Early adolescence is considered a key risk period for the onset of social phobia, an anxiety disorder of which the principal symptom is persistent and intensive anxiety arising in one or more situations where there are other people around. The excessive anxiety leads to subjective suffering or avoiding one or more such situations altogether (APA, 1994). Adolescence coincides with increased demands for social interaction with peers and in formal social situations. Thus, suffering and the functional harm that social phobia invokes rise significantly. Longitudinal research indicates that earlier social phobia may precede anxiety, depression, or alcohol use in early adulthood. Thus, assessment, identification and epidemiological knowledge of adolescent social phobia are indeed important.
The present study investigated the psychometric assessment, epidemiology and correlates of social phobia among Finnish adolescents aged 12 to 17 years. Of the psychosocial correlates of social phobia, special emphasis was placed on peer victimization. The specific aims of the study were to demonstrate the psychometric properties of the Finnish version of the Social Phobia Inventory (SPIN-FIN), a 17-item self-report instrument of social phobia symptoms, for use among Finnish adolescents, and to examine the prevalence, comorbidity, and psychosocial correlates of social phobia among Finnish adolescents using both the SPIN-FIN and semi-structured clinical interview, the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) as principal research methods.
Four school-based samples of adolescents were utilised. A total of 802 13 to 17-year-oldadolescents from two secondary schools in Kangasala and Tampere completed the SPIN-FIN twice over five weeks in the SPIN-FIN Test-Retest Study in 2000. Secondly, a sample of 752 12 to 17- year-old adolescents representing three age cohorts in Ylöjärvi participated in the two-stage Well Being in Adolescence Study in 2000-2001; Stage I consisting of screening with the SPIN-FIN, Stage II consisting of clinical interview with the K-SADS-PL. Finally, two separate samples from a large prospective survey study among Finnish adolescents, the Adolescent Mental Health Cohort study were used, representing students from all secondary schools in the participating cities. The first of these comprised 5252 12 to 17-year-old students from Pori in 2000, Tampere in 2002 and Vantaa in 2003 and completing the SPIN-FIN; and the other comprised 3156 15 to 19-year-old students from Tampere and Vantaa in 2002 and 2003, completing a questionnaire containing the SPIN-FIN, the Finnish adaptation of the13-item Beck Depression Inventory (RBDI), and a broad range of self-report instruments assessing mental health and questions of family, school, and peer relationships and socio-demographic factors.
The SPIN-FIN was found to be a reliable self-report instrument used among Finnish adolescents. Test-retest reliability (Spearman’s correlation coefficient 0.81) and internal consistency (Cronbach’s alpha 0.89) were both good. Confirmatory factor analysis suggested a one-factor structure, or alternatively a three-factor structure, both of which need to be replicated in subsequent studies. SPIN-FIN demonstrated good construct validity, differentiating adolescents with DSM-IV social phobia and sub-clinical social phobia from those without these diagnoses. It was also capable of differentiating adolescents with social phobia from those with other anxiety disorders, disruptive disorders, and, to some extent, depressive disorders. The diagnostic efficiency analyses indicated adequate screening properties for the SPIN-FIN. A cut-off score of 24 points can be used when using the scale as a screen for social phobia in general adolescent populations.
A 3.2 % prevalence rate for 12-month DSM-IV social phobia among 12 to 17-year-old Finnish adolescents was found. In addition, 4.6 % suffered from sub-clinical social phobia, having full symptoms of SP without functional impairment. The prevalence of social phobia rose and the gender ratio shifted to female preponderance as age increased. SP was frequently comorbid with other anxiety disorders (41%) and depressive disorders (41 %). Adolescents with social phobia and sub-clinical social phobia were impaired in their academic and global functioning, and reported more parental psychiatric treatment contacts than adolescents without psychiatric disorders. Two thirds (68 %) of adolescents with SP reported having been bullied by peers. Only one fifth of adolescents with non-comorbid SP had been in contact with a mental health professional. In studying the peer relationship correlates of comorbid and non-comorbid social phobia and depression it was found that comorbidity between the two conditions was associated with higher frequencies of peer victimization than what was found for social phobia or depression alone. Multivariate analyses showed that depression alone did not maintain an independent association with peer victimization when social phobia and other common correlates of depression were controlled for.
To conclude, this study demonstrated that the SPIN-FIN is a reliable and valid measure of social phobia among Finnish adolescents. Social phobia seems to be a common and undertreated disorder among Finnish adolescents, and is associated with depressive disorders and other anxiety disorders in over 40 % of cases. Overt and covert peer victimization seem to be associated with social phobia, rather than depression, among adolescents.
