title: Lifetime comorbidities between phobic disorders and major depression in Japan: results from the World Mental Health Japan 2002-2004 Survey.
abstract: BACKGROUND
  Although often considered of minor significance in themselves, evidence exists that early-onset phobic disorders might be predictors of later more serious disorders, such as major depressive disorder (MDD). The purpose of this study is to investigate the association of phobic disorders with the onset of MDD in the community in Japan.
  
  
  METHODS
  Data from the World Mental Health Japan 2002-2004 Survey were analyzed. A total of 2,436 community residents aged 20 and older were interviewed using the WHO Composite International Diagnostic Interview 3.0 (response rate, 58.4%). A Cox proportional hazard model was used to predict the onset of MDD as a function of prior history of DSM-IV specific phobia, agoraphobia, or social phobia, adjusting for gender, birth-cohort, other anxiety disorders, education, and marital status at survey.
  
  
  RESULTS
  Social phobia was strongly associated with the subsequent onset of MDD (hazard ratio [HR]=4.1 [95% CI: 2.0-8.7]) after adjusting for sex, birth cohort, and the number of other anxiety disorders. The association between agoraphobia or specific phobia and MDD was not statistically significant after adjusting for these variables.
  
  
  CONCLUSIONS
  Social phobia is a powerful predictor of the subsequent first onset of MDD in Japan. Although this finding argues against a simple neurobiological model and in favor of a model in which the cultural meanings of phobia play a part in promoting MDD, an elucidation of causal pathways will require more fine-grained comparative research.
authors.affiliation: Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ono
authors.forename: Yoshibumi
authors.initials: Y
authors.lastname: Nakane
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Hisateru
authors.initials: H
authors.lastname: Tachimori
authors.forename: Noboru
authors.initials: N
authors.lastname: Iwata
authors.forename: Hidenori
authors.initials: H
authors.lastname: Uda
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nakane
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Naganuma
authors.forename: Toshiaki A
authors.initials: TA
authors.lastname: Furukawa
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hata
authors.forename: Masayo
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Miyake
authors.forename: Tadashi
authors.initials: T
authors.lastname: Takeshima
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kikkawa
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000379:Agoraphobia / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology* / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology* / Q000523:psychology; D018570:Risk Assessment / Q000706:statistics & numerical data; D014944:World Health Organization; D055815:Young Adult