Research reportEconomic costs of social phobia: A population-based study
Introduction
Social phobia is characterized by a persistent fear of negative evaluation or scrutiny by others in social or performance situations (APA, 1994). Population studies indicate that social phobia is one of the most prevalent psychiatric disorders (Kasper, 1998, Kessler et al., 1994, Furmark et al., 1999). It is associated with huge losses in quality of life (Wittchen et al., 2000, Acarturk et al., 2008), serious functional impairment in various domains of life (Schneier et al., 1994) and high levels of service use (Magee et al., 1996). This debilitating mental disorder is also associated with increased economic costs (Patel et al., 2002, Andlin-Sobocki et al., 2005). Previous research indicated that people with social phobia experience increased financial dependency (Schneier et al., 1992, Leon et al., 1995), reduced work productivity (Kessler and Frank, 1997, Wittchen et al., 2000, Wittchen and Beloch, 1996), high levels of unemployment (Patel et al., 2002, Wittchen and Beloch, 1996), absenteeism from work (Lecrubier et al., 2000, Wittchen and Beloch, 1996), and use of prescribed medication (Patel et al., 2002).
Despite these indications of the burden of social phobia, the economic cost of this disorder in the general population is less well studied (Patel et al., 2002, Löthgren, 2004, Greenberg et al., 1999, Smit et al., 2006, Konnopka et al., 2009). The only study that to our knowledge has specifically examined the economic costs of social phobia states that people with social phobia have significantly more GP contacts and they use significantly more prescribed oral medication compared to the not mentally disordered population (Patel et al., 2002). However, to understand the overall economic burden of social phobia, more research in this area is needed.
Social phobia often occurs together with other psychiatric disorders (Lecrubier et al., 2000). This co-morbidity leads to increased disability, lower quality of life (Wittchen et al., 2000) and higher economic costs (Patel et al., 2002). It is clear that if the costs of co-morbid disorders are included in calculating the burden of social phobia, that this burden will be overestimated. On the other hand, since co-morbidity is so common in social phobia, these extra costs cannot be ignored either (Greenberg et al., 1999). Therefore, it is important to take these co-morbid disorders into account when calculating costs for social phobia.
The present study firstly aims to examine whether social phobia is associated with significantly increased medical and non-medical costs compared to no mental disorder. This is performed in a large, representative, sample of the Dutch population. Secondly, we examine how the economic costs of social phobia are broken down according to the distinct types of social fears. Earlier research has documented that social fears other than the speaking fears are related to higher disease burden (Kessler et al., 1998). However, no previous study has investigated the relationship between type of fear and economic costs. This touches on another issue. According to some research, social phobia lies on a continuum, and its disease burden is related to the number of social fears rather than to the distinct types of fear (Stein et al., 2000). Therefore, it is also interesting to study the relationship between the economic costs and the number of social fears. Finally, we examine the economic costs of subthreshold social phobia. Previous research indicated that the burden of the illness and the reduction in work productivity in subthreshold social phobia resemble those of full-blown social phobia (Wittchen et al., 2000). Highlighting the economic burden of subthreshold social phobia may underscore the importance of developing awareness, recognition and effective treatment of social phobia especially in its early phases.
Section snippets
Methods
The present study is part of a series of studies on the costs of mental disorders with NEMESIS, beginning with the study of Smit et al. (2006) on the costs of common mental disorders and followed a study on the costs of minor depression (Cuijpers et al., 2007) and of panic disorder (Batelaan et al., 2007).
Demographics
Of the present sample 109 had social phobia and 124 had subthreshold social phobia. The whole sample (N = 4879) can be described as follows. 53% were women with a mean age of 42 years (range 18–64). The levels of education was distributed as follows: elementary 6%, lower vocational 36%, secondary 28%, higher vocational and academic 30%.Of the sample, 73% were living with a partner, 82% living in urban and 69% was employed. We refer to Table 1 for the demographics of the subsamples such as social
Discussion
This study investigated the economic costs of social phobia, not only in the people with social phobia but also at the level of society at large. The cost of social phobia appears to be substantial. Per million inhabitants, the adjusted costs of social phobia were 136 million euro. In the study of Andlin-Sobocki et al. (2005), it is acknowledged that mental disorders including social phobia were hardly associated with increased direct medical and direct non-medical costs, but with indirect
Role of funding source
This study was funded by the University to which the authors are associated. NEMESIS is funded by the Netherlands Ministry of Health (VWS).
Conflict of interests
There are no conflicts of interest, for any of the authors.
References (48)
Economic costs of full-blown and subthreshold panic disorder
J Affect Disord
(2007)- et al.
Size and burden of social phobia in Europe
Eur Neuropsychopharmacol
(2005) Social phobia: the nature of the disorder
J Affect Disord
(1998)- et al.
Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review
J Affect Disord
(2009) - et al.
A European perspective on social anxiety disorder
Eur Psychiatr
(2000) Implications of the severity of social phobia
J Affect Disord
(1998)- et al.
The economic consequences of social phobia
J Affect Disord
(2002) - et al.
Effectiveness research and implications for study design: sample size and statistical power
Gen Hosp Psych
(1999) - et al.
Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study
Eur Psychiatr
(2000) - et al.
Social Phobia and number of social fears, and their association with comorbidity, health-related quality of life and help seeking: a population-based study
Soc Psychiatr Epidemiol
(2008)
Diagnostic and Statistical Manual of Mental Disorders
Cost of disorders of the brain in Europe
Eur J Neurol
Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Soc Psychiatry Psychiatr Epidemiol
The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design
Soc Psychiatry Psychiatr Epidemiol
Productivity losses without absence: measurement validation and empirical evidence
Health Policy
Health Interview Questionnaire
Economic costs of minor depression: a population based study
Acta Psychiatr Scand
Psychiatric and sociodemographic predictors of attrition in a longitudinal study
Am J Epidemiol
Social phobia in the general population: prevalence and sociodemographic profile
Soc Psychiatry Psychiatr Epidemiol
The epidemiology of social anxiety disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions
J Clin Psychiatry
The economic burden of anxiety disorders in the 1990s
J Clin Psychiatry
The impact of psychiatric disorders on work loss days
Psychol Med
Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States
Arch Gen Psychiatry
Social phobia subtypes in the National Comorbidity Survey
Am J Psychiatrt.
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