Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 15, 2019
RESEARCH ARTICLE

The Prevalence of Specific Phobia by Age in an Italian Nationwide Survey: How Much Does it Affect the Quality of Life?



Federica Sancassiani1, *, Ferdinando Romano2, Matteo Balestrieri3, Filippo Caraci4, 5, Guido Di Sciascio6, Filippo Drago4, Maria Carolina Hardoy1, Maria Francesca Moro1, 7, Rita Roncone8, Martina Piras1, Antonio Preti1, Liliana Dell’Osso9, Carlo Faravelli10, Mauro Giovanni Carta1
1 University of Cagliari,Cagliari,Italy
2 University of Rome “La Sapienza”,Rome,Italy
3 Psychiatry Unit, DAME, University of Udine,Udine,Italy
4 University of Catania,Catania,Italy
5 I.R.C.C.S. Associazione Oasi Maria SS. ONLUS-Troina, Troina, Italy
6 University of Bari, Bari, Italy
7 Mailman School of Public Health Columbia University,Columbia, NY, US
8 University of L’Aquila,L’Aquila,Italy
9 University of Pisa,Pisa,Italy
10 University of Florence,Florence,Italy

Abstract

Introduction:

The study aimed to see if a community survey conducted by clinical interviewers with semi-structured psychiatric interviews shows lifetime prevalence rates of Specific Phobia (SP) similar to those found by surveys carried out by lay interviewers and if the high level of impairment found in SP may be confirmed.

Methods:

This is a community survey on an Italian nationwide sample randomly selected from registers of municipalities. Tools: semi-structured ANTAS psychiatric interview derived from the SCID-DSM-IV, carried out by clinicians (psychologists or physicians); Short Form Health Survey (SF-12) as a measure of Quality of Life (QoL). Analyses: means of the χ2 test odds ratios were adopted to test several associations regarding SP prevalence. One-way ANOVA was used to compare different groups on attributable burden due to SP and/or other disorders in worsening QoL.

Results:

The lifetime prevalence of SP was 2.3%. No difference was found by age class. Females showed more than twice the frequency of males (p<0.0001). The disorders showing the closest association with SP were: social phobia (OR=17.53); general anxiety disorder (OR=11.57); anorexia (OR=11.13) and agoraphobia (OR=10.03), but also obsessive compulsive disorders (OR=8.8), eating disorders (OR=7.2), panic disorder (OR=5.9), post-traumatic stress disorder (OR=5.8), and major depressive disorder (OR=4.8) presented an association that achieved statistical significance. The QoL of people with SP and at least one disorder of anxiety, mood or eating in comorbidity, measured as a score at SF12, was worse than controls without SP (p <0.001) but that of people with SP without co-morbidity was not (p = 0.809).

Conclusion:

An epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of SP, at least from the public health perspective. Future prospective studies will better clarify the role of SP in the context of anxiety disorders.



Article Information


Identifiers and Pagination:

Year: 2019
Volume: 15
First Page: 30
Last Page: 37
Publisher Id: CPEMH-15-30
DOI: 10.2174/1745017901915010030

Article History:

Received Date: 02/01/2019
Revision Received Date: 24/01/2019
Acceptance Date: 24/01/2019
Electronic publication date: 20/02/2019
Collection year: 2019

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 723
Abstract HTML Views: 585
PDF Downloads: 226
ePub Downloads: 192
Total Views/Downloads: 1726

Unique Statistics:

Full-Text HTML Views: 466
Abstract HTML Views: 331
PDF Downloads: 149
ePub Downloads: 120
Total Views/Downloads: 1066
Geographical View

© 2019 Sancassiani et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the DDepartment of Medical Sciences and Public Health, University of Cagliari,Cagliari,Italy; Tel: +39 3493119215; E-mail: federicasancassiani@yahoo.it




