Clinical staging model applied to young people presenting with social anxiety

Although the use of illness-staging models in clinical medicine has proved particularly useful, the concept has not been widely applied in mental health. Here, we apply a clinical staging framework to a population of help-seeking young people presenting with social anxiety. The goal was to provide a detailed description of common clinical stage of those presenting for treatment of social anxiety, and to delineate the associations between symptom type, severity and clinical stage.

The results of a structured clinical interview along with background clinical information formed the basis for consensus-derived decisions regarding clinical stage. Subjects also completed self-report measures to assess anxiety and depressive symptoms. Comparisons were conducted largely between those subjects who were considered to have reached a critical clinical threshold for discrete or progressive disorders (i.e., those staged at two and beyond) and those with 'attenuated syndromes' (stage 1b - 69% of subjects).

One hundred forty-three subjects (63% male, mean age = 22.1 years) were clinically assessed prior to entry into active treatment programmes. Subjects assigned to stage two or above reported more psychological distress, higher depression scores and more alcohol use. However, these subjects did not report more severe anxiety symptoms. A higher incidence of substance misuse was a significant feature of those in later clinical stages.

The study suggests that those who present with social anxiety are characterized by a broad range of symptom severity, with a small, though significant proportion representing individuals whose mental health problems have already progressed to a stage characterized by greater co-morbidity and risk of chronicity. Our data specifically suggest that depressive symptoms and substance abuse/dependence may differentiate those in earlier and later clinical stages.