Internet Survey of Social Anxiety Disorder and its Comorbidity in Chinese Populations

Jen-Yeu Chen¹, Ya-Mei Bai², Chao-Cheng Lin³

1. Department of Psychiatry, Yu-Li Veterans Hospital, Hualien, Taiwan.

2. Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan

3. Department of Psychiatry, National Taiwan University Hospital, Taiwan

Introduction:

   Social anxiety disorder (SAD) is a chronic psychiatric problem associated with functional impairment. SAD is characterized by the fear of humiliation or embarrassment in social or performance situations as well as the avoidance of such situations. With a life time prevalence of about 13 % and a 1-month prevalence rate of 4.5%, SAD is the most prevalent of the anxiety disorder (Magee et al. 1996).

    The majority of people with SAD report a lifetime prevalence of at least one other psychiatric disorder. In the NCS study, 81% of people with SAD reported a life-time history of at least one additional DSM-III-R disorder (Magee et al. 1996). A number of community and clinical studies showed that SAD is significantly comorbid with mood disorder and anxiety disorder. 41% of SAD patients reported co-occurrence with any mood disorder in life-time. Major depressive disorder was found to occur in 37.2% of people with SAD and dysthymia was found to occur in 14.6% (Magee et al. 1996). In the majority of patients with SAD and comorbid mood disorder, SAD comes before the mood disorder (Regier et al. 1998). Substance abuse or dependence, particular alcohol abuse/dependence, was found high prevalence rate in the community studies. Schneier et al. (1992) found a lifetime prevalence rate of 18.8% for alcohol abuse, and 13.0% for drug abuse in people with SAD.

    In a Korean study, Lee et al. (1990) found a lifetime prevalence rate of 0.53% of DSM-III SAD, and Hwu et al. (1989) reported a lifetime prevalence rate of 0.6% for DSM-III SAD in Taiwanese study. The lower rate of SAD in East Asia may show the lower rate of psychiatric disorders in general. Or, it may derive from the culture differences with regarding to the willingness to divulge information assessed in structured clinical interview. This study conducted a survey for the occurrence of SAD and its comorbidity via the internet in Taiwan.

Methods:

The study designed the Internet-based Self-assessment Program for Mental Health Screening (ISP-MHS) for people to freely screen mental disorders online (http://www.psychpark.org/guideline/MHS). The hyperlink located on the Psychpark Web, which is a famous mental website in Taiwan. This ISP-MHS program was designed by three senior psychiatrists based on the MINI and DSM-IV. The flow chart of survey contained screening questions and the specified questions for each specific psychiatric disorder. ISP-MHS contained one screening question and three subsequent questions related to SAD. Total duration of the internet survey persisted from Oct. 2002 to Nov. 2005.

Results:

A total of six thousands and two performed this online survey during a period of thirty-eight months. Five thousands and twenty-two participants (male/female= 1204/3818) completed this survey via the Internet. The completed rate was 83.7%. The detail demographic data showed on Table 1. Most of them were female (Male/Female= 1/3). Mean age of these participants was 30.5 years old, and fourteen percent had married history.

Table 1. Demographic data of the 5022 Internet survey population

33.3% in these participants was suspected to have SAD. The 7 most prevalent psychiatric diagnoses and percentage in this survey were shown in Table 2. The most common comorbidity of these SAD candidates were depression (23.2%) and generalized anxiety disorder (20.3%). The detail data were shown in Table 3.

Table 2. Most prevant psychiatric disorders in this Internet survey

Table 3. Psychiatric diagnosis of comorbidity with SAD

Conclusions:

To our best knowledge, this is the first Internet survey for SAD and its comorbidity of mental illnesses. The higher percentage of SAD in the internet survey than the general population is found in our study. Significant higher female than male was found in this survey, which is higher than previous reports. Similar percentage of comorbidity with depression and generalized anxiety disorder were found in our study when compared with previous community or clinical studies. Lower alcohol problem in our study may be due to the culture difference. Internet addition tendency was as high as 16.2% in our survey but the proportion for SAD was only 7.9%, which implied the Internet could be the alternative communicational tool in SAD population and might be less addictive than those without SAD.

Our study has several limitations. First, our sample came from a mental health website. These populations who came to the website may have higher mental problems than general populations. Second, the survey based on the MINI as the questions, which is not as valid as the clinical interview to make definite diagnosis of the mental illnesses. Finally, it’s difficult to differentiate the over-shyness and SAD in our survey.

Internet-based tools can help screen people with SAD and its comorbidity who often hide behind the internet. Further study can use the Internet to develop other applications to help these patients in the future.

Reference:

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