1. INTRODUCTION

Although Specific Phobia (SP) is a topic not often addressed by epidemiologists [1Tsuang MT, Tohen M. Textbook in Psychiatric Epidemiology 2nd ed. 2nd ed.2002.[http://dx.doi.org/10.1002/0471234311] ], we have today a series of studies that place the lifetime prevalence of this disorder from 7.4% to 12.5% [2Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62(6): 593-602.[http://dx.doi.org/10.1001/archpsyc.62.6.593] [PMID: 15939837] -10Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820] ]. A milestone was the World Health Organization’s World Mental Health Survey, an epidemiology project conducted on 25 representative population-based samples coming from 22 countries and on 124.902 interviews in total [10Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820] ]. This large survey has found overall cross-national lifetime SP prevalence rates of 7.4%, with higher frequencies in females (9.8 vs.. 4.9%) and in high- and higher-middle-income countries [10Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820] ].

Large-scale epidemiological studies have established that specific phobia is associated with a high level of disability and co-morbidity with other psychiatric disorders [7Stinson FS, Dawson DA, Patricia Chou S, et al. The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 2007; 37(7): 1047-59.[http://dx.doi.org/10.1017/S0033291707000086] [PMID: 17335637] ]. In fact, the National Comorbid Survey shows a considerable impairment in people having a diagnosis of SP, with 34.2% reporting significant role impairments, even higher than in agoraphobia (26.5%), and similar to social phobia 33.5% [11Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53(2): 159-68.[http://dx.doi.org/10.1001/archpsyc.1996.01830020077009] [PMID: 8629891] ]. This shows that comorbid phobias are more severe and impairing than phobias without comorbidity [11Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53(2): 159-68.[http://dx.doi.org/10.1001/archpsyc.1996.01830020077009] [PMID: 8629891] ].

Based on the results of epidemiological studies, it is commonly accepted that the onset of phobia is precocious and precedes that of other psychiatric disorders in comorbidity [10Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820] ]. However, one of the few studies conducted through repeated interviews on the same cohort showed a cumulative incidence that increased up to 50 years (age of last evaluation), with a prevalence in the cohort that increased fivefold from 1978 to 2008 [12Angst J, Paksarian D, Cui L, et al. The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich cohort Study. Epidemiol Psychiatr Sci 2016; 25(1): 24-32.[http://dx.doi.org/10.1017/S204579601500027X] [PMID: 25802979] ]. These results appear to indicate that SP onset is not restricted to youth groups. It is to be noted that the latter research differs from others because in this survey, the diagnoses were conducted by clinicians through highly structured interviews and not by lay interviewers.

It is discussed whether a methodology adopting lay interviewers and rigid structured interviews can identify cases that overlap with those that would be recognized in a clinical setting [13Sancassiani F, Carmassi C, Romano F, et al. Impairment of Quality of Life associated with Lifetime Diagnosis of PTSD in women of a national survey in Italy. Clin Pract Epidemiol Ment Health 2019. submitted-15Carta MG, Angst J. Screening for bipolar disorders: A public health issue. J Affect Disord 2016; 205: 139-43.[http://dx.doi.org/10.1016/j.jad.2016.03.072] [PMID: 27442457] ]. In fact, the diagnoses derived from non-clinical interviewers might have identified a broader spectrum of cases (including sub-threshold ones) than those known in clinical practice. Although clinical reappraisal studies show sufficient concordance between structured interview-based and clinical diagnoses of specific phobia [16Haro JM, Arbabzadeh-Bouchez S, Brugha TS, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006; 15(4): 167-80.[http://dx.doi.org/10.1002/mpr.196] [PMID: 17266013] ], the methodology of such reappraisal studies has raised relevant critical issues [15Carta MG, Angst J. Screening for bipolar disorders: A public health issue. J Affect Disord 2016; 205: 139-43.[http://dx.doi.org/10.1016/j.jad.2016.03.072] [PMID: 27442457] ].

