Impact of generalized social anxiety disorder in managed care

objective: The authors determined the costs associated with generalized soc ial anxiety disorder in a managed care setting. Method: A three-phase mail and telephone survey was conducted from July to October 1998 in two outpatient clinics of a large health maintenance organi zation (HMO). The survey assessed direct costs, indirect costs, health-rela ted quality of life, and clinical severity associated with generalized soci al anxiety disorder, both alone and with comorbid psychopathology. Results: The weighted prevalence rate of current generalized social anxiety disorder was 8.2%. In the past year, only 0.5% of subjects with generalize d social anxiety disorder had been accurately diagnosed. Yet 44.1% had a me ntal health specialty visit or had been prescribed an antidepressant, and p sychiatric comorbidity was found in 43.6%. Noncomorbid generalized social a nxiety disorder was associated with significantly lower health-related qual ity of life, work productivity, and earnings and greater utilization of hea lth services; generalized social anxiety disorder with comorbid psychopatho logy was even more disabling. Suicide was attempted by 21.9% of subjects wi th noncomorbid generalized social anxiety disorder. Persons with average-se verity generalized social anxiety disorder had probabilities of graduating from college that were 10 percentage points lower, earned wages that were 1 0% lower, and had probabilities of holding a technical, professional, or ma nagerial job that were 14 percentage points lower than the comparison group . Conclusions: In a community cohort of HMO members, generalized social anxie ty disorder was rarely diagnosed or treated despite being highly prevalent and associated with significant direct and indirect costs, comorbid depress ion, and impairment.