When social anxiety and depression go together: A population study of comorbidity and associated consequences

- MDD-SAD occurs in young individuals and impacts men more than women.
- Individuals with MDD-SAD have earlier MDD onset than individuals with MDD only.
- Individuals with MD-SAD have earlier onset of first mental disorder then MDD, and MDD-1ANX group.
- MDD-SAD has similar levels of dysfunction and suicidality with MDD-1ANX group.
- MDD≥2ANX has higher levels of suicidality and dysfunction than MDD-SAD group.

BackgroundDespite several studies suggesting higher depression severity and dysfunction occurring in individuals with major depressive disorder (MDD) comorbid with social anxiety disorder (SAD), a clear understanding of the specific risks associated with this comorbidity is lacking. In this study we compared the disease characteristics and level of disability of individuals with MDD-SAD with other comorbidities between depression and anxiety.MethodsData from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N=20,013) were used. Individuals were divided in four groups comparing MDD-SAD with MDD alone, as well as other comorbidities between MDD and one anxiety (MDD-1ANX) or more than two anxiety disorders (MDD≥2ANX), with respect to several clinical, demographic, and functional characteristics.ResultsMDD-SAD comorbidity in the general population occurred in younger people, particularly men, and seemed to have an earlier onset of MDD. Occupational and social dysfunction was similar between individuals with MDD-SAD and those with MDD-1ANX. However, individuals with MDD≥2ANX had significantly higher severity as measured by suicidality as well as substance abuse and social and occupational dysfunction. SAD was the most prevalent comorbid anxiety in this group.LimitationsThe findings of this study were derived from the cross-sectional data.ConclusionOur results suggest that the particular risks associated with MDD-SAD are the early onset and likelihood of additional anxiety, leading to higher severity and disability levels. Clinicians should increase the screening and treatment of SAD and other anxiety disorders in individuals with MDD given the higher associated health risk and functional impairment.