Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys
Ymkje Anna de Vries,
Ali Al-Hamzawi,
Jordi Alonso,
Guilherme Borges,
Ronny Bruffaerts,
Brendan Bunting,
José Miguel Caldas-de-Almeida,
Alfredo H. Cia,
Giovanni De Girolamo,
Rumyana V. Dinolova,
Oluyomi Esan,
Silvia Florescu,
Oye Gureje,
Josep Maria Haro,
Chiyi Hu,
Elie G. Karam,
Aimee Karam,
Norito Kawakami,
Andrzej Kiejna,
Viviane Kovess-Masfety,
Sing Lee,
Zeina Mneimneh,
Fernando Navarro-Mateu,
Marina Piazza,
Kate Scott,
Margreet ten Have,
Yolanda Torres,
Maria Carmen Viana,
Ronald C. Kessler,
Peter de Jonge,
on behalf of the WHO World Mental Health Survey Collaborators
Affiliations
Ymkje Anna de Vries
Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen
Ali Al-Hamzawi
College of Medicine, Al-Qadisiya University
Jordi Alonso
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute
Guilherme Borges
National Institute of Psychiatry Ramón de la Fuente Muñiz
Ronny Bruffaerts
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg
Brendan Bunting
School of Psychology, Ulster University
José Miguel Caldas-de-Almeida
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa
Alfredo H. Cia
Anxiety Clinic and Research Center
Giovanni De Girolamo
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli
Rumyana V. Dinolova
National Center of Public Health and Analyses
Oluyomi Esan
Department of Psychiatry, College of Medicine, University of Ibadan
Silvia Florescu
National School of Public Health, Management and Development
Oye Gureje
Department of Psychiatry, University College Hospital
Josep Maria Haro
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona
Chiyi Hu
Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital
Elie G. Karam
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University
Aimee Karam
Institute for Development Research Advocacy and Applied Care (IDRAAC)
Norito Kawakami
National Institute of Mental Health, National Center for Neurology and Psychiatry
Andrzej Kiejna
Wroclaw Medical University
Viviane Kovess-Masfety
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University
Sing Lee
Department of Psychiatry, Chinese University of Hong Kong
Zeina Mneimneh
Survey Research Center, Institute for Social Research, University of Michigan
Fernando Navarro-Mateu
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia
Marina Piazza
Instituto Nacional de Salud
Kate Scott
Department of Psychological Medicine, University of Otago
Margreet ten Have
Trimbos Instituut, Netherlands Institute of Mental Health and Addiction
Yolanda Torres
Center for Excellence on Research in Mental Health, CES University
Maria Carmen Viana
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo
Ronald C. Kessler
Department of Health Care Policy, Harvard Medical School
Peter de Jonge
Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen
on behalf of the WHO World Mental Health Survey Collaborators
Abstract Background Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. Methods We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. Results Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3–2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4–1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7–1.8, p < 0.001). Conclusions This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
