Psychological Medicine

Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey

R. C. KESSLER a1c1, P. STANG a1, H.-U. WITTCHEN a1, M. STEIN a1 and E. E. WALTERS a1
a1 Department of Health Care Policy, Harvard Medical School, Boston, MA, Department of Epidemiology, University of North Carolina, SmithKline-Beecham, NC and Department of Psychiatry, University of California, San Diego, CA, USA; and Department of Clinical Psychology, Max Planck Institute of Psychiatry, Munich, Germany


Background. General population data were used to study co-morbidities between lifetime social phobia and mood disorders.

Methods. Data come from the US National Comorbidity Survey (NCS).

Results. Strong associations exist between lifetime social phobia and major depressive disorder (odds ratio 2·9), dysthymia (2·7) and bipolar disorder (5·9). Odds ratios increase in magnitude with number of social fears. Reported age of onset is earlier for social phobia than mood disorders in the vast majority of co-morbid cases. Temporally-primary social phobia predicts subsequent onset of mood disorders, with population attributable risk proportions of 10–15%. Social phobia is also associated with severity and persistence of co-morbid mood disorders.

Conclusions. Social phobia is a commonly occurring, chronic and seriously impairing disorder that is seldom treated unless it occurs in conjunction with another co-morbid condition. The adverse consequences of social phobia include increased risk of onset, severity and course of subsequent mood disorders. Early outreach and treatment of primary social phobia might not only reduce the prevalence of this disorder itself, but also the subsequent onset of mood disorders.

c1 Address for correspondence: Professor Ronald C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.