Stein Dan J, Lim Carmen C W, Roest Annelieke M, de Jonge Peter, Aguilar-Gaxiola Sergio, Al-Hamzawi Ali, Alonso Jordi, Benjet Corina, Bromet Evelyn J, Bruffaerts Ronny, de Girolamo Giovanni, Florescu Silvia, Gureje Oye, Haro Josep Maria, Harris Meredith G, He Yanling, Hinkov Hristo, Horiguchi Itsuko, Hu Chiyi, Karam Aimee, Karam Elie G, Lee Sing, Lepine Jean-Pierre, Navarro-Mateu Fernando, Pennell Beth-Ellen, Piazza Marina, Posada-Villa Jose, Ten Have Margreet, Torres Yolanda, Viana Maria Carmen, Wojtyniak Bogdan, Xavier Miguel, Kessler Ronald C, Scott Kate M
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
BMC Med. 2017 Jul 31;15(1):143. doi: 10.1186/s12916-017-0889-2.
There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis.
Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates.
SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries.
While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.
有证据表明社交焦虑障碍（SAD）是一种普遍且致残的疾病。然而，关于这种疾病流行病学的现有数据大多来自西方高收入国家。世界心理健康（WMH）调查倡议提供了一个机会，来调查这种疾病在世界不同地理区域的一系列高、中、低收入国家中的患病率、病程、损害、社会人口学相关因素、共病情况及治疗情况，并解决社交焦虑障碍的差异是否仅仅反映诊断阈值差异的问题。
对世界心理健康调查倡议中28项社区调查的数据进行分析，这些调查共有142,405名受访者。我们评估了各国社交焦虑障碍的30天、12个月及终生患病率、发病年龄以及与社交焦虑障碍相关的角色损害严重程度。此外，我们还调查了社交焦虑障碍的社会人口学相关因素、社交焦虑障碍与其他精神障碍的共病情况以及合并样本中社交焦虑障碍的治疗情况。使用交叉表来计算患病率、损害、共病情况及治疗情况。生存分析用于估计发病年龄，逻辑回归和生存分析用于检验社会人口学相关因素。
在所有国家中，社交焦虑障碍的30天、12个月及终生患病率估计分别为1.3%、2.4%和4.0%。社交焦虑障碍患病率在低收入/中低收入国家以及非洲和东地中海地区最低，在高收入国家以及美洲和西太平洋地区最高。全球发病年龄都较早，而在中高收入国家、非洲和东地中海地区，持续时间最长。不同国家收入水平和地理区域在严重角色损害领域存在一些差异，但在有任何严重角色损害的受访者比例方面，不同收入水平和地理区域之间没有显著差异。此外，在各个国家，社交焦虑障碍与特定的社会人口学特征（年龄较小、女性、未婚、教育程度较低和收入较低）以及相似的共病模式相关。低/中低收入国家中任何有损害者的治疗率最低，高收入国家最高。
虽然各国社交焦虑障碍患病率的差异很明显，但我们在全球发现了一些一致的模式，包括发病年龄早、持续存在、多领域损害，以及特征性的社会人口学相关因素和相关的精神共病情况。此外，虽然全球与社交焦虑障碍相关的损害模式存在一些差异，但关键的相似之处表明，无论国家收入水平或地理位置如何，诊断阈值是相似的。综合来看，这些跨国数据强调了社交焦虑障碍在国际临床和公共卫生方面的重要性。
