Work Characteristics and Social Phobia in a Nationally Representative Employed Sample

Article excerpt

Objective: Social phobia is associated with long-term impairment and disability. Environmental and genetic influences may be important in etiology and persistence. This is the first study to examine the association of work characteristics with social phobia in a representative nationally employed population.

Method: Self-reported work characteristics were linked to 12-month social phobia diagnosed by the World Mental Health Composite International Diagnostic Interview in 24 324 employed individuals from the Canadian Community Health Survey.

Results: High job strain (OR = 1.62, 95%CI, 1.06 to 2.49) and job insecurity (OR = 2.47, 95%CI, 1.73 to 3.51) were associated with an increased risk of 12-month social phobia, adjusting for sociodemographic variables, prevalent depression, and other work characteristics.

Conclusions: Work characteristics are associated with social phobia. Characteristics such as job insecurity may be a consequence of illness in employed populations, while high job strain may increase the risk of symptoms. More investigation is needed of the relation between work and social phobia to understand how to reduce occupational disability.

Can J Psychiatry 2008;53(6):371-376

Clinical Implications

* An inquiry about work characteristics should be included in the clinical evaluation of social phobia patients.

* Social phobia may be contributing to problems with working relations.

* Job choice may be an important consideration in the long-term management of social phobia.

Limitations

* As this is a cross-sectional survey, there are limitations to the causal conclusions that can be drawn.

* Self-report work characteristics are subject to mood-related response bias, although adjustment for current depression may reduce this.

* New and established cases of social phobia cannot be distinguished.

Key Words: work stress, social phobia, employment, epidemiology

Social phobia has an early onset, carries a high risk of persistence, and is comorbid with other anxiety disorders, substance abuse, depressive disorder, and bipolar disorder.1,2,3 Schneir conceives social phobia as a trait-like, dimensional disorder with links to shyness, avoidant personality disorder, and selective mutism.4 Social phobia is a common disorder with 12-month prevalence rates in the range of 7% to 10% and lifetime prevalence in the range of 12% to 14%.3 Lower prevalence rates have been reported in a nationally representative study from the United States with 2.8% and 5.0%, respectively,5 and in individuals older than 55 years with 1.32% and 4.94% in the CCHS 1.2.6 The mean age of onset is 16.9 years,6 and 90% have first onset by 23 years.3

There is strong evidence for the genetic origin of social phobia with an association between social phobia in parents and children.7 Nevertheless, there is also evidence of environmental influence in the etiology of social phobias.8 Parental phobias may be linked to phobias in their offspring through social learning and modelling as well as through genetic links. The high prevalence of social phobia in those with low income, low educational attainment, in Native Americans and Afro-Caribbean individuals, and those living in rural areas suggest the possibility of environmental influences.5'6'9'10 Adverse social experiences, including sexual abuse, marital conflict, and negative life events have been linked to the onset of social phobia.11-13 There is also evidence of differential risk factors by sex: among females, parental conflict and childhood physical abuse were risk factors for social phobia, while absence of a close, confiding relationship with a parent or other adult while growing up was a risk factor among males.

One aspect of the environment is the impact of working conditions on social phobia. Negative aspects of the psychosocial work environment were linked to an increased risk of psychological distress14,15 and MDD;16,17 and to anxiety disorders to a lesser extent. …