Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades

SummaryPrevious analysis of data from the U.S. National Comorbidity Survey (NCS) suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

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Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

European Psychiatry ◽

10.1016/j.eurpsy.2014.10.005 ◽

2015 ◽

Vol 30 (1) ◽

pp. 99-105 ◽

Cited By ~ 17

Author(s):

M. Bauer ◽

T. Glenn ◽

M. Alda ◽

O.A. Andreassen ◽

E. Angelopoulos ◽

...

Keyword(s):

Family History ◽

Birth Cohort ◽

Age Of Onset ◽

Cohort Analysis ◽

Cohort Effect ◽

First Episode ◽

Mixture Analysis ◽

Bipolar I Disorder ◽

Model Based Clustering ◽

Birth Cohort Effect

AbstractPurpose:Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.Methods:The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.Results:There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.Conclusion:These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

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Compulsive Buying Disorder: A Review of the Evidence

CNS Spectrums ◽

10.1017/s1092852900020630 ◽

2007 ◽

Vol 12 (2) ◽

pp. 124-132 ◽

Cited By ~ 70

Author(s):

Donald W. Black

Keyword(s):

Age Of Onset ◽

Marital Therapy ◽

Adult Population ◽

Compulsive Buying ◽

Developed Countries ◽

The United States ◽

Future Research ◽

Subjective Distress ◽

Financial Counseling ◽

Compulsive Buying Disorder

ABSTRACTCompulsive buying disorder is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding shopping and spending that lead to subjective distress or impaired functioning. Compulsive buying disorder is estimated to have a lifetime prevalence of 5.8% in the United States general adult population. In clinical settings, most individuals with compulsive buying disorder are women (∼80%).This gender difference may be artifactual. Compulsive buying disorder is typically chronic or intermittent, with an age of onset in the late teens or early 20s. Comorbid mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control are common, as are Axis II disorders. The disorder occurs worldwide, mainly in developed countries with market-based economies, and it tends to run in families with mood disorders and substance abuse. There is no standard treatment for compulsive buying disorder, but group cognitive-behavioral models seem promising, and psychopharmacologic treatments are being actively studied. Other treatment options include simplicity circles, 12-step programs, financial counseling, bibliotherapy, marital therapy, and financial counseling. Directions for future research are discussed.

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The effects of co-morbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys

Psychological Medicine ◽

10.1017/s0033291702006104 ◽

2002 ◽

Vol 32 (7) ◽

pp. 1213-1225 ◽

Cited By ~ 31

Author(s):

R. C. KESSLER ◽

L. H. ANDRADE ◽

R. V. BIJL ◽

D. R. OFFORD ◽

O. V. DEMLER ◽

...

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Composite International Diagnostic Interview ◽

The United States ◽

Elevated Risk ◽

World Health ◽

Generalized Anxiety ◽

Co Morbidity ◽

First Onset ◽

History Of

Background. Although it is well known that generalized anxiety disorder (GAD) is highly co-morbid with other mental disorders, little is known about the extent to which earlier disorders predict the subsequent first onset and persistence of GAD. These associations are examined in the current report using data from four community surveys in the World Health Organization (WHO) International Consortium in Psychiatric Epidemiology (ICPE).Method. The surveys come from Brazil, Canada, the Netherlands and the United States. The Composite International Diagnostic Interview (CIDI) was used to assess DSM-III-R anxiety, mood and substance use disorders in these surveys. Discrete-time survival analysis was used to examine the associations of retrospectively reported earlier disorders with first onset of GAD. Logistic regression analysis was used to examine the associations of the disorders with persistence of GAD.Results. Six disorders predict first onset of GAD in all four surveys: agoraphobia, panic disorder, simple phobia, dysthymia, major depression and mania. With the exception of simple phobia, only respondents with active disorders have elevated risk of GAD. In the case of simple phobia, in comparison, respondents with a history of remitted disorder also have consistently elevated risk of GAD. Simple phobia is also the only disorder that predicts the persistence of GAD.Conclusions. The causal processes linking temporally primary disorders to onset of GAD are likely to be state-dependent. History of simple phobia might be a GAD risk marker. Further research is needed to explore the mechanisms involved in the relationship between simple phobia and subsequent GAD.

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Prevalence and the Shift in Age of Onset

CNS Spectrums ◽

10.1017/s1092852900027152 ◽

2004 ◽

Vol 9 (S1) ◽

pp. 12-18

Author(s):

Melissa P. DelBello

Keyword(s):

