The Burden of Social Phobia in a Brazilian Community and its Relationship with Socioeconomic Circumstances,Health Status and Use of Health Services: The Bambui Study
Restricted accessResearch articleFirst published online September, 2004
The Burden of Social Phobia in a Brazilian Community and its Relationship with Socioeconomic Circumstances,Health Status and Use of Health Services: The Bambui Study
Aims: Social phobia in the environment of poverty and major social inequalities, as observed in most developing countries, has received little attention. This population-based study was carried out in a poor community in Brazil (15,000 inhabitants), aiming at determining the prevalence of social phobia and its associated factors.
Method: The Composite International Diagnostic Interview was applied in a random sample of 1037 residents aged 5 18 years.
Results: The 1-month, 1-year and lifetime prevalence of social phobia were 7.9, 9.1 and 11.8%, respectively. One-month social phobia was independently associated with age (45-64 years), marital status (divorced/separated), worse socioeconomic indicators (family income and education), number of months worked, worse health status and use of health services and medications.
Conclusion: There was an important burden of social phobia in the study community, due to its high prevalence (similar or superior to those observed in most developed countries), and due to its association with worse health status and use of health services and medications. The strong association between social phobia and socioeconomic circumstance, even in a small and poor community, is certainly a reflex of the major social inequalities in Brazil.
ABOU-SALEH, M.T. , GHUBASH, R. & DARADKEH, T.K. (2001) Al Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates . Social Psychiatry and Psychiatric Epidemiology, 36, 20-28 .
2.
AMERICAN PSYCHIATRIC ASSOCIATION (1987) Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. edn (DSM III R). Washington, DC: American Psychiatric Association .
3.
ANDREWS, G. , HENDERSON, S. & HALL, W. (2001) Prevalence, comorbidity, disability and service utilisation: overview of the Australian National Mental Health Survey . British Journal of Psychiatry, 178, 145-153 .
4.
ANGST, J. & DOBLER-MIKOLA, A. (1985) The Zurich Study. V. Anxiety and phobia in young adults . European Archives of Psychiatry and Clinical Neuroscience, 235, 171-178 .
5.
ARMITAGE, P. & BERRY, G. (1987) Statistical Methods in Medical Research. Oxford: Blackwell Scientific Publications .
6.
CANINO, G.J. , BIRD, H.R. , SHROUT, P.E. , RUBIO-STIPEC, M. , BRAVO, M. , MARTINEZ, R. , SESMAN, M. & GUEVARA, L.M. (1987) The prevalence of specific psychiatric disorders in Puerto Rico . Archives of General Psychiatry, 44, 727-735 .
7.
CARAVEO-ANDUAGA, J.J. & COLMENARES, E. (2000) Prevalencia de los transtornos de ansiedad fobica en la poblacion adulta de la ciudad deMexico Salud Mental, 23, 10-19 .
8.
CHAPMAN, T.F. , MANNUZZA, S. & FYER, A.J. (1995) Epidemiology and family studies of social phobia. In Social phobia: diagnosis, assessment and treatment (ed. R.G. Heimberg , M.R. Liebowitz , D.A. Hope & F.R. Schneier ). New York: Guilford Press .
9.
DAVIDSON, J.R. , HUGHES, D.C. , GEORGE, L.K. & BLAZER, D.G. (1993) The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study . Psychological Medicine, 23, 709-718 .
10.
DAVIDSON, J.R. , HUGHES, D.C. , GEORGE, L.K. & BLAZER, D.G. (1994) The boundary of social phobia: exploring the threshold . Archives of General Psychiatry, 51, 975-983 .
11.
DEAN, A.G. , DEAN, J.A. , COULOMBIER, D. , BURTON, A.H. , BRENDEL, K.A. , SMITH, D.C.et al. (1994) Epi info: a word processing database and statistics program for epidemiology on microcomputers. Atlanta, GA: Centers for Disease Control and Prevention .
12.
DEGONDA, M. & ANGST, J. (1993) The Zurich study. XX. Social phobia and agoraphobia . European Archives of Psychiatry and Clinical Neuroscience, 243, 95-102 .
13.
FURMARK, T. (2002) Social phobia: overview of community surveys . Acta Psychiatrica Scandinavica, 105, 84-93 .
14.
FURMARK, T. , TILLFORS, M. , EVERZ, P. , MARTEINSDOTTIR, I. , GEFVERT, O. & FREDRIK SON, M. (1999) Social phobia in the general population: prevalence and sociodemographic profile . Social Psychiatry and Psychiatric Epidemiology, 34, 416-424 .
15.
HEIMBERG, R.G. , HOPE, D.A. , DODGE, C.S. & BECKER, R.E. (1990) DSM-III-R subtypes of social phobia: comparison of generalized social phobics and public speaking phobics . Journal of Nervous and Mental Disease, 178, 172-179 .
16.
HOSMER, D.W. & LEMENSHOW, S. (1989) Applied Logistic Regression. New York: John Wiley & Sons.
17.
HWU, H.G. , YEH, E.K. & CHANG, L.Y. (1989) Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule . Acta Psychiatrica Scandinavica, 79, 136-147 .
18.
