Disability and quality of life in social phobia: epidemiologic findings

OBJECTIVE: Social phobia in clinical studies is vividly associated with extensive disability and reduced quality of life. It is difficult to obtain a clear portrayal of the impairment associated with social phobia in community samples. Furthermore, it has been unclear in prior studies to what extent indices were attributable to social phobia as opposed to comorbid major depression. The authors examined relevant data from the Ontario Health Survey Mental Health Supplement. METHOD: The Ontario Health Survey Mental Health Supplement, a survey of more than 8,000 residents of Ontario, Canada, aged 15-64, used the University of Michigan Composite International Diagnostic Interview to assign DSM-III-R diagnoses. Several indicators of disability and quality of life were included. The authors compared these indices for persons with and without social phobia and adjusted where indicated for the effects of major depression and relevant sociodemographic factors. RESULTS: Persons with social phobia were impaired on a broad spectrum of measures, ranging from dropping out of school to experiencing disability in one's main activity. They were also significantly more likely than persons without social phobia to rate themselves as "low functioning" on the Quality of Well-Being Scale and to report dissatisfaction with many aspects of life. Depressive comorbidity seemed to contribute only modestly to these outcomes. CONCLUSIONS: Social phobia can be a serious, disabling anxiety disorder associated with marked reduction in quality of life. Impairment in social phobia is substantial, even in the absence of comorbid major depression.