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

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. Electronic supplementary material The online version of this article (10.1186/s12916-019-1328-3) contains supplementary material, which is available to authorized users.

Common Phobias among Egyptian Primary Schoolchildren: An Emergency Trigger for Panic Disorder due to Corona Pandemic

“…The present study demonstrated that more than 5% of the studied schoolchildren had more than 5 types of phobia. This finding is supported by a study done by de Vries et al, 2019, who found that 8% of children reported four or more phobias [31]. The present study also scored the phobia into the low score (1-9) and high score (≥10) which accounted for 60.9% and 35.2%, respectively, of the studied participants.…”

“…Most of the phobias generally appear in early childhood, the studied fifth or sixth graders (9-12 years) showed the highest percentage for almost all types of phobia because older children are more susceptible to phobia than younger children. With respect to phobias, our results are in agreement with Bener et al, 2011;Varughese and Peteru, 2019;and de Vries et al, 2019 suggesting that phobias were common in the age group 6-11 years [5], [26], [31]. Results of other studies were somewhat different from those found in our sample, two studies suggested that the average age of onset of phobias symptoms at approximately 8 years [11], [37].…”

Predictors of persistence of anxiety disorders across the lifespan: a systematic review

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Transdiagnostic development of internalizing psychopathology throughout the life course up to age 45: a World Mental Health Surveys report

“…It is also possible that people with high symptom levels at the time of interview are more likely to recall symptoms experienced earlier in life, which could potentially lead to spurious associations between the latent trajectory classes and 12-month outcomes. We have previously found that associations between childhood specific phobia and lifetime outcomes were present among people with and without psychopathology at the time of interview (De Vries et al, 2019), suggesting that current symptomatology cannot fully explain the association between childhood symptoms and later outcomes. Prospective research has also found consistent associations between childhood-onset disorders and later outcomes (e.g.…”