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Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life.
Arch Gen Psychiatry. 2007 Aug; 64(8):903-12.AG

Abstract

CONTEXT

Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence.

OBJECTIVES

To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression.

DESIGN

Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers.

SETTING

Community sample in Munich.

PARTICIPANTS

Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up.

MAIN OUTCOME MEASURES

Cumulative incidence of SAD and depression (major depressive episode or dysthymia).

RESULTS

Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%) that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P = .02]) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P = .03]) as the remaining significant predictors.

CONCLUSIONS

Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences.

Authors+Show Affiliations

Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17679635

Citation

Beesdo, Katja, et al. "Incidence of Social Anxiety Disorder and the Consistent Risk for Secondary Depression in the First Three Decades of Life." Archives of General Psychiatry, vol. 64, no. 8, 2007, pp. 903-12.
Beesdo K, Bittner A, Pine DS, et al. Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry. 2007;64(8):903-12.
Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Höfler, M., Lieb, R., & Wittchen, H. U. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64(8), 903-12.
Beesdo K, et al. Incidence of Social Anxiety Disorder and the Consistent Risk for Secondary Depression in the First Three Decades of Life. Arch Gen Psychiatry. 2007;64(8):903-12. PubMed PMID: 17679635.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. AU - Beesdo,Katja, AU - Bittner,Antje, AU - Pine,Daniel S, AU - Stein,Murray B, AU - Höfler,Michael, AU - Lieb,Roselind, AU - Wittchen,Hans-Ulrich, PY - 2007/8/8/pubmed PY - 2007/8/30/medline PY - 2007/8/8/entrez SP - 903 EP - 12 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 64 IS - 8 N2 - CONTEXT: Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence. OBJECTIVES: To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression. DESIGN: Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers. SETTING: Community sample in Munich. PARTICIPANTS: Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up. MAIN OUTCOME MEASURES: Cumulative incidence of SAD and depression (major depressive episode or dysthymia). RESULTS: Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%) that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P = .02]) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P = .03]) as the remaining significant predictors. CONCLUSIONS: Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/17679635/Incidence_of_social_anxiety_disorder_and_the_consistent_risk_for_secondary_depression_in_the_first_three_decades_of_life_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.64.8.903 DB - PRIME DP - Unbound Medicine ER -