KESSLER, R.C. , MCGONAGLE, K.A. , ZHAO, S. , NELSON, C.B. , HUGHES, M. , ESHLEMAN, S. , WITTCHEN, H.U. & KENDLER, K.S. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey . Archives of General Psychiatry, 51, 8-19 .
19.
LEE, C.K. , KWAK, Y.S. , YAMAMOTO, J. , RHEE, H. , KIM, Y.S. , HAN, J.H. , CHOI, J.O. & LEE, Y.H. (1990a) Psychiatric epidemiology in Korea. Part I: gender and age differences in Seoul . Journal of Nervous and Mental Disorders, 178, 242-246 .
20.
LEE, C.K. , KWAK, Y.S. , YAMAMOTO, J. , RHEE, H. , KIM, Y.S. , HAN, J.H. , CHOI, J.O. & LEE, Y.H. (1990b) Psychiatric epidemiology in Korea. Part II: urban and rural differences . Journal of Nervous and Mental Disorders, 178, 247-252 .
21.
LEPINE, J.P. & LELLOUCH, J. (1995) Classification and epidemiology of social phobia . European Archives of Psychiatry and Clinical Neuroscience, 244, 290-296 .
22.
LIMA-COSTA, M.F. , BARRETO, S.M. , GUERRA, H.L. , FIRMO, J.O. , UCHOA, E. & VIDIGAL, P.G. (2001) Ageing with Trypanosoma cruzi infection in a community where the transmission has been interrupted: the Bambuí health and ageing study (BHAS) . International Journal of Epidemiology, 30, 887-893 .
23.
LIMA-COSTA, M.F.F. , UCHOA, E. , GUERRA, H.L. , FIRMO, J.O. , VIDIGAL, P.G. & BARRETO, S.M. (2000) The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil . Revista de Saude Publica, 34, 126-135 .
24.
LINDAL, E. & STEFANSSON, J.G. (1993) The lifetime prevalence of anxiety disorders in Iceland as estimated by the US National Institute of Mental Health Diagnostic Interview Schedule . Acta Psychiatrica Scandinavica, 88, 29-34 .
25.
LOPES, C. (1994) Reliability of the Brazilian version of the CIDI in a case-control study of risk factors for drug abuse among adults in Rio de Janeiro . Bulletin of Pan American Health Organization, 28, 34-41 .
26.
MAGEE, W.J. , EATON, W.W. , WITTCHEN, H.U. , McGONAGLE, K.A. & KESSLER, R.C. (1996) Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey . Archives of General Psychiatry, 53, 159-168 .
27.
MENEC, V.H. , CHIPPERFIELD, J.G. & PERRY, R.P. (1999) Self-perceptions of health: a prospective analysis of mortality, control, and health . Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 54, P85-P93 .
28.
OFFORD, D.R. , BOYLE, M.H. , CAMPBELL, D. , GOERING, P. , LIN, E. , WONG, M. & RACINE, Y.A. (1996) One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age . Canadian Journal of Psychiatry, 41, 559-563 .
29.
SCHNEIER, F.R. , JOHNSON, J. , HORNIG, C.D. , LIEBOWITZ, M.R. & WEISSMAN, M.M. (1992) Social phobia: comorbidity and morbidity in an epidemiologic sample . Archives of General Psychiatry, 49, 282-288 .
30.
STATA CORPORATION (1997) Stata statistical software. 7.0. College Station, TX: Stata Corporation .
31.
STEIN, M.B. , WALKER, J.R. & FORDE, D.R. (1994) Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety . American Journal of Psychiatry, 151, 408-412 .
32.
SZEKELY, M. & HILGERT, M. (1999) The 1990s in Latin America: another decade of persistent inequality. Report no. 410. Washington, DC: Inter-American Development Bank, Research Department .
33.
THOMPSON, J.W. , BURNS, B.J. , BARTKO, J. , BOYD, J.H. , TAUBE, C.A. & BOURDON, K.H. (1988) The use of ambulatory services by persons with and without phobia . Medical Care, 26, 183-198 .
34.
WEILLER, E. , BISSERBE, J.C. , BOYER, P. , LEPINE, J.P. & LECRUBIER, Y. (1996) Social phobia in general health care: an unrecognised undertreated disabling disorder . British Journal of Psychiatry, 168, 169-174 .
35.
WEISSMAN, M.M. , BLAND, R.C. , CANINO, G.J. , GREENWALD, S. , LEE, C.K. , NEWMAN, S.C. , RUBIO-STIPEC, M. & WICKRAMARATNE, P.J. (1996) The cross-national epidemiology of social phobia: a preliminary report . International Clinical Psychopharmacology, 11(Suppl. 3), 9-14 .
36.
WITTCHEN, H.U. , ESSAU, C.A. , VON ZERSSEN, D. , KRIEG, J.C. & ZAUDIG, M. (1992) Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study . European Archives of Psychiatry and Clinical Neuroscience, 241, 247-258 .
37.
WITTCHEN, H.U. , FUETSCH, M. , SONNTAG, H. , MULLER, N. & LIEBOWITZ, M. (2000) Disability and quality of life in pure and comorbid social phobia: findings from a controlled study . European Psychiatry, 15, 46-58 .
38.
WORLD HEALTH ORGANIZATION (1993) Composite International Diagnostic Interview (CIDI). 1.1. Geneva: WHO .