In contrast, the methodology based on structured interviews and the collection of all symptoms by lay interviewers may provide information about prevalence and relevance of sub-syndromic pictures [17Pincus HA, Davis WW, McQueen LE. ‘Subthreshold’ mental disorders. A review and synthesis of studies on minor depression and other ‘brand names’. Br J Psychiatry 1999; 174: 288-96.[http://dx.doi.org/10.1192/bjp.174.4.288] [PMID: 10533546] ]. The results of epidemiological surveys in the community and primary care settings adopting such a methodology have in fact clarified that there is an impact in terms of disability associated with sub-syndromic features in several disorders [18Rucci P, Gherardi S, Tansella M, et al. Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. J Affect Disord 2003; 76(1-3): 171-81.[http://dx.doi.org/10.1016/S0165-0327(02)00087-3] [PMID: 1294 3947] ]. Such results appear to indirectly confirm the validity of the approach: if these conditions are not clinically confirmed, they should not be associated with disability. But in the case of SP, the question arises as to whether comorbidities with other clinically relevant and severely disabling pathologies (which is very frequent) may lead sub-threshold cases of SP to apprear as an association with disability that may not be caused by the SP per se but by the conditions in co-morbidity. It is, therefore, necessary to clarify to what extent the levels of impairment found in people with social phobia depend on this disorder, to what extent they are the consequence of comorbid disorders and how much they may not depend on the amplifying effect of multiple concomitant disorders.

We consider this of interest to study how much SP may impair the perception of Quality of Life (QoL). This concept involves physical and psychological components of wellness [19Mantovani G, Astara G, Lampis B, et al. Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different “psychosocial” treatment approaches. A randomized clinical trial. Support Care Cancer 1996; 4(2): 129-40. [PubMed].[http://dx.doi.org/10.1007/BF01845762] [PMID: 8673350] ]. Thus, QoL is used as an outcome measure in chronic diseases and in those that require long-term treatments and which greatly impact daily life [20Mantovani G, Astara G, Lampis B, et al. Impact of psychosocial intervention on the quality of life of elderly cancer patients. Psychooncology 1996; 5: 127-35.[http://dx.doi.org/10.1002/(SICI)1099-1611(199606)5:2<127::AID-PON220>3.0.CO;2-L] -22Sancassiani F, Machado S, Ruggiero V, et al. The management of fibromyalgia from a psychosomatic perspective: an overview. Int Rev Psychiatry 2017; 29(5): 473-88.[http://dx.doi.org/10.1080/09540261.2017.1320982] [PMID: 2868 1628] ].

Our study, therefore, intends to see if a community survey conducted by clinical interviewers with semi-structured psychiatric interviews will show lifetime prevalence rates of SP similar to those found in surveys carried out by lay interviewers and if the high level of impairment found in SP is confirmed.

2. METHODS

The methodology of the epidemiological study has been described in detail in a previously published paper [23Carta MG, Aguglia E, Bocchetta A, et al. The use of antidepressant drugs and the lifetime prevalence of major depressive disorders in Italy. Clin Pract Epidemiol Ment Health 2010; 6: 94-100.[http://dx.doi.org/10.2174/1745017901006010094] [PMID: 21253459] ].

2.1. Design

It is a community epidemiologic survey.

2.2. Setting

The survey was conducted in six Italian regions (Abruzzi, Friuli-Venezia Giulia, Puglia, Sicily, Sardinia and Tuscany) representative of the geographical distribution and economic diversity of the 20 Italian regions. In each region, one urban, one suburban and at least one rural area were chosen.

2.3. Sample

The sample was randomly selected from the records of the municipalities involved. Randomization was conducted after stratification in eight cells by gender and age groups 18-29; 30-44; 45-64; >64. People selected were contacted by phone and email. The interviews were conducted face-to-face. Diagnoses were conducted according to DSM-IV using a semi-structured interview (ANTAS-SCID-IV) carried out by physicians or clinical psychologists [23Carta MG, Aguglia E, Bocchetta A, et al. The use of antidepressant drugs and the lifetime prevalence of major depressive disorders in Italy. Clin Pract Epidemiol Ment Health 2010; 6: 94-100.[http://dx.doi.org/10.2174/1745017901006010094] [PMID: 21253459] ]. The Italian version [24Apolone G, Mosconi P, Quattrociocchi L, Gianicolo EA, Groth N, Ware JE. Questionario sullo stato di salute SF-12 Versione Italiana 2001.] of the Short Form Health Survey (SF-12) [25Ware J Jr, Kosinski M, Keller SDA. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34(3): 220-33.[http://dx.doi.org/10.1097/00005650-199603000-00003] [PMID: 8628 042] ] was used to measure the QoL.

