Young people with social anxiety disorder are at risk for subsequent depressive disorders

March 14, 2001

Social anxiety disorder (also known as "social phobia") during the teenage years or young adulthood is an important predictor of subsequent depressive disorders; moreover, the presence of both social anxiety disorder and depressive disorder at an early age is associated with a more severe course and character of subsequent depressive illness, according to an article in the March issue of the Archives of General Psychiatry, a member of the JAMA family of journals. Murray B. Stein, M.D., UCSD Department of Psychiatry and the Veterans Administration San Diego Healthcare System, La Jolla, Calif., and colleagues obtained data from a prospective, longitudinal epidemiologic study of 2,548 respondents aged 14-24 years with a 34-50 month follow-up to evaluate the influence of social anxiety disorder at baseline on the risk, course and characteristics of depressive disorders.

The researchers found that at baseline, the prevalence of social anxiety disorder was 7.2 percent. However, the presence of social anxiety disorder in nondepressed persons at the beginning of the study was associated with 3.5 times an increased likelihood of developing depressive disorder during the follow-up period. Having both social anxiety disorder and depressive disorder at baseline was associated with a worse prognosis compared with depressive disorder without comorbid social anxiety disorder at baseline. This is exemplified by the greater likelihood of depressive disorder persistence or recurrence (2.3 times greater likelihood) and attempted suicide (6.1 times greater likelihood).

"Though we caution once again about imparting causality to our findings, they do support the proposal made by numerous investigators that early intervention with socially phobic youth be tested as a primary prevention of depressive illness," the authors conclude. "Furthermore, our results suggest that the union of depression with [social anxiety disorder] (and probably other anxiety disorders as well) in adolescence or early adulthood is a particularly sinister combination that heralds an increased risk for subsequent depressive episode(s) of increased severity, with amplified suicide risk. Given the substantial morbidity and mortality risks associated with adolescent-onset major depressive disorder, serious efforts should be initiated to identify and test treatments for youth who fit this clinical profile (i.e., early-onset anxiety and depressive disorders)."

According to background information cited in the article, social anxiety disorder is a prevalent disorder that typically has a childhood or adolescent onset. It is estimated that 4 percent to 8 percent of adults in the general population suffer from social anxiety disorder in a given year, with even higher rates when lifetime prevalence is considered.
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The study was funded by the German Ministry of Research and Technology. (Arch Gen Psychiatry 2001;58:251-256)

University of California - San Diego

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