Bipolar Disorder ◽

The Netherlands ◽

Prevalence Rate ◽

Age Of Onset ◽

Manic Episode ◽

The United States ◽

Juvenile Detention ◽

Trinucleotide Repeats ◽

Lifetime Prevalence ◽

Cross Sectional

Bipolar disorder is presenting at a younger age of onset. In the past, many children with bipolar disorder were undiagnosed and ended up in juvenile detention centers. These children were also often misdiagnosed with severe attention-deficit/hyperactivity disorder (ADHD) or conduct disorder. In addition, an increased prevalence rate of substance use disorders and possibly stimulant prescriptions may be responsible for the shift in age of onset of bipolar disorder. The most compelling epidemiological observations have come out of the Netherlands, where they typically treat ADHD behaviorally rather than with stimulants. Childhood bipolar disorder remains unidentified in the Netherlands despite aggressive searching, whereas adolescent and adult bipolar disorder has been found in numbers similar to those in the United States. This provides cross-sectional epidemiological evidence that stimulants may be shifting the age of onset in patients who are presenting with potentially prodromal bipolar symptoms. Lastly, several researchers speculate that trinucleotide repeats in the DNA (deoxyribonucleic acid) may be responsible for so-called genetic anticipation phenomenon, by which expansion of trinucleotide repeats in successive generations may be shifting the age of onset to an earlier age. These are just some of the mechanistic possibilities for why we are seeing a shift in the age of onset of bipolar disorder.Lewinsohn and colleagues found that the lifetime prevalence of adolescent bipolar I and II disorder is ~1%, with a 5% lifetime prevalence rate of subsyndromal bipolar disorder. Many symptomatic children and adolescents do not meet full duration criteria for a hypomanic or manic episode, or they may be one symptom short of meeting criteria for the disorder.

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Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance

European Psychiatry ◽

10.1016/s0924-9338(00)00212-1 ◽

2000 ◽

Vol 15 (1) ◽

pp. 38-45 ◽

Cited By ~ 224

Author(s):

N.T. Godart ◽

M.F. Flament ◽

Y. Lecrubier ◽

P. Jeammet

Keyword(s):

Anorexia Nervosa ◽

Anxiety Disorder ◽

Bulimia Nervosa ◽

Anxiety Disorders ◽

Separation Anxiety ◽

Age Of Onset ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Separation Anxiety Disorder ◽

Co Morbidity

SummaryThe objectives of the study were to assess lifetime prevalence of specific anxiety disorders, and their age of onset relative to that of eating disorders (ED), in a French sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). We assessed frequencies of seven anxiety disorders and childhood histories of separation anxiety disorder among 63 subjects with a current DSM-IV diagnosis of an ED, using the Composite International Diagnostic Interview (CIDI). Eighty-three percent of subjects with AN and 71% of those with BN had at least one lifetime diagnosis of an anxiety disorder. By far, the most frequent was social phobia (55% of the anorexics and 59% of the bulimics). When present, the co-morbid anxiety disorder had predated the onset of the ED in 75% of subjects with AN, and 88% of subjects with BN. Our results are consistent with those of studies conducted in other countries, and show that an anxiety disorder frequently exists before an ED. This has to be taken in consideration for successful treatment of patients with AN or BN.

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Differentiation of 2 Obsessive-Compulsive Disorder Subgroups with Regard to Demographic and Phenomenological Characteristics Combining Multiple Correspondence and Latent Class Analysis

Psychopathology ◽

10.1159/000518906 ◽

2021 ◽

Vol 54 (6) ◽

pp. 315-324

Author(s):

Lia Koumantanou ◽

Yiannis Kasvikis ◽

Georgios Giaglis ◽

Petros Skapinakis ◽

Venetsanos Mavreas

Keyword(s):

Latent Class Analysis ◽

Obsessive Compulsive Disorder ◽

Latent Class ◽

Age Of Onset ◽

Multiple Correspondence Analysis ◽

Clinical Sample ◽

Future Research ◽

Class Analysis ◽

Obsessive Compulsive ◽

Compulsive Disorder

Introduction: Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions. Objective and Methods: This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used. Results: MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup. Conclusions: Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.

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Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders

Psychological Medicine ◽

10.1017/s0033291700035893 ◽

1996 ◽

Vol 26 (6) ◽

pp. 1169-1177 ◽

Cited By ~ 88

Author(s):

H.-U. Wittchen ◽

S. Zhao ◽

J. M. Abelson ◽

J. L. Abelson ◽

R. C. Kessler

Keyword(s):

Social Phobia ◽

Large Scale ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Cross Sectional ◽

Epidemiological Surveys ◽

Co Morbidity ◽

Coding Rules ◽

Test Retest Reliability ◽

Post Hoc

SynopsisWe evaluate the long-term test–retest reliability and procedural validity of phobia diagnoses in the UM-CIDI, the version of the Composite International Diagnostic Interview, used in the US National Co-morbidity Survey (NCS) and a number of other ongoing large-scale epidemiological surveys. Test–retest reliabilities of lifetime diagnoses of simple phobia, social phobia, and agoraphobia over a period between 16 and 34 months were K = 0·46, 0·47, and 0·63, respectively. Concordances with the Structured Clinical Interview for DSM-III-R (SCID) were K = 0·45, 0·62, and 0·63, respectively. Diagnostic discrepancies with the SCID were due to the UM-CIDI under-diagnosing. Post hoc analysis demonstrated that modification of UM-CIDI coding rules could dramatically improve cross-sectional procedural validity for both simple phobia (K = 0·57) and social phobia (K = 0·95). Based on these results, it seems likely that future modification of CIDI questions and coding rules could lead to substantial improvements in diagnostic validity.

