی: شیوع و همبودی

Background Social phobia may seriously impair the functioning of affected individuals. It is frequently associated with other mental disorders. Aims To estimate the co-occurrence of social phobia with major depressive disorder (MDD) and to analyze their interaction. Method Subjects were 18,980 individuals, aged 15 years or older, representative of the general population of the United Kingdom, Germany, Italy, Spain and Portugal, who were interviewed by telephone. DSM-IV diagnoses were made with the Sleep-EVAL system. Results The point prevalence for social phobia was 4.4% (95% confidence interval: 4.1–4.7%) of the sample. It was higher in women (odds ratio: 1.6) and decreased with age. MDDs were found in 19.5% of participants with social phobia. Co-occurrence of another anxiety disorder was high and increased when a MDD was present (65.2%). The odds of developing a major depressive episode 2 years after the appearance of the social phobia was of 5.74. Conclusions Social phobia is highly prevalent in the general population. It increases the risk of developing a MDD and has a high comorbidity with other mental disorders. Social phobia is often present in the course of depression, more obviously during remission period of MDD. Physicians must explore and treat more systematically this frequent pathology.

Social phobia is an anxiety disorder fairly common in the general population. In its more severe forms, the disorder has important repercussions in the daily life of the individuals. Since its introduction in the DSM-III, prevalence of social phobia was provided in more than 30 community-based surveys around the world [1]. Studies based on DSM-III classification reported 1-month prevalence ranging between 0.5% and 1.3% and lifetime prevalence between 1% and 8% [2], [3], [4], [5], [6], [7] and [8]. Studies based on the DSM-III-R classification found 1-month prevalence between 2% and 7%, 12-month prevalence between 4.8% and 11.1%, and lifetime prevalence between 4.0% and 16% [9], [10], [11], [12], [13] and [14]. Prevalences based on DSM-IV classification show a one-month prevalence between 1.6% and 15.6%, 12-month prevalence between 1.2% and 7.2% and lifetime prevalence between 2.3% and 7.3% [15], [16], [17], [18], [19], [20] and [21]. Divergences between the reported prevalences are based primarily on three points: 1. The evolution of the DSM classification, especially between the DSM-III and its revision. Social phobia criteria remained roughly the same between DSM-III-R and DSM-IV. 2. The diagnostic threshold was rarely the same from one study to another. The level of interference in psychosocial functioning or distress varied between studies ranging from nearly non-existent to severe impairment. Studies that used different thresholds showed that small variations influenced the prevalence. 3. Cultural differences may also played a role as would suggest large discrepancies between Asian and Middle East countries and Western countries. However, studies that investigated these differences are seldom [22] and [23]. Social phobia, although one of the most frequent disorders in individuals with mood disorders in clinical studies, has been surprisingly little investigated in co-occurrence with depressive disorders in the general population [14] and [24]. In clinical studies, high associations were found between social phobia and other phobias (59%), panic disorder (49%) and major depressive disorder (MDD) (17%) [25] and [26]. In the general population, individuals with social phobia had the highest likelihood of developing a MDD in the two years following the onset of social phobia [27]. Longitudinal studies showed that adolescents and young adults with social phobia were more likely to have experienced a depressive disorder in the 2–5-year follow-up period [24] and [28]. Social phobia has been also related to the severity and persistence of mood disorders [29]. Consequently, we decided to examine the current prevalence of social phobia in a European sample. More specifically, we wanted to assess how the co-occurrence of social phobia with depressive disorder modifies different key variables such as sociodemographic determinants, health care utilization, and psychotropic treatment. We also examined whether the co-occurrence of social phobia and depressive disorder increased the likelihood of other comorbid anxiety disorders.