title: When social anxiety and depression go together: A population study of comorbidity and associated consequences.
abstract: Despite several studies suggesting higher depression severity and dysfunction occurring in individuals with major depressive disorder (MDD) comorbid with social anxiety disorder (SAD), a clear understanding of the specific risks associated with this comorbidity is lacking. In this study we compared the disease characteristics and level of disability of individuals with MDD-SAD with other comorbidities between depression and anxiety.
  
  
  
  Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N=20,013) were used. Individuals were divided in four groups comparing MDD-SAD with MDD alone, as well as other comorbidities between MDD and one anxiety (MDD-1ANX) or more than two anxiety disorders (MDD≥2ANX), with respect to several clinical, demographic, and functional characteristics.
  
  
  
  MDD-SAD comorbidity in the general population occurred in younger people, particularly men, and seemed to have an earlier onset of MDD. Occupational and social dysfunction was similar between individuals with MDD-SAD and those with MDD-1ANX. However, individuals with MDD≥2ANX had significantly higher severity as measured by suicidality as well as substance abuse and social and occupational dysfunction. SAD was the most prevalent comorbid anxiety in this group.
  
  
  
  The findings of this study were derived from the cross-sectional data.
  
  
  
  Our results suggest that the particular risks associated with MDD-SAD are the early onset and likelihood of additional anxiety, leading to higher severity and disability levels. Clinicians should increase the screening and treatment of SAD and other anxiety disorders in individuals with MDD given the higher associated health risk and functional impairment.
authors.affiliation: Department of Psychiatry, University of Saskatchewan, Canada. Electronic address: camelia.adams@usask.ca.
authors.forename: G Camelia
authors.initials: GC
authors.lastname: Adams
authors.affiliation: Department of Psychiatry, University of Saskatchewan, Canada.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Balbuena
authors.affiliation: Department of Psychiatry, McGill University & Douglas Mental Health University Institute, Canada.
authors.forename: XiangFei
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Psychology, University of Regina, Canada.
authors.forename: Gordon J G
authors.initials: GJ
authors.lastname: Asmundson
mesh_terms: D000328:Adult; D017668:Age of Onset; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072861:Phobia, Social / Q000150:complications*; D015995:Prevalence; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Anxiety disorders; Comorbidity; Impairment; Major depressive disorder; Severity; Social anxiety disorder