title: The costs of social anxiety disorder: the role of symptom severity and comorbidities.
abstract: BACKGROUND
  Social anxiety disorder (SAD) is associated with low direct costs compared to other anxiety disorders while indirect costs tend to be high. Mental comorbidities have been identified to increase costs, but the role of symptom severity is still vague. The objective of this study was to determine the costs of SAD, and to explore the impact of symptoms and comorbidities on direct and indirect costs.
  
  
  METHODS
  Baseline data, collected within the SOPHO-NET multi-centre treatment study (N=495), were used. Costs were calculated based on health care utilization and lost productivity. Symptom severity was measured with the Liebowitz-Social-Anxiety-Scale; comorbidities were included as covariates.
  
  
  RESULTS
  Total 6-month costs were accrued to €4802; 23% being direct costs. While there was no significant association with SAD symptom severity for direct costs, costs of absenteeism increased with symptom severity in those with costs >0; comorbid affective disorders and eating disorders had an additional effect. Self-rated productivity was lower with more pronounced symptoms even after controlling for comorbidities.
  
  
  CONCLUSIONS
  As the study was based on a clinical sample total costs were considered, rather than net costs of SAD and no population costs could be calculated.
  
  
  CONCLUSIONS
  The burden associated with lost productivity was considerable while costs of healthcare utilization were rather low as most patients had not sought for treatment before. Efforts to identify patients with SAD earlier and to provide adequate treatment should be further increased. Mental comorbidities should be addressed as well, since they account for a large part of indirect costs associated with SAD.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany. Electronic address: n.stuhldreher@uke.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Stuhldreher
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Leibing
authors.affiliation: Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Leichsenring
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.affiliation: Clinical Psychology and Psychotherapy and Clinic for Psychotherapy and Psychosomatic Medicine, Technische Universitaet Dresden, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Hoyer
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Konnopka
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Salzer
authors.affiliation: Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Wiltink
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000041:Absenteeism; D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D012720:Severity of Illness Index; D012919:Social Behavior; D055815:Young Adult
keywords: Cost; Economic; Mental comorbidity; Social anxiety disorder