2.4. Statistical Analysis

The measure of frequency adopted was lifetime prevalence.

The odds ratio for DSM-IV simple phobia lifetime prevalence by age, gender and co-morbidity with DSM-IV anxiety, mood and eating disorders diagnosis was calculated using one group for each table as a “pivot”.

Table 1
Lifetime Prevalence of Specific Phobia by sex and age.


Table 2
Comorbidity between Specific Phobia and Other Disorders.


The specific frequencies and the measure of association were calculated in people <30 years old vs.. ≥30 years old; these were calculated concerning any anxiety, mood or eating disorder in comorbidity as well as for comorbidity with Major Depressive Disorder (MDD), Panic Disorder (PD) and Generalized Anxiety Disorder (GAD).

Statistical significance in these analyses was calculated by means of the χ2 test odds ratios as the measure of association and confidence intervals at 95% by adopting Miettinen’s simplified method [26Miettinen O. Confounding and effect-modification. Am J Epidemiol 1974 Nv; 100(5): 350-3.[http://dx.doi.org/10.1093/oxfordjournals.aje.a112044] ].

The numeric comparisons between the scores of SF-12 of the different groups as well as the comparison of the value of attributable burden derived from the SF-12 in different groups were made by means of One-way ANOVA.

The “attributable burden” due to SP in worsening QoL was calculated as the difference between the SF-12 score in a sample of people without SP and the SF-12 score of the sample with SP. This control group of people without SP was randomly extracted in a stratified (by gender and age) block created for each person with SP, including all people without SP of the same gender and ±2 years old from the database of the research.

A similar matching after block (by gender and age) was used to calculate the weight of the SP in worsening the QoL in disorders with more frequent comorbidity (MDD, PD and GAD). That is to say, a group of persons with that specific disease (MDD, PD and GAD) was made, but without the SP, from the database matching 1/2 with each person with this specific disorder plus SP. The attributable burden was calculated as the difference between the SF12 score of people with the disorder (MDD, PD or GAD) and without SP and the SF-12 score of people with the same disorder with SP.

2.5. Ethical Aspects

The researchers provided full information about the aims of the research, about the possibility of terminating the interview and data protection and privacy laws to each interviewed person. The researchers explained that the data would be used as an anonymous database to guarantee confidentiality. Each participant signed a written informed consent form. Each step of the study was carried out in accordance with the Helsinki Declaration.

Table 3
Comorbidity between Specific Phobia and other disorders in young people.


Table 4
Comparison on Quality of Life of people with Specific Phobia and people without Specific Phobia (matching controls ½ from the community sample drawn after standardization by gender and age).


3. RESULTS

The lifetime prevalence of SP in the overall sample was 2.3%. No variation of frequencies by age class emerged, but females had more than twice the frequency of males (3.17 vs.. 1.18%, p <0.0001) Table 1. GAD (18.5%), PD (16.6%) and MDD (16.6%) were the most common in people with SP between anxiety, mood or eating disorders Table 2. However, in relation to the frequencies in people without SP, the disorders showing the closest association with SP were: Social Phobia (OR=17.53); GAD (OR=11.57); Anorexia (OR=11.13) and Agoraphobia (OR=10.03), but also Obsessive Compulsive Disorders (OR=8.8), Eating Disorders (OR=7.2), Panic Disorder (OR=5.9), PTSD (OR=5.8), Major Depressive Disorder (OR=4.8) presented an association that achieved statistical significance Table 2.

People with SP under 30 years of age did not show a higher frequency of at least one diagnosis (anxiety, mood or eating disorder) in comorbidity compared to people over 29. The same occurred for comorbidity with MDD, PD and GAD Table 3.

The QoL of people with SP was worse than that of controls without-SP matched by gender and age (p = 0.005).

