Social anxiety symptoms across diagnoses among outpatients attending a tertiary care mood and anxiety disorders service

Abstract

Background Social phobia is a common, persistent and disabling anxiety disorder in which co-existing depressive symptoms are common. However the prevalence of social anxiety symptoms in patients with other mood and anxiety disorders is uncertain. Method In consecutive patients attending a tertiary referral mood and anxiety disorders service, depressive symptoms were assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS) and social anxiety symptoms by the Liebowitz Social Anxiety Scale (LSAS). The Clinical Global Impression of Severity (CGI-S) was completed following the appointment. Results 75 patients (48 women, 27 men; mean age 45.9 years) completed the study. 38 had a single diagnosis and 37 co-morbid diagnoses: 15 patients had bipolar disorder, 35 unipolar depressive disorder, 19 an anxiety disorder, and 6 other disorders. Independent samples t-tests and one-way between-subjects ANOVA revealed that the severity of social anxiety symptoms but not depressive symptoms was significantly greater in patients with co-morbid diagnoses (LSAS 73.7 vs 54.2, t(72) = 2.44, p < .05; MADRS 21.9 vs 18.0, t(73) = 1.76, p = .08; CGI-S 3.7 vs 3.2, t(73) = 2.64, p < .05); and in anxiety disorders than in unipolar depression or bipolar disorder (respectively; LSAS 78.8 vs 59.4 vs 50.0, F(2, 65) = 3.13, p = .05; MADRS 22.2 vs 19.8 vs 17.5, F(2, 66) < 1, ns; CGI-S 3.9 vs 3.3 vs 3.1, F(2, 66) = 5.43, p < .01). In the overall sample, correlation coefficients were MADRS and LSAS, R 2 = 0.2628, p < .001; MADRS and CGI-S, R 2 = 0.5863, p < .001; and LSAS and CGI-S, R 2 = 0.327, p < .001. Correlations between MADRS and LSAS scores were higher in bipolar disorder ( R 2 = 0.4900, p < .01) than in unipolar depression ( R 2 = 0.376, p < .01) or anxiety disorders ( R 2 = 0.0041, ns). Limitations Small size of convenience sample undergoing varying treatments within a single specialist tertiary referral centre. Conclusions There was only a moderate correlation between depressive and social anxiety symptoms across a range of diagnoses. Depressive and social anxiety symptoms were most severe but least well correlated among tertiary care outpatients with anxiety disorders, emphasising the need for comprehensive evaluation and treatment.