The impact of social phobia on quality of life

Although social phobia is a prevalent mental disorder in the general population, it has only recently received clinical and public attention and very few and rather general data are currently available on the general and disease-specific impairments, disabilities, handicaps and economic burdens associated with social phobia. This report summarizes findings from a case-control study in which quality of life and other indices of impairment in 65 subjects with social phobia but without significant comorbidity of other psychiatric disorders (pure social phobia) were compared to those in a matched control group of 65 subjects with a history of herpes infection. On the basis of the standardized Composite International Diagnostic Interview (CIDI, core version 1.1), the subjects with social phobia had been chronically impaired clinically for more than two decades, with an average duration of 22.9 years and an onset predominantly in childhood or adolescence. As assessed by the Social Functioning (SF-36) questionnaire, these subjects had a significantly lower quality of life, particularly in the scales measuring vitality, general health, mental health, role limitations due to emotional health and social functioning. Standardized summed scores for mental health components of the SF-36 showed that 23.1% of all the subjects with social phobia were severely impaired and 24.6% were significantly impaired compared to only 4.5% of control subjects impaired. Work productivity in the week before the study day, assessed by the Work Productivity And Impairment (WPAI) questionnaire, was significantly diminished in the subjects with social phobia, as indicated by (1) a threefold higher rate of unemployed cases, (2) a significantly elevated rate of mean work hours missed due to social phobia problems and (3) a significantly higher number of subjects reporting significant impairments in work performance. Slightly elevated rates of current (past 4 weeks) treatment by mental health specialists were found (9.2%) in the subjects with social phobia, and higher rates of lifetime psychotropic medication use (24.6%). Overall, these findings emphasize that social phobia is a chronic, impairing anxiety disorder, which results in considerable subjective suffering and has a long-term negative impact on work performance and social relationships. Current disabilities and impairments are usually less pronounced than in the past, presumably due to adaptive behaviors in the lifestyle of the respondents. Our data also suggest that social phobia is poorly recognized and treated by the health care and mental health system.