The QoL of people with SP and at least one comorbid of anxiety, mood or eating disorder measured as a score at SF12, was worse than controls without SP (p <0.001) but of people with SP without co-morbidity, it was not worse (p = 0.809) Table 4.

The attributable burden in worsening QoL due to SP without comorbidity with anxiety mood or eating disorders was found lower than all the psychiatric disorders (MDD, PD, Eating Disorders, PTSD and OCD) and all non-psychiatric diseases (Celiac Disease, Multiple Sclerosis, Wilson’s Disease and Carotid Atherosclerosis) Table 5. On the contrary, attributable burden in worsening QoL due to SP in comorbidity with anxiety mood or eating disorders was found similar to that of diseases such as Wilson’s Disease and Carotid Atherosclerosis and to psychiatric disorders such as MDD, PD, Eating Disorder, PTSD and OCD; it was found higher than the attributable burden due to Celiac Disease and Panic Disorder and lower only than a severe and disability-associated disease such as Multiple Sclerosis Table 5. The difference between attributable burden in worsening QoL due to SP with comorbidity with anxiety mood or eating disorders and the attributable burden due to SP without comorbidity was of statistical significance.

Table 6 shows how the association of SP in co-morbidity worsens the QoL of people with MDD, PD and GAD to a statistically non-significant extent. In fact, the average scores at SF-12 in samples of people in the general population with these diagnoses but without SP were higher than those of people in our sample with these diagnoses in comorbidity with SP. However, in none of the three cases did the comparison reach statistical significance (MDD 33.0 ± 9.1 with SP vs. 35.5 ± 7.7 without SP, P=434; PD 33.3 ± 9.8 with SP vs. 34.55 ± 6.2 without SP, P=0.700; GAD 30.9 ± 7. with SP vs. 32.7 ± 7.5 without SP, P=0.560).

Even the attributable burden due to SP in the three sample of people with MDD, PD and GAD in comorbidity with SP was found lower than that due to SP comparing people with SP to those without. Thus, the impact of SP was found to be similar in people with MDD, PD and GAD and in people without such a diagnosis.

4. DISCUSSION

An epidemiological survey conducted on a national basis in Italy with diagnostic methods closer to clinical practice (clinical interviewers and use of semi-structured interviews) than those usually adopted in community surveys (lay interviewers and structured interviews) has found lower (2.3%) lifetime prevalence rates of SP in the community compared to the range found in surveys conducted with a different methodology (7.4-12.5%).

Table 5
Attributable burden in worsening Quality of Life due to Specific Phobia and comparison with other disorders.


Table 6
Worsening of Quality of Life in Specific Phobia in co-morbid disorders in comparison with disorders without Specific Phobia and Attributable Burden due to Specific Phobia.


Women confirmed frequencies of 2.5 times higher than males, but unlike other studies, the frequencies were found stable in different age groups. This datum is consistent with the result of the Zurich study [12Angst J, Paksarian D, Cui L, et al. The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich cohort Study. Epidemiol Psychiatr Sci 2016; 25(1): 24-32.[http://dx.doi.org/10.1017/S204579601500027X] [PMID: 25802979] ] which showed a stable incidence rate in different ages; it must, in fact, be considered that the average duration of the disorder is not all life-long but about 20 years, thus a stable incidence rate (and an increase in the cumulative rate over the years) may produce a stable lifetime prevalence. The Swiss study is the only one, like ours, that employed clinical interviewers [12Angst J, Paksarian D, Cui L, et al. The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich cohort Study. Epidemiol Psychiatr Sci 2016; 25(1): 24-32.[http://dx.doi.org/10.1017/S204579601500027X] [PMID: 25802979] ].

The study confirms a close association of SP with other psychiatric disorders, in particular, anxiety disorders, especially Social Phobia, Agoraphobia, Generalized Anxiety Disorder and Panic Disorder, but also with other psychiatric disorders such as Anorexia and Major Depressive Disorder. The frequency of co-morbidity with Major Depressive Disorder is slightly lower than that reported in the WMH survey, while the association with anxiety disorders does not appear to show differences [10Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820] ]. The frequency of co-morbidities with other disorders does not differ under 30 years, and also not for the association with at least one diagnosis of mood, anxiety or eating disorders.

