Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life.
BACKGROUND
Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence.


OBJECTIVE
To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression.


METHODS
Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers.


METHODS
Community sample in Munich.


METHODS
Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up.


METHODS
Cumulative incidence of SAD and depression (major depressive episode or dysthymia).


RESULTS
Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%) that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P = .02]) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P = .03]) as the remaining significant predictors.


CONCLUSIONS
Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences.
Beesdo
Katja
K
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
Bittner
Antje
A
Pine
Daniel S
DS
Stein
Murray B
MB
Höfler
Michael
M
Lieb
Roselind
R
Wittchen
Hans-Ulrich
HU
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D010555:Personality Inventory; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D000297:Psychology, Adolescent; D012306:Risk; D012307:Risk Factors