Epidemiology and psychological treatment of social phobia
Başlık çevirisi mevcut değil.
- Tez No: 400336
- Danışmanlar: PROF. DR. W. J. M. J. CUIJPERS, DR. A. VAN STRATEN, DR. R. DE GRAAF
- Tez Türü: Doktora
- Konular: Psikoloji, Psychology
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2009
- Dil: İngilizce
- Üniversite: Vrije Universiteit Amsterdam
- Enstitü: Yurtdışı Enstitü
- Ana Bilim Dalı: Klinik Psikoloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 124
Özet
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Özet (Çeviri)
Social phobia, which is a highly prevalent disorder, has only begun to receive increasing attentionrecently. Previous studies indicated that social phobia is a debilitating disorder. It is associatedwith decreased quality of life, high comorbidity rates with other mental disorders, and seriousfunctional impairments. Though research related to social phobia is increasing, the focus ofresearch has been on the burden of the disorder. However, to make a more comprehensiveexamination of social phobia there is a clear need for further study especially on the number ofsocial fears, incidence rates and economic costs of this mental disorder. For that reason, after acomprehensive examination of the burden of social phobia with a focus on the number of socialfears in the general Dutch population (chapter 2), the economic costs (chapter 3) and its incidence(chapter 4) were described.In the study described in chapter 2, we studied the epidemiology of social phobia in the generalDutch population. We used the data from the Netherlands Mental Health Survey and IncidenceStudy (NEMESIS) (N=7076). The 12-month prevalence of social phobia was 4.8% and the meanage of onset 19.1. Consistent with the previous studies being female, young, low educated, asingle parent, living alone, not having a paid job and having a somatic disorder are associatedwith 12-month social phobia. Moreover, we found a high comorbidity rate (66%) with otherDSM-III-R mental health disorders. As expected, 12-month social phobia was significantlyassociated with lower quality of life and higher service utilization. As an another aim of the studywe also examined whether social phobia can be seen as a dimensional condition in which anincreasing number of feared situations is related to decreased quality of life. Results showed thatas the number of feared social situations increases, the burden of social phobia rises. In the lightof these findings we concluded that social phobia is a debilitating disorder and in order to checkits severity, mental health care givers also should pay attention to the number of social fears,besides the functional impairments, service utilization and comorbidity.In chapter 3 economic costs of people with social phobia were compared to the costs of peoplewithout any mental disorder. In contrast to earlier studies, we also studied the relationshipbetween the economic costs and the type and number of social fears. In addition, we explored theeconomic burden of subthreshold social phobia. Using data of the second wave of theNetherlands Mental Health Survey and Incidence Study (NEMESIS) (n = 4,789). Costs which aredirect medical costs, direct non-medical and indirect non-medical costs were calculated for thereference year 2003. Analysis indicated the annual per capita total costs of social phobia as ?11,952 which is significantly higher than the total costs for people with no mental disorder, ?2,957. Although after the adjustment for mental and somatic comorbidity, the costs decreased to? 5,765, it was still significantly higher than the costs among people with no mental disorder.Furthermore, the costs of subthreshold social phobia (? 4,645) were also significantly higher thanthe costs for people without any mental disorder. These findings indicated that social phobia has asubstantial economic burden, and those of subthreshold social phobia approach those of the fullblowndisorder.Exploring the incidence of social phobia was an important aim of the present study. Theincidence rate of social phobia in the general population was (1.0%). We investigated a broadrange of etiological factors. In order to identify the high risk group for cost effective prevention atthe earliest stage, a methodology which is developed by Smith et al. (2004), was applied. Westudied sociodemographic factors, childhood trauma, parental psychiatric history, personalitytraits, and current stressors. Significant factors were: low education, low mastery, low selfesteem,emotional neglect in childhood and ongoing difficulties. To answer the question whetherincluding other mental disorders as risk indicators can explain the incidence of social phobiabetter, we included them in the model. After the inclusion, the incidence was found to be morecommon among those with low mastery, major depression, subthreshold social phobia, emotionalneglect, negative life events, and low education. However, the findings indicated that theinclusion of psychiatric history in the risk set did not improve the model overall. Therefore, weconcluded that an important portion of the incident cases of social phobia can be detected with asmall group of risk indicators.Earlier studies indicated that several psychological treatments have been developed to decreasethe burden of social phobia. Previous meta-analysis examined their effects and found promisingresults. However, they included non-randomized and uncontrolled studies which may haveresulted in an overestimation of the effects. In order to investigate whether the previous positiveresults of the earlier meta-analyses remain positive when we include only randomized trials, weconducted a new meta-analysis. Moreover, half of the included studies were all new studieswhich were not included in earlier meta-analyses. Consistent with former meta-analyses, wefound that psychological treatments are indeed effective in adults with social phobia. The overalleffect size we found (d = 0.70) is in the large range. However, the low to moderate heterogeneity(I2=29.8%) indicated that there might be possible systematic differences in the target populationsor in interventions. Series of subgroup analyses pointed that studies with waiting list controlgroups had higher effect sizes studies in which pill placebo control groups were used. Moreover,we found that studies which included subjects meeting diagnostic criteria for social phobia hadsignificantly lower effect sizes than studies in which no formal diagnosis was established. Ifmeeting a diagnostic criterion for social phobia will indicate a more severe form of social phobiathen we may suggest that psychological treatment of social phobia is more effective in mildcases.Based on our findings, we could conclude that social phobia - which is a prevalent disorder - issignificantly associated with impairments in quality of life, high levels of service use, increasedcomorbidity rates, serious functional impairments and considerable economic costs. However,though it is a debilitating disorder, psychological treatments of social phobia are effective.Furthermore, by detecting high risk groups, early intervention and prevention of it might bepossible.
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