Comorbidity and Quality of Life in DSM-5 Social Anxiety Disorder Among a Nationally Representative Sample

Tapan A. Patel, MS ; Frederick T. Schubert, BA ; Jesse R. Cougle, PhD

J Clin Psychiatry. 2024;85(2):23m15217

Abstract

Objective: Social anxiety disorder (SAD) is a prevalent and debilitating psychiatric disorder that is associated with impairments in functioning and detrimental outcomes such as suicide, poor physical quality of life (QOL), and overall mental health. The goal of the present study was to examine the past year comorbidities of DSM-5 SAD among a large nationally representative sample of US adults (N = 36,309) and to examine correlates of physical QOL and overall mental health among individuals with past-year SAD (N = 980).

Methods: The study utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to examine diagnostic correlates of SAD as well as how symptoms and features of SAD are related to QOL using survey-weighted regression analyses.

Results: We found that comorbid depression, anxiety disorders, posttraumatic stress disorder, and borderline personality disorder were positively associated with SAD. Further, presence of these disorders was also associated with poorer mental health among those with SAD. We also found that specific feared situations (eg, eating and drinking in public) and social anxiety symptoms (panic attack and avoidance) were linked to both forms of QOL (all ps <0.01).

Conclusion: The present findings highlight that SAD is comorbid with other impairing disorders and that these comorbidities, specific feared situations, and SAD symptoms are related to worse QOL in individuals with SAD.

J Clin Psychiatry 2024;85(2):23m15217

Author affiliations are listed at the end of this article.

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References (37)

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th rev ed. 2022. https://doi.org/10.1176/appi.books.9780890425787.
Grant BF, Hasin DS, Blanco C, et al. The epidemiology of social anxiety disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2005;66(11):1351–1361. PubMed CrossRef
Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593–602. PubMed CrossRef
Kessler RC, Petukhova M, Sampson NA, et al. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–184. PubMed CrossRef
Chavira DA, Stein MB. Childhood social anxiety disorder: from understanding to treatment. Child Adolesc Psychiatr Clin N Am. 2005;14(4):797–818. PubMed CrossRef
de Lijster JM, Dierckx B, Utens EMWJ, et al. The age of onset of anxiety disorders. Can J Psychiatry. 2017;62(4):237–246. PubMed CrossRef
Asher M, Asnaani A, Aderka IM. Gender differences in social anxiety disorder: a review. Clin Psychol Rev. 2017;56:1–12. PubMed CrossRef
Asher M, Aderka IM. Gender differences in social anxiety disorder. J Clin Psychol. 2018;74(10):1730–1741. PubMed CrossRef
Xu Y, Schneier F, Heimberg RG, et al. Gender differences in social anxiety disorder: results from the national epidemiologic sample on alcohol and related conditions. J Anxiety Disord. 2012;26(1):12–19. PubMed CrossRef
Patel TA, Schubert FT, Zech JM, et al. Prevalence and correlates of cannabis use among individuals with DSM-5 social anxiety disorder: findings from a nationally representative sample. J Psychiatr Res. 2023;163:406–412. PubMed CrossRef
Buckner JD, Schmidt NB, Lang AR, et al. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. 2008;42(3):230–239. PubMed CrossRef
Patel TA, Grubaugh AL, Cougle JR. Demographic and clinical correlates of social anxiety disorder among US veterans: findings from the NESARC-III study. Soc Psychiatry Psychiatr Epidemiol. 2023;58:1019–1028. PubMed
Buckner JD, Lemke AW, Jeffries ER, et al. Social anxiety and suicidal ideation: test of the utility of the interpersonal-psychological theory of suicide. J Anxiety Disord. 2017;45:60–63. PubMed CrossRef
Comer JS, Blanco C, Hasin DS, et al. Health-related quality of life across the anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions (NESARC). J Clin Psychiatry. 2010;71(1):8126.
Dryman MT, Gardner S, Weeks JW, et al. Social anxiety disorder and quality of life: how fears of negative and positive evaluation relate to specific domains of life satisfaction. J Anxiety Disord. 2016;38:1–8. PubMed CrossRef
Patel TA, Schubert FT, Hom MA, et al. Correlates of treatment seeking in individuals with social anxiety disorder: findings from a nationally representative sample. J Anxiety Disord. 2022;91:102616. PubMed CrossRef
Galbraith T, Heimberg RG, Wang S, et al. Comorbidity of social anxiety disorder and antisocial personality disorder in the national epidemiological survey on alcohol and related conditions (NESARC). J Anxiety Disord. 2014;28(1):57–66. PubMed CrossRef
Adams GC, Balbuena L, Meng X, et al. When social anxiety and depression go together: a population study of comorbidity and associated consequences. J Affect Disord. 2016;206:48–54. PubMed CrossRef
McMillan KA, Asmundson GJG, Sareen J. Comorbid PTSD and social anxiety disorder: associations with quality of life and suicide attempts. J Nerv Ment Dis. 2017;205(9):732–737. PubMed CrossRef
Fehm L, Beesdo K, Jacobi F, et al. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Soc Psychiatry Psychiatr Epidemiol. 2008;43(4):257–265. PubMed CrossRef
Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233. PubMed CrossRef
Hambrick JP, Turk CL, Heimberg RG, et al. The experience of disability and quality of life in social anxiety disorder. Depress Anxiety. 2003;18(1):46–50. PubMed CrossRef
Rhee TG, Steffens DC. Major depressive disorder and impaired health-related quality of life among US older adults. Int J Geriatr Psychiatry. 2020;35(10):1189–1197. PubMed CrossRef
Bommersbach TJ, Rosenheck RA, Rhee TG. Association of recent and past suicide attempts with health-related quality of life. J Clin Psychiatry. 2023;84(2):22m14441. PubMed CrossRef
Grant BF, Chu A, Sigman R, et al. Source and Accuracy Statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). National Institute on Alcohol Abuse and Alcoholism; 2014.
Grant BF, Goldstein RB, Smith SM, et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend. 2015;148:27–33. PubMed CrossRef
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2022. https://www.R-project.org/.
Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9(8):1–19.
Asnaani A, Richey JA, Dimaite R, et al. A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. J Nerv Ment Dis. 2010;198(8):551–555. PubMed CrossRef
Koyuncu A, İnce E, Ertekin E, et al. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs Context. 2019;8:212573. PubMed CrossRef
Gros DF, McCabe RE, Antony MM. Using a hybrid model to investigate the comorbidity and symptom overlap between social phobia and the other anxiety disorders and unipolar mood disorders. Psychiatry Res. 2013;210(1):188–192. PubMed CrossRef
Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69(4):533–545. PubMed CrossRef
Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder. Compr Psychiatry. 1999;40(4):245–252. PubMed CrossRef
Keuroghlian AS, Gunderson JG, Pagano ME, et al. Interactions of borderline personality disorder and anxiety disorders over 10 years. J Clin Psychiatry. 2015;76(11):1529–1534. PubMed CrossRef
Morris EP, Stewart SH, Ham LS. The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clin Psychol Rev. 2005;25(6):734–760. PubMed CrossRef
Hendriks SM, Spijker J, Licht CMM, et al. Disability in anxiety disorders. J Affect Disord. 2014;166:227–233. PubMed CrossRef
Kinley DJ, Cox BJ, Clara I, et al. Panic attacks and their relation to psychological and physical functioning in Canadians: results from a nationally representative sample. Can J Psychiatry. 2009;54(2):113–122. PubMed CrossRef