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The cross-national epidemiology of specific phobia in the World Mental Health Surveys

  • K. J. Wardenaar (a1), C. C. W. Lim (a2), A. O. Al-Hamzawi (a3), J. Alonso (a4), L. H. Andrade (a5), C. Benjet (a6), B. Bunting (a7), G. de Girolamo (a8), K. Demyttenaere (a9), S. E. Florescu (a10), O. Gureje (a11), T. Hisateru (a12), C. Hu (a13), Y. Huang (a14), E. Karam (a15), A. Kiejna (a16), J. P. Lepine (a17), F. Navarro-Mateu (a18), M. Oakley Browne (a19), M. Piazza (a20) (a21), J. Posada-Villa (a22), M. L. ten Have (a23), Y. Torres (a24), M. Xavier (a25), Z. Zarkov (a26), R. C. Kessler (a27), K. M. Scott (a2) and P. de Jonge (a1)...
  • Please note a correction has been issued for this article.

Abstract

Background

Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.

Method

Data came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.

Results

The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.

Conclusions

Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.

Copyright

Corresponding author

*Address for correspondence: K. J. Wardenaar, Ph.D., Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands. (Email: k.j.wardenaar@umcg.nl)

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