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Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication

Psychological Medicine ◽

10.1017/s0033291707001699 ◽

2007 ◽

Vol 38 (1) ◽

pp. 15-28 ◽

Cited By ~ 383

Author(s):

A. M. Ruscio ◽

T. A. Brown ◽

W. T. Chiu ◽

J. Sareen ◽

M. B. Stein ◽

...

Keyword(s):

Social Phobia ◽

Functional Impairment ◽

Household Survey ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

World Health ◽

Treatment Seeking ◽

National Comorbidity Survey Replication ◽

National Comorbidity Survey ◽

Co Morbidity

BackgroundDespite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R).MethodThe NCS-R is a nationally representative household survey fielded in 2001–2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia.ResultsThe estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose–response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment.ConclusionsSocial phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.

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Home Snack Environments in the United States: Latent Class Analysis Findings From a Home Food Environment Survey

Health Education & Behavior ◽

10.1177/1090198121995777 ◽

2021 ◽

pp. 109019812199577

Author(s):

April Hermstad ◽

Michelle C. Kegler ◽

Rebecca C. Woodruff ◽

Ilana G. Raskind ◽

Regine Haardörfer

Keyword(s):

Latent Class Analysis ◽

Food Environment ◽

Latent Class ◽

Caloric Intake ◽

The United States ◽

Future Research ◽

Snack Food ◽

Class Analysis ◽

Snack Foods ◽

Home Food

Snacking occasions have increased in frequency and energy density in recent decades, with considerable implications for diet. Studies have linked presence of foods in the home with intake of those foods. This study examines home snack food inventories among a large sample of U.S. adults using latent class analysis findings to present latent classes of home snack food inventories and multinomial regression to model classes as correlates of percent of calories from fat. Participants ( n = 4,896) completed an online household food environment survey including presence of 23 snack foods in the home and demographics. Less healthy snack foods were more commonly reported than healthier snack foods ( M = 4.3 vs. M = 3.5). Among White and Latinx participants, high-income households reported greater numbers of both healthier and less healthy snack foods than lower income households, with larger income-based differences in inventory sizes for healthier snack foods. Latent class analysis revealed three classes by inventory size (Small, Medium, and Large) and three classes by inventory content (Healthy Snacks, Standard American, and Limited Standard American). Compared with the Small Inventory class, the Healthy Snacks class had lower caloric intake from fat ( p = .002), the Large and Medium Inventory classes had much higher caloric intake from fat ( p < .0001), and Standard American and Limited Standard American class members had somewhat higher caloric intake from fat ( p < .0001, and p = .0001, respectively). Future research should explore the role of snacks in Americans’ diets, their impact on diet quality and health, and how interventions can support healthy home food and snack food environments to foster healthy eating.

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A Person-Centered Approach to Profiling COVID-Related Experiences in the United States: Preliminary Findings from the Epidemic-Pandemic Impacts Inventory (EPII)

10.31234/osf.io/v36hj ◽

2020 ◽

Author(s):

Damion Grasso ◽

Margaret J. Briggs-Gowan ◽

Alice Carter ◽

Brandon Goldstein ◽

Julian D. Ford

Keyword(s):

Public Health ◽

Interpersonal Relationships ◽

Latent Class ◽

Empirical Test ◽

The United States ◽

Future Research ◽

Sociodemographic Characteristics ◽

Health Crisis ◽

Meaningful Experiences ◽

The Impact

The COVID-19 pandemic has had a profound impact on individuals, families, and communities around the world. Intensive health precautions have created constraints on mobility, work, education, family life, and interpersonal relationships. Preliminary survey studies have reported an increase in the prevalence and severity of psychosocial impairments in the pandemic’s immediate wake. However, the impact of specific pandemic-related experiences and patterns of experiences has not been systematically assessed and studied. The goal of the present study was to develop and conduct a preliminary empirical test of a novel, comprehensive assessment of pandemic-related experiences, the Epidemic-Pandemic Impacts Inventory (EPII), using person-centered latent class analysis (LCA). Aims were to (1) test the hypothesis that LCA would identify unique subgroups based on patterns of negative and positive pandemic-related experiences across personal and social domains, and (2) examine whether identified subgroups would significantly differ on sociodemographic characteristics and indicators of mental health and functioning. Results supported hypotheses, with several unique subgroups identified across domains that were differentiated on sociodemographic characteristics and measures of perceived stress, depression, anxiety, PTSD, and perceived social support. Findings support the EPII as an instrument for measuring tangible and meaningful experiences in the context of an unprecedented pandemic disaster. This study, combined with future research with the EPII, may serve to inform public health strategies for supporting families and communities in the current pandemic and under similar mass public health crisis circumstances in the future.

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