Our study did not evaluate the age of onset of SP or other comorbid disorders. However, our data on the stability of the prevalence of SP in the different age groups, as well as the stability of frequency of co-morbid disorders between young and elderly people did not appear to support the hypothesis that SP can be considered a frequent antecedent insurgent in youth always of other disorders, especially anxiety disorder that would appear later.

The impact produced by the disorder on the QoL was found to be considerable, but on analyzing the data in detail, this impact was found to be much higher in the forms of SP in comorbidity with other disorders than in the forms in which SP is present as the only psychopathological element. In this case, the burden due to disorder in worsening the QoL is quite low. This was also evidenced by the fact that the attributable burden in worsening QoL due to non-comorbid SP was significantly lower than that of all other compared disorders, both psychiatric (MDD, PD, Eating Disorders, Agoraphobia, PTSD) as well non-psychiatric (Multiple Sclerosis, Wilson's Disease, Celiac Disease and Carotid Atherosclerosis). On the contrary, the attributable burden in worsening QoL due to SP with comorbidity with anxiety mood or eating disorders was found similar to that of diseases such as Wilson’s Disease and Carotid Atherosclerosis and to psychiatric disorders such as MDD, PD, Eating Disorder, PTSD and OCD; the burden was found higher than the attributable burden due to Celiac Disease and Panic Disorder and lower only than a severe and disability-associated disease such as Multiple Sclerosis. Although in MDD, PD and DAG, the association with SP appears to aggravate the QoL, this aggravation is not worse than that caused by the same disorders when not in comorbidity with SP. These results appear to put into perspective the statement that SP is associated with a substantial impairment [10Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820] , 11Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53(2): 159-68.[http://dx.doi.org/10.1001/archpsyc.1996.01830020077009] [PMID: 8629891] ].

In conclusion, an epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of a disorder such as SP, at least from the public health perspective, owing to:

  1. the frequency of the disorder in the community, so its impact in terms of public health appears to be lower than the estimate using lay interviewers and structured interviews for diagnosis;
  2. the burden in worsening the QoL attributable to the disorder is very low if it excludes the sole effect of the forms in comorbidity. On the other hand, in co-morbid forms, the presence of SP does not appear to cause an amplification of the impairment. In fact, the level of the QoL in MDD, PD and GAD without SP is not worse than in the same three disorders in comorbidity with SP;
  3. the data appear to produce some doubts about the hypothesis that SP may be an antecedent of more serious disorders, useful in identification in terms of prevention.

The study has undoubted limitations: firstly, the age of SP onset has not been studied and the different sub-types have not been identified. Furthermore, the transversal design makes it possible to generate hypotheses rather than to verify them. However, the same methodology by adopting the formula “Attributable Burden of Specific Disorder = SF-12 score in a matched sample of people without the disorder SF-12 score of people with diagnosis of this disorder” was proposed also in previous studies on the same database for measuring the attributable burden due to several disorders in worsening of QoL [27Carta MG, Tondo L, Balestrieri M, et al. Sub-threshold depression and antidepressants use in a community sample: searching anxiety and finding bipolar disorder. BMC Psychiatry 2011; 11: 164.[http://dx.doi.org/10.1186/1471-244X-11-164] [PMID: 21985128] -33Carta MG, Conti A, Lecca F, et al. The Burden of Depressive and Bipolar Disorders in Celiac Disease. Clin Pract Epidemiol Ment Health 2015; 11: 180-5.[http://dx.doi.org/10.2174/1745017901511010180] [PMID: 26962323] ]. This method guarantees the homogeneity of the control groups without the specific disease analyzed, used as a comparison criterion to calculate the attributable burden due to a given disease or disorder, thus allowing a reliable comparison between the attributable burden of different diseases.

CONCLUSION

An epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of SP at least from the public health perspective. Future prospective studies will better clarify the role of SP in the context of anxiety disorders.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The ethical committee of the Italian National Health Institute, Rome (“Istituto Superiore della Sanità”) approved the study.

