Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys

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de Vries, Ymkje Anna ^{[1, 2]} ; Al-Hamzawi, Ali ^[3] ; Alonso, Jordi ^{[4, 5, 6]} ; Borges, Guilherme ^[7] ; Bruffaerts, Ronny ^[8] ; Bunting, Brendan ^[9] ; Caldas-de-Almeida, Jose Miguel ^{[10, 11]} ; Cia, Alfredo H. ^[12] ; De Girolamo, Giovanni ^[13] ; Dinolova, V, Rumyana ; Esan, Oluyomi ^[14] ; Florescu, Silvia ^[15] ; Gureje, Oye ^[16] ; Haro, Josep Maria ^{[17, 18]} ; Hu, Chiyi ^{[19, 20]} ; Karam, Elie G. ^{[21, 22, 23]} ; Karam, Aimee ^[22] ; Kawakami, Norito ^[24] ; Kiejna, Andrzej ^{[25, 26]} ; Kovess-Masfety, Viviane ^[27] ; Lee, Sing ^[28] ; Mneimneh, Zeina ^[29] ; Navarro-Mateu, Fernando ^{[30, 31, 32]} ; Piazza, Marina ^{[33, 34]} ; Scott, Kate ^[35] ; ten Have, Margreet ^[36] ; Torres, Yolanda ^[37] ; Viana, Maria Carmen ^[38] ; Kessler, Ronald C. ^[39] ; de Jonge, Peter ^{[1, 2]} ; Aguilar-Gaxiola, Sergio ; Al-Kaisy, Mohammed Salih ; Andrade, Laura Helena ; Benjet, Corina ; Bromet, Evelyn J. ; de Almeida, Jose Miguel Caldas ; Cardoso, Graca ; Chatterji, Somnath ; Degenhardt, Louisa ; Demyttenaere, Koen ; de Girolamo, Giovanni ; Hinkov, Hristo ; Hu, Chi-yi ; Karam, Aimee Nasser ; Lepine, Jean-Pierre ; Levinson, Daphna ; McGrath, John ; Medina-Mora, Maria Elena ; Moskalewicz, Jacek ; Pennell, Beth-Ellen ; Posada-Villa, Jose ; Scott, Kate M. ; Slade, Tim ; Stagnaro, Juan Carlos ; Stein, Dan J. ; Whiteford, Harvey ; Williams, David R. ; Wojtyniak, Bogdan ; Colla, WHO World Mental Hlth Survey

Affiliation:Show less -

^[1] Univ Groningen, Fac Behav & Social Sci, Dept Dev Psychol, Groningen - Netherlands

^[2] Univ Groningen, Univ Med Ctr Groningen, Interdisciplinary Ctr Psychopathol & Emot Regulat, Groningen - Netherlands

^[3] Al Qadisiya Univ, Coll Med, Diwaniya Governorate - Iraq

^[4] Pompeu Fabra Univ UPF, Barcelona - Spain

^[5] CIBERESP, Barcelona - Spain

^[6] IMIM Hosp del Mar Med Res Inst, Hlth Serv Res Unit, Barcelona - Spain

^[7] Natl Inst Psychiat Ramon de la Fuente Muniz, Mexico City, DF - Mexico

^[8] UPC KUL, Campus Gasthuisberg, Leuven - Belgium

^[9] Ulster Univ, Sch Psychol, Derry, Londonderry - North Ireland

^[10] Univ Nova Lisboa, Lisbon Inst Global Mental Hlth, NOVA Med Sch, Fac Ciencias Med, Lisbon - Portugal

^[11] Univ Nova Lisboa, Chron Dis Res Ctr CEDOC, NOVA Med Sch, Fac Ciencias Med, Lisbon - Portugal

^[12] Anxiety Clin & Res Ctr, Buenos Aires, DF - Argentina

^[13] IRCCS Ist Ctr San Giovanni Dio Fatebenefratelli, Brescia - Italy

^[14] Univ Ibadan, Coll Med, Dept Psychiat, Ibadan - Nigeria

^[15] Natl Sch Publ Hlth Management & Dev, Bucharest - Romania

^[16] Univ Coll Hosp, Dept Psychiat, Ibadan - Nigeria

^[17] Univ Barcelona, Parc Sanitari St Joan de Deu, CIBERSAM, Barcelona - Spain

^[18] King Saud Univ, Coll Educ, Dept Psychol, Riyadh - Saudi Arabia

^[19] Shenzhen Inst Mental Hlth, Shenzhen - Peoples R China

^[20] Shenzhen Kangning Hosp, Shenzhen - Peoples R China

^[21] Balamand Univ, Fac Med, Dept Psychiat & Clin Psychol, Beirut - Lebanon

^[22] IDRAAC, Beirut - Lebanon

^[23] St George Hosp Univ Med Ctr, Dept Psychiat & Clin Psychol, Beirut - Lebanon

^[24] Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Kodaira, Tokyo - Japan

^[25] Wroclaw Med Univ, Wroclaw - Poland

^[26] Univ Lower Silesia, Wroclaw - Poland

^[27] Paris Descartes Univ, EHESP, EA 4057, Paris - France

^[28] Chinese Univ Hong Kong, Dept Psychiat, Tai Po, Hong Kong - Peoples R China

^[29] Univ Michigan, Survey Res Ctr, Inst Social Res, Ann Arbor, MI - USA

^[30] CIBERESP Murcia, UDIF SM, Subdirecc Gen Planificac Innovac & Cronicidad, Serv Murciano Salud, IMIB Arrixaca, Murcia - Spain

^[31] IMIB Virgen Arrixaca, Murcia - Spain

^[32] Ctr Invest Biomed ERed Epidemiol & Salud PUbl CIB, Murcia - Spain

^[33] Univ Cayetano Heredia, Lima - Peru

^[34] Inst Nacl Salud, Lima - Peru

^[35] Univ Otago, Dept Psychol Med, Dunedin, Otago - New Zealand

^[36] Netherlands Inst Mental Hlth & Addict, Trimbos Inst, Utrecht - Netherlands

^[37] CES Univ, Ctr Excellence Res Mental Hlth, Medellin - Colombia

^[38] Univ Fed Espirito Santo, Dept Social Med, Postgrad Program Publ Hlth, Vitoria, ES - Brazil

^[39] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA 02115 - USA

• Document type: Journal article
• Source: BMC MEDICINE; v. 17, MAY 24 2019.
• Web of Science Citations: 0

Abstract

BackgroundSpecific 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.MethodsWe 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 (<13years) SP.ResultsAmong 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 (3.5days out of role in the past month) than those without childhood SP (1.1days) or with only 1 subtype (1.8days) (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).ConclusionsThis 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. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants