Screening for social fears and social anxiety disorder in psychiatric outpatients

Abstract

The ability of a diagnostic interview to identify all individuals with a particular psychiatric disorder depends, in part, on the performance of the interview's initial screening questions. The Structured Clinical Interview for the Diagnostic and Statistical Manual, Fourth Edition (SCID) is the most widely used research diagnostic interview, yet little research has examined the performance of the SCID screening questions. Because social anxiety disorder (SAD) is one of the most frequent psychiatric disorders, we examined the performance of the SCID screening question in the SAD module to detect social fears and SAD. The incremental validity of a more comprehensive list of social fears was examined by determining how many patients were diagnosed with SAD in those who were originally missed by the SCID screening question. Five percent of those originally missed by the SCID screening question subsequently received a lifetime diagnosis of SAD, and there was a significant increase in the prevalence of social fears after patients were cued by the social fears list. The most commonly reported fears missed by the SCID screening question included speaking in a group, with sexually attractive others, and with authority figures. Results suggest that perhaps these fears could be added to the SCID screening question to capture individuals missed by the SCID screening question and to provide more comprehensive information for treatment purposes.

Figure 1

Frequency of Responses to the SCID Screening Question for Social Anxiety Disorder, the Social Fears List, and Frequency of Diagnoses