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.

CONSENT FOR PUBLICATION

Written and informed consents were obtained from each participant.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Tsuang MT, Tohen M. Textbook in Psychiatric Epidemiology 2nd ed. 2nd ed.2002.[http://dx.doi.org/10.1002/0471234311]
[2] Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62(6): 593-602.[http://dx.doi.org/10.1001/archpsyc.62.6.593] [PMID: 15939837]
[3] Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51(1): 8-19.[http://dx.doi.org/10.1001/archpsyc.1994.03950010008002] [PMID: 8279933]
[4] Bijl RV, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998; 33(12): 587-95.[http://dx.doi.org/10.1007/s001270050098] [PMID: 9857791]
[5] Alonso J, Angermeyer MC, Bernert S, et al. (ESEMeD) Project. (2004). 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2000; 420: 28-37.
[6] Wells JE, Browne MA, Scott KM, McGee MA, Baxter J, Kokaua J. Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey. Aust N Z J Psychiatry 2006; 40(10): 845-54.[http://dx.doi.org/10.1080/j.1440-1614.2006.01903.x] [PMID: 1695 9010]
[7] Stinson FS, Dawson DA, Patricia Chou S, et al. The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 2007; 37(7): 1047-59.[http://dx.doi.org/10.1017/S0033291707000086] [PMID: 17335637]
[8] de Graaf R, ten Have M, van Gool C, van Dorsselaer S. Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psychiatry Psychiatr Epidemiol 2012; 47(2): 203-13.[http://dx.doi.org/10.1007/s00127-010-0334-8] [PMID: 21197531]
[9] Grenier S, Schuurmans J, Goldfarb M, et al. The epidemiology of specific phobia and subthreshold fear subtypes in a community-based sample of older adults. Depress Anxiety 2011; 28(6): 456-63.[http://dx.doi.org/10.1002/da.20812] [PMID: 21400642]
[10] Wardenaar KJ, Lim CCW, Al-Hamzawi AO, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47(10): 1744-60.[http://dx.doi.org/10.1017/S0033291717000174] [PMID: 28222820]
[11] Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53(2): 159-68.[http://dx.doi.org/10.1001/archpsyc.1996.01830020077009] [PMID: 8629891]
[12] Angst J, Paksarian D, Cui L, et al. The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich cohort Study. Epidemiol Psychiatr Sci 2016; 25(1): 24-32.[http://dx.doi.org/10.1017/S204579601500027X] [PMID: 25802979]
[13] Sancassiani F, Carmassi C, Romano F, et al. Impairment of Quality of Life associated with Lifetime Diagnosis of PTSD in women of a national survey in Italy. Clin Pract Epidemiol Ment Health 2019. submitted
[14] Altamura AC, Carta MG, Tacchini G, Musazzi A, Pioli MR. Prevalence of somatoform disorders in a psychiatric population: an Italian nationwide survey. Eur Arch Psychiatry Clin Neurosci 1998; 248(6): 267-71.[http://dx.doi.org/10.1007/s004060050048] [PMID: 9928903]
[15] Carta MG, Angst J. Screening for bipolar disorders: A public health issue. J Affect Disord 2016; 205: 139-43.[http://dx.doi.org/10.1016/j.jad.2016.03.072] [PMID: 27442457]
[16] Haro JM, Arbabzadeh-Bouchez S, Brugha TS, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006; 15(4): 167-80.[http://dx.doi.org/10.1002/mpr.196] [PMID: 17266013]
[17] Pincus HA, Davis WW, McQueen LE. ‘Subthreshold’ mental disorders. A review and synthesis of studies on minor depression and other ‘brand names’. Br J Psychiatry 1999; 174: 288-96.[http://dx.doi.org/10.1192/bjp.174.4.288] [PMID: 10533546]
