Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population.
BACKGROUND
There is a lack of data systematically describing subthreshold expressions of social anxiety disorder (SAD) with regard to prevalence, comorbidity, and impairment.


METHODS
This analysis was based on data from the German Health Survey (GHS) and its Mental Health Supplement (GHS-MHS). Social anxiety disorder and its syndromes as well as other mental disorders were assessed with a standardized diagnostic interview (M-CIDI) in 4,174 adults.


RESULTS
The 12-month prevalence rate for threshold SAD was 2.0%, subthreshold and symptomatic social anxiety (one DSM-IV criterion missing/two or more criteria missing) was found in 3.0 and 7.5% of the participants, respectively. As expected, threshold SAD was characterized by an elevated risk for comorbid disorders and associated with impairment in diverse areas of life. However, this was also true for the two subthreshold expressions of social anxiety, which were also significantly associated with higher comorbidity and greater impairment compared to the control group.


CONCLUSIONS
Our results suggest that social anxiety below the diagnostic threshold is clearly associated with adverse outcomes. Prospective designs should examine the exact temporal and possible causal pathways of this burden in order to inform prevention and early intervention programs.
Fehm
Lydia
L
Institute of Psychology, Humboldt-Unversität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany. lydia.fehm@psychologie.hu-berlin.de
Beesdo
Katja
K
Jacobi
Frank
F
Fiedler
Agnes
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010698:Phobic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011159:Population Surveillance; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires