Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors

Abstract

Objectives: High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods: A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments: Social Phobia Inventory (SPIN), Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19) and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes) were also investigated. Results: The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women) reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3%) patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions: SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence. RESUMOObjetivos: Altas taxas de comorbidade têm sido descritas entre o transtorno de ansiedade social (TAS) e os transtornos por uso de álcool, mas os preditores dessa comorbidade são pouco conhecidos, e a maioria dos estudos envolve pacientes com diagnóstico primário de TAS. Os objetivos foram estimar a prevalência e a gravidade de sintomas de TAS em pacientes dependentes de álcool e investigar fatores sociodemográficos e clínicos associados

Lifetime psychiatric hospital diagnoses among 8,412 Danish men registered in an outpatient alcohol clinic

“…Other non‐psychotic disorders were also prevalent in the present study (32.0%), but none of the previous studies included a combined category of other non‐psychotic disorders. However, several of the previous studies found that neuroses and anxiety disorders were prevalent among individuals receiving AUD treatment with prevalence estimates up to 52.3% (Burns et al., 2005; Gale et al., 2010; Mellentin et al., 2015, 2018; Nordholm & Nielsen, 2007; Schneider et al., 2001; Smith & Book, 2010; Tomasson & Vaglum, 1995; Yoshimi et al., 2016). In contrast, another study reported that the prevalence of anxiety disorders was 6.6% among individuals receiving AUD treatment (Flensborg‐Madsen et al., 2009), which was similar to the prevalence of 8.6% observed in the present study.…”

“…First, the previous studies were based on populations receiving different types of AUD treatment. Thus, some of the studies included individuals receiving inpatient AUD treatment (Gale et al., 2010; Kushner et al., 2005; Schneider et al., 2001; Tomasson & Vaglum, 1995), other included individuals receiving outpatient AUD treatment (Burns et al., 2005; Mellentin et al., 2015, 2018; Nordholm & Nielsen, 2007; Smith & Book, 2010; Yoshimi et al., 2016), and one included individuals receiving both inpatient and outpatient AUD treatment (Flensborg‐Madsen et al., 2009). Second, the studies were based on populations from different countries including Denmark (Flensborg‐Madsen et al., 2009; Mellentin et al., 2015, 2018; Nordholm & Nielsen, 2007), Iceland (Tomasson & Vaglum, 1995), Sweden (Gale et al., 2010), Germany (Schneider et al., 2001), Australia (Burns et al., 2005), Brazil (Yoshimi et al., 2016), and the United States (Kushner et al., 2005; Smith & Book, 2010), possibly reflecting different traditions of registration and treatment of psychiatric disorders.…”

“…Addressing this issue can be difficult, but one possible solution is to study psychiatric comorbidity among individuals who were exclusively treated for AUD, for example, in outpatient alcohol clinics. However, studies of individuals receiving outpatient AUD treatment have mostly focused on personality disorders, mood disorders, and anxiety disorders and the results were relatively heterogeneous as both current prevalence estimates (Mellentin et al, 2015(Mellentin et al, , 2018Nordholm & Nielsen, 2007;Smith & Book, 2010;Yoshimi et al, 2016;Zikos et al, 2010), 12-month prevlences estimates (Burns et al, 2005), and lifetime prevalence estimates (Nordholm & Nielsen, 2007) were reported. Thus, the prevalence of personality disorders has been observed to range between 34% and 59% (Nordholm & Nielsen, 2007;Zikos et al, 2010), while the prevalence of mood disorders ranged from 15.7% to 58.0% (Burns et al, 2005;Mellentin et al, 2015;Nordholm & Nielsen, 2007).…”

“…Australia (Burns et al, 2005), Brazil (Yoshimi et al, 2016), and the United States (Kushner et al, 2005;Smith & Book, 2010) Gale et al, 2010;Mellentin et al, 2015Mellentin et al, , 2018Nordholm & Nielsen, 2007;Schneider et al, 2001), Diagnostic and Statistical Manual of Mental Disorders (DSM, version III and IV) (Burns et al, 2005;Kushner et al, 2005;Schneider et al, 2001;Smith & Book, 2010;Tomasson & Vaglum, 1995), and The Social Phobia Inventory (Yoshimi et al, 2016). Finally, some studies reported lifetime prevalence estimates of neuroses and anxiety disorders (Flensborg-Madsen et al, 2009;Gale et al, 2010;Nordholm & Nielsen, 2007;Tomasson & Vaglum, 1995), while one reported the 12-month prevalence (Burns et al, 2005), and other reported the current prevalence (Kushner et al, 2005;Mellentin et al, 2015Mellentin et al, , 2018Schneider et al, 2001;Smith & Book, 2010;Yoshimi et al, 2016).…”

“…Thus, the prevalence of personality disorders has been observed to range between 34% and 59% (Nordholm & Nielsen, 2007; Zikos et al., 2010), while the prevalence of mood disorders ranged from 15.7% to 58.0% (Burns et al., 2005; Mellentin et al., 2015; Nordholm & Nielsen, 2007). Finally, the prevalence of anxiety disorders has been observed to range from 12.7% to 46.2% (Burns et al., 2005; Mellentin et al., 2015, 2018; Nordholm & Nielsen, 2007; Smith & Book, 2010; Yoshimi et al., 2016).…”