[18] Rucci P, Gherardi S, Tansella M, et al. Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. J Affect Disord 2003; 76(1-3): 171-81.[http://dx.doi.org/10.1016/S0165-0327(02)00087-3] [PMID: 1294 3947]
[19] Mantovani G, Astara G, Lampis B, et al. Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different “psychosocial” treatment approaches. A randomized clinical trial. Support Care Cancer 1996; 4(2): 129-40. [PubMed].[http://dx.doi.org/10.1007/BF01845762] [PMID: 8673350]
[20] Mantovani G, Astara G, Lampis B, et al. Impact of psychosocial intervention on the quality of life of elderly cancer patients. Psychooncology 1996; 5: 127-35.[http://dx.doi.org/10.1002/(SICI)1099-1611(199606)5:2<127::AID-PON220>3.0.CO;2-L]
[21] Baiano M, Salvo P, Righetti P, et al. Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review. BMC Psychiatry 2014; 14: 165.[http://dx.doi.org/10.1186/1471-244X-14-165] [PMID: 24898768]
[22] Sancassiani F, Machado S, Ruggiero V, et al. The management of fibromyalgia from a psychosomatic perspective: an overview. Int Rev Psychiatry 2017; 29(5): 473-88.[http://dx.doi.org/10.1080/09540261.2017.1320982] [PMID: 2868 1628]
[23] Carta MG, Aguglia E, Bocchetta A, et al. The use of antidepressant drugs and the lifetime prevalence of major depressive disorders in Italy. Clin Pract Epidemiol Ment Health 2010; 6: 94-100.[http://dx.doi.org/10.2174/1745017901006010094] [PMID: 21253459]
[24] Apolone G, Mosconi P, Quattrociocchi L, Gianicolo EA, Groth N, Ware JE. Questionario sullo stato di salute SF-12 Versione Italiana 2001.
[25] Ware J Jr, Kosinski M, Keller SDA. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34(3): 220-33.[http://dx.doi.org/10.1097/00005650-199603000-00003] [PMID: 8628 042]
[26] Miettinen O. Confounding and effect-modification. Am J Epidemiol 1974 Nv; 100(5): 350-3.[http://dx.doi.org/10.1093/oxfordjournals.aje.a112044]
[27] Carta MG, Tondo L, Balestrieri M, et al. Sub-threshold depression and antidepressants use in a community sample: searching anxiety and finding bipolar disorder. BMC Psychiatry 2011; 11: 164.[http://dx.doi.org/10.1186/1471-244X-11-164] [PMID: 21985128]
[28] Carta MG, Preti A, Moro MF, et al. Eating disorders as a public health issue: prevalence and attributable impairment of quality of life in an Italian community sample. Int Rev Psychiatry 2014; 26(4): 486-92.[http://dx.doi.org/10.3109/09540261.2014.927753] [PMID: 25137115]
[29] Carta MG, Moro MF, Aguglia E, et al. The attributable burden of panic disorder in the impairment of quality of life in a national survey in Italy. Int J Soc Psychiatry 2015; 61(7): 693-9.[http://dx.doi.org/10.1177/0020764015573848] [PMID: 25770204]
[30] Carta MG, Moro MF, Lorefice L, et al. The risk of Bipolar Disorders in Multiple Sclerosis. J Affect Disord 2014; 155: 255-60.[http://dx.doi.org/10.1016/j.jad.2013.11.008] [PMID: 24295600]
[31] Carta MG, Sorbello O, Moro MF, et al. Bipolar disorders and Wilson’s disease. BMC Psychiatry 2012; b12(1): 52.[http://dx.doi.org/10.1186/1471-244X-12-52] [PMID: 22646910]
[32] Carta MG, Lecca ME, Saba L, et al. Patients with carotid atherosclerosis who underwent or did not undergo carotid endarterectomy: outcome on mood, cognition and quality of life. BMC Psychiatry 2015; 15: 277.[http://dx.doi.org/10.1186/s12888-015-0663-y] [PMID: 26563766]
[33] Carta MG, Conti A, Lecca F, et al. The Burden of Depressive and Bipolar Disorders in Celiac Disease. Clin Pract Epidemiol Ment Health 2015; 11: 180-5.[http://dx.doi.org/10.2174/1745017901511010180] [PMID: 26962323]

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open