Research report
Economic costs of social phobia: A population-based study

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Abstract

Background

Information about the economic costs of social phobia is scant. In this study, we examine the economic costs of social phobia and subthreshold social phobia.

Methods

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population-based prospective study (n = 4,789). Costs related to health service uptake, patients' out-of-pocket expenses, and costs arising from production losses were calculated for the reference year 2003. The costs for people with social phobia were compared with the costs for people with no mental disorder.

Results

The annual per capita total costs of social phobia were € 11,952 (95% CI = 7,891-16,013) which is significantly higher than the total costs for people with no mental disorder, € 2957 (95% CI = 2690–3224). When adjusting for mental and somatic co-morbidity, the costs decreased to € 6,100 (95% CI = 2681–9519), or 136 million euro per year per 1 million inhabitants, which was still significantly higher than the costs for people with no mental disorder. The costs of subthreshold social phobia were also significantly higher than the costs for people without any mental disorder, at € 4,687 (95% CI = 2557–6816).

Limitations

The costs presented here are conservative lower estimates because we only included costs related to mental health services.

Conclusions

The economic costs associated with social phobia are substantial, and those of subthreshold social phobia approach those of the full-blown disorder.

Introduction

Social phobia is characterized by a persistent fear of negative evaluation or scrutiny by others in social or performance situations (APA, 1994). Population studies indicate that social phobia is one of the most prevalent psychiatric disorders (Kasper, 1998, Kessler et al., 1994, Furmark et al., 1999). It is associated with huge losses in quality of life (Wittchen et al., 2000, Acarturk et al., 2008), serious functional impairment in various domains of life (Schneier et al., 1994) and high levels of service use (Magee et al., 1996). This debilitating mental disorder is also associated with increased economic costs (Patel et al., 2002, Andlin-Sobocki et al., 2005). Previous research indicated that people with social phobia experience increased financial dependency (Schneier et al., 1992, Leon et al., 1995), reduced work productivity (Kessler and Frank, 1997, Wittchen et al., 2000, Wittchen and Beloch, 1996), high levels of unemployment (Patel et al., 2002, Wittchen and Beloch, 1996), absenteeism from work (Lecrubier et al., 2000, Wittchen and Beloch, 1996), and use of prescribed medication (Patel et al., 2002).

Despite these indications of the burden of social phobia, the economic cost of this disorder in the general population is less well studied (Patel et al., 2002, Löthgren, 2004, Greenberg et al., 1999, Smit et al., 2006, Konnopka et al., 2009). The only study that to our knowledge has specifically examined the economic costs of social phobia states that people with social phobia have significantly more GP contacts and they use significantly more prescribed oral medication compared to the not mentally disordered population (Patel et al., 2002). However, to understand the overall economic burden of social phobia, more research in this area is needed.

Social phobia often occurs together with other psychiatric disorders (Lecrubier et al., 2000). This co-morbidity leads to increased disability, lower quality of life (Wittchen et al., 2000) and higher economic costs (Patel et al., 2002). It is clear that if the costs of co-morbid disorders are included in calculating the burden of social phobia, that this burden will be overestimated. On the other hand, since co-morbidity is so common in social phobia, these extra costs cannot be ignored either (Greenberg et al., 1999). Therefore, it is important to take these co-morbid disorders into account when calculating costs for social phobia.

The present study firstly aims to examine whether social phobia is associated with significantly increased medical and non-medical costs compared to no mental disorder. This is performed in a large, representative, sample of the Dutch population. Secondly, we examine how the economic costs of social phobia are broken down according to the distinct types of social fears. Earlier research has documented that social fears other than the speaking fears are related to higher disease burden (Kessler et al., 1998). However, no previous study has investigated the relationship between type of fear and economic costs. This touches on another issue. According to some research, social phobia lies on a continuum, and its disease burden is related to the number of social fears rather than to the distinct types of fear (Stein et al., 2000). Therefore, it is also interesting to study the relationship between the economic costs and the number of social fears. Finally, we examine the economic costs of subthreshold social phobia. Previous research indicated that the burden of the illness and the reduction in work productivity in subthreshold social phobia resemble those of full-blown social phobia (Wittchen et al., 2000). Highlighting the economic burden of subthreshold social phobia may underscore the importance of developing awareness, recognition and effective treatment of social phobia especially in its early phases.

Section snippets

Methods

The present study is part of a series of studies on the costs of mental disorders with NEMESIS, beginning with the study of Smit et al. (2006) on the costs of common mental disorders and followed a study on the costs of minor depression (Cuijpers et al., 2007) and of panic disorder (Batelaan et al., 2007).

Demographics

Of the present sample 109 had social phobia and 124 had subthreshold social phobia. The whole sample (N = 4879) can be described as follows. 53% were women with a mean age of 42 years (range 18–64). The levels of education was distributed as follows: elementary 6%, lower vocational 36%, secondary 28%, higher vocational and academic 30%.Of the sample, 73% were living with a partner, 82% living in urban and 69% was employed. We refer to Table 1 for the demographics of the subsamples such as social

Discussion

This study investigated the economic costs of social phobia, not only in the people with social phobia but also at the level of society at large. The cost of social phobia appears to be substantial. Per million inhabitants, the adjusted costs of social phobia were 136 million euro. In the study of Andlin-Sobocki et al. (2005), it is acknowledged that mental disorders including social phobia were hardly associated with increased direct medical and direct non-medical costs, but with indirect

Role of funding source

This study was funded by the University to which the authors are associated. NEMESIS is funded by the Netherlands Ministry of Health (VWS).

Conflict of interests

There are no conflicts of interest, for any of the authors.

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