Considering Comorbidity in Adolescents with Social Anxiety Disorder

Social anxiety disorder is a highly prevalent psychiatric disorder, with elevated comorbidity rates with other mental health disorders and may cause severe negative consequences. In adolescence, there is a lack of research on how comorbid disorders to social anxiety tends to form particular associations. With a large sample of adolescents with a clinical diagnosis of social anxiety disorder, data have revealed that certain disorders are more frequent and tend to dwell on concrete aggregates. Thus, it may be particularly useful and efficient for mental health providers, pediatricians and school counselors to screen for generalized anxiety disorder and specific phobia when assessing SAD in youth. Overall, findings stress the presence of comorbidity being the rule rather than the exception in adolescents with social anxiety disorder, and the need for further examination of its impact on assessment and differential diagnosis on this psychiatric disorder.     

Social and behavioral predictors of insufficient sleep among African Americans and Caucasians

BackgroundFew studies have examined the social and behavioral predictors of insufficient sleep.ObjectiveTo assess the social and behavioral predictors of insufficient sleep in the U.S. population.MethodsData from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Telephone interviews were conducted in six representative states that completed the optional sleep module. A total of 31,059 respondents were included in the present analysis. BRFSS-provided weights were applied to analyses to adjust for the use of complex design.ResultsThe mean age for the sample was 56 ± 16 years, with 63% of the sample being female; 88% identified as non-Hispanic white and 12% identified as non-Hispanic black; 42% were not married and 8% did not have a high school degree. The prevalence of insufficient sleep (<7 hours) was 37%. Multivariate-adjusted logistic regression revealed associations of four important factors with insufficient sleep, which were: working more than 40 hours per week [OR = 1.65, p < 0.001, 95% CI = 1.65–1.66], black race/ethnicity [OR = 1.37, p < 0.001, 95% CI = 1.37–1.38], history of heart disease [OR = 1.26, p < 0.001, 95% CI = 1.25–1.28], care-giving to family/friends [OR = 1.50, p < 0.001, 95% CI = 1.49–1.51], and lack of social and emotional support [OR = 1.24, p < 0.001, 95% CI = 1. 23–1.25].ConclusionSocial and behavioral predictors of health uniquely contribute to the report of insufficient sleep and should be considered when developing programs to increase awareness of the adverse effects of insufficient sleep.     

The factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale

The Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS) are two compendium measures that have become some of the most popular self-report scales of social anxiety. Despite their popularity, it remains unclear whether it is necessary to maintain two separate scales of social anxiety. The primary objective of the present study was to examine the factor analytic structure of both measures to determine the factorial validity of each scale. For this purpose, we administered both scales to 577 patients at the beginning of outpatient treatment. Analyzing both scales simultaneously, a CFA with two correlated factors showed a better fit to the data than a single factor model. An additional EFA with an oblique rotation on all 40 items using the WLSMV estimator further supported the two factor solution. These results suggest that the SIAS and SPS measure similar, but not identical facets of social anxiety. Thus, our findings provide support to retain the SIAS and SPS as two separate scales.     

Analysis of Altered Baseline Brain Activity in Drug-Naive Adult Patients with Social Anxiety Disorder Using Resting-State Functional MRI

Objective

We hypothesize that the amplitude of low-frequency fluctuations (ALFF) is involved in the altered regional baseline brain function in social anxiety disorder (SAD). The aim of the study was to analyze the altered baseline brain activity in drug-naive adult patients with SAD.

Methods

We investigated spontaneous and baseline brain activities by obtaining the resting-state functional magnetic resonance imaging data of 20 drug-naïve adult SAD patients and 19 healthy controls. Voxels were used to analyze the ALFF values using one- and two-sample t-tests. A post-hoc correlation of clinical symptoms was also performed.

Results

Our findings show decreased ALFF in the bilateral insula, left medial superior frontal gyrus, left precuneus, left middle temporal gyrus, right middle temporal pole, and left fusiform gyrus of the SAD group. The SAD patients exhibited significantly increased ALFF in the right inferior temporal gyrus, right middle temporal gyrus, bilateral middle occipital gyrus, orbital superior frontal gyrus, right fusiform gyrus, right medial superior frontal gyrus, and left parahippocampal gyrus. Moreover, the Liebowitz Social Anxiety Scale results for the SAD patients were positively correlated with the mean Z values of the right middle occipital and right inferior occipital but showed a negative correlation with the mean Z values of the right superior temporal gyrus and right medial superior frontal gyrus.

Conclusion

These results of the altered regional baseline brain function in SAD suggest that the regions with abnormal spontaneous activities are involved in the underlying pathophysiology of SAD patients.     

Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome

We examined social anxiety and internalizing symptoms using the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Social Anxiety Scale for Children -Revised (SASC-R), and the Child Behavior Checklist (CBCL) in a sample of fifty-four high-functioning subjects with autism or Asperger syndrome (HFA/AS) (M = 11.2 ± 1.7 years) and 305 community subjects (M = 12.2 ± 2.2 years). Children and adolescents completed the SPAI-C and SASC-R, and their parents completed the CBCL Internalizing scale. Adolescents with HFA/AS scored higher than the community sample on all measures. Behavioural avoidance and evaluative social anxiety increased by age within the HFA/AS group, whereas behavioural avoidance decreased by age in control participants. Data support that HFA/AS in adolescents may be associated with clinically relevant social anxiety symptoms.     

Brief fear of negative evaluation scale-revised

Rodebaugh et al. [2004: Psychol Assess 2:169-181] recently performed a confirmatory factor analysis (CFA) on the Brief Fear of Negative Evaluation scale (BFNE; Leary, 1983: Psychol Bull 9:371-375]. Their study resulted in the emergence of a two-factor solution comprising straightforwardly worded items and reverse-worded items. They concluded by recommending use of only the straightforwardly worded items in the BFNE. Our intent in this study was to evaluate this recommendation through replication and extension. Participants included 385 undergraduates from the Universities of Regina and Houston, who provided responses to a questionnaire battery including either the BFNE or a revision utilizing straightforwardly worded versions of the reverse-worded items (BFNE-II). A CFA of the BFNE, using the two-factor model proposed by Rodebaugh et al., supported their conclusion that the reverse-worded items comprise a separate, methodologically based factor. However, CFA of the BFNE-II resulted in an acceptable unitary model that conforms to the theoretical basis for the BFNE, without risking loss of sensitivity from item removal. Additional analyses suggest use of the BFNE-II rather than a shortened form.     

Comorbid Anxiety in Bipolar Disorder Alters Treatment and Prognosis

Mood disorders in general, and bipolar disorder in particular, are unique among the psychiatric conditions in that they are associated with extraordinarily high rates of comorbidity with a multitude of psychiatric and medical conditions. Among all the potential comorbidities, co-occurring anxiety disorders stand out due to their very high prevalence. Outcome in bipolar illness is worse in the presence of a comorbid anxiety disorder. The coexistence of an anxiety disorder presents a particularly difficult challenge in the treatment of bipolar illness since antidepressants, the mainstay of pharmacologic treatments for anxiety, may adversely alter the course of manic-depression. Identification of anxiety disorders in bipolar patients is important. The treatment plan needs to balance the potential benefit and harm of antidepressant administration.     

The relationship between perceived discrimination and Generalized Anxiety Disorder among African Americans, Afro Caribbeans, and non-Hispanic Whites

The present study examined the relationship between frequency of race based and non-race based discrimination experiences and Generalized Anxiety Disorder (GAD) in a sample of 3570 African Americans, 1438 Afro Caribbeans, and 891 non-Hispanic Whites from the National Survey of American Life (NSAL). Because GAD and the experience of racial discrimination are both associated with symptoms of worry and tension, we expected race based discrimination to predict GAD prevalence for African Americans, but not other groups. We did not expect non-race based discrimination to predict GAD. Results showed that while more frequent experiences of non-race based discrimination predicted GAD for all groups, experiencing race based discrimination was associated with significantly higher odds of endorsing lifetime GAD for African Americans only. Results are interpreted in light of the different contexts that these three ethnic groups represent relative to their history within the United States as well as their present day circumstances.     

Refining and validating the Social Interaction Anxiety Scale and the Social Phobia Scale

Background: The Social Interaction Anxiety Scale and Social Phobia Scale 6 are companion measures for assessing symptoms of social anxiety and social phobia. The scales have good reliability and validity across several samples, 3 , 6 however, exploratory and confirmatory factor analyses have yielded solutions comprising substantially different item content and factor structures. These discrepancies are likely the result of analyzing items from each scale separately or simultaneously. The current investigation sets out to assess items from those scales, both simultaneously and separately, using exploratory and confirmatory factor analyses in an effort to resolve the factor structure. Methods: Participants consisted of a clinical sample (n5353; 54% women) and an undergraduate sample (n5317; 75% women) who completed the Social Interaction Anxiety Scale and Social Phobia Scale, along with additional fear‐related measures to assess convergent and discriminant validity. Results: A three‐factor solution with a reduced set of items was found to be most stable, irrespective of whether the items from each scale are assessed together or separately. Items from the Social Interaction Anxiety Scale represented one factor, whereas items from the Social Phobia Scale represented two other factors. Conclusion: Initial support for scale and factor validity, along with implications and recommendations for future research, is provided. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Psychometric evaluation of the Concerns of Social Reprisal Scale: Further explicating the roots of fear of positive evaluation

Fear of positive evaluation (FPE) has been proposed to be an important feature of social anxiety disorder (SAD) and to be rooted, at least partly, in concerns of social reprisal due to positive impressions. In order to formally test this hypothesis, the Concerns of Social Reprisal Scale (CSRS) was developed. The purpose of the present series of studies was to examine the psychometric profile of the CSRS across several independent samples including: a large (n = 981) undergraduate sample; a clinical sample of individuals diagnosed with social anxiety disorder (n = 27), and a demographically-matched subsample of healthy control participants (n = 24). The factorial validity, internal consistency, and construct validity of the CSRS were examined. Results across both studies provided support for the psychometric profile of the CSRS. The implications of concerns of social reprisal for the assessment of social anxiety symptoms, theoretical models of fear of evaluation and SAD, and their potential clinical utility with regard to treating SAD are discussed.     

The Medium is the Message: Effects of Mediums of Communication on Perceptions and Emotions in Social Anxiety Disorder

We examined the use of voice/text and visual mediums and their effects on perceptions and emotions in social anxiety disorder (SAD). Our sample included 88 individuals: 44 individuals with SAD and 44 non-socially-anxious (NSA) individuals. We used an experience sampling methodology (ESM) in which participants received daily links to online measures at random times during the day, for 21 days and reported on social interactions, emotions and perceptions. Results indicated that individuals with SAD used voice/text mediums to a greater extent and used visual mediums to a lesser extent compared to NSA individuals. However, despite preferring voice/text mediums, use of visual mediums resulted in immediate increases in positive perceptions and emotions for individuals with SAD. These findings were above and beyond the effect of depressive symptoms and remained when social anxiety was represented as a continuum of severity. This has important implications for exposure interventions in the treatment of SAD.     

Reliability and Validity of the Chinese Version of the Social Anxiety Scale for Adolescents

This study evaluated the psychometric properties of the Chinese version of the Social Anxiety Scale for Adolescents (SAS-A) in a sample of 296 adolescents (49% boys) in Grades 7, 8, 9, 10, and 12 with a mean age of 15.52 years. Confirmatory factor analysis replicated the three-factor structure of the SAS-A in the Chinese sample: Fear of Negative Evaluation (FNE), Social Avoidance and Distress in New Situations (SAD-New), and Social Avoidance and Distress-General (SAD-General). Internal consistency and test-retest reliability were appropriate. The results also revealed a clear and predictable pattern of relationships between the SAS-A and the Questionnaire about Interpersonal Difficulties for Adolescents and the International Personality Item Pool. Chinese boys reported greater SAD-General than Chinese girls, and this difference increased with grade. The SAS-A scores were compared to previously collected data from the USA and Spain, revealing that Chinese adolescents scored significantly higher in social anxiety than American and Spanish adolescents.     

Social anxiety and discomfort with friendly giving

Individuals higher in social anxiety report more impaired friendship quality, which past research suggests may stem from constrained warmth. We examined three motivations for constrained warmth in friendships and determined how these motivations related to social anxiety and friendship impairment. To do so, we assessed the psychometric properties of the Favor Scale (FS), which measures an individual's response to friendly giving. Results indicated that the FS has three subscales: negative reactions to favors (NEG), positive reactions to favors (POS), and expectation of tit-for-tat behavior (E-TFT). Structural equation modeling demonstrated that social anxiety related directly to NEG, and indirectly to POS and E-TFT through NEG. POS related directly to friendship quality, indicating that friendships may be impaired in social anxiety disorder due to the cumulative effects of responding negatively to friendly behavior.     

Factor Structure of the Liebowitz Social Anxiety Scale for Children and Adolescents

The purpose of this study was to evaluate the factor structure of the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). The LSAS-CA was administered to 225 children and adolescents as a component of various clinical studies. In addition, other measures of psychopathology and impairment were administered to a subgroup of the sample. Confirmatory factor analyses of the social interaction and performance subscales for the anxiety and avoidance ratings yielded poor fit indices. Exploratory factor analysis supported a two-factor solution with a higher order factor for the LSAS-CA anxiety and avoidance ratings. Based on item content, factors were named Social and School Performance. The internal consistency of the factors was high and the convergent and divergent validity was supported vis-à-vis correlations with measures of depression and social anxiety, and clinician ratings of impairment and functioning. Findings suggest that the anxiety and avoidance ratings are best explained by a two-factor solution that measures social anxiety and avoidance in social and school performance interactions. This factor structure appears to be a reliable and valid framework for assessing childhood social phobia.This research was funded by a grant from SmithKline Beecham to Drs. Liebowitz and Masia-Warner. The authors would like to thank Heather Dent and Sharon Davies for their contributions to the execution of this study.     

Social phobia, fear of negative evaluation and harm avoidance.

This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.