Social Phobia among Secondary School Students in Baghdad/Iraq

Iraq represents a model of the challenging mental health needs of children in conflict-affected, low-income countries. Long-term instability, violent conflict and wars undermine health and mental health status of people in Iraq, particularly children, who form half its population. Raising the level of knowledge and recognition of children’s psychological health in this country has been difficult. The knowledge base has been limited by the shortage of resources, international sanctions and the isolation of Iraqi scholars (AlObaidi, Corcoran, & Scarth, 2013).

This short report presents the data from research conducted in 2003 to estimate the prevalence rate of social phobia among secondary school students in Baghdad, the capital city of Iraq. A random sample of 1080 secondary school students was selected from six secondary schools in Baghdad. The sample consisted of 540 females and 540 males; the age range was 12–20 years. Two stages of screening were used; in the first stage, the Social Phobia Inventory (SPIN), a self-rating scale to detect suspected cases of social phobia was utilized. In the second stage face-to-face interviews were conducted and DSM-IV criteria were used to confirm the clinical diagnosis of social phobia. The Social Phobia Inventory (SPIN) is a brief and simple self-rated scale to assess the main clinical symptoms of social phobia (Connor et al., 2000), and has been validated to use cross-culturally (Garcia-Lopez, Bermejo, & Hidalgo, 2010). SPIN had been standardized for our research by applying test-retest reliability, translation to translation validity and face validity tests. The local educational authority approved the research and consent from the children and their parents was sought.

Results showed that SPIN revealed that 44% of the study sample showed symptoms of social phobia but after applying DSM-IV criteria the rate dropped to only 1.67%. Two third of the socially phobic students were in the age group of 15–17 years, the rate of social phobia is higher in females than males with ratio of 3.5:1. The discrepancy in SPIN and DSM-IV rates may be explained partly by the ambiguous boundary between normal and pathological fear particularly with self-rating, showing a greater prevalence of subsydromal symptoms in this population. Recent findings from wide range studies in the world suggest social phobia prevalence rates among children and adolescents from 3% to 6.8% in clinical settings and 5% to 9% in community surveys by applying different survey tools including DSMIV criteria (Hitchcock, Chavira, & Stein, 2009; Beesdo, Knappe, & Pine, 2009).

This study presents an attempt to demonstrate some basic population parameters in a context where health researchers are working under many obstacles and risky circumstances. The psychosocial status of Iraqi children and adolescents is substantially affected by the current environment, which undermines best practice and evidence-based interventions. There is a limited scientific research base for tackling psychosocial and welfare issues of Iraqi children. Therefore a need remains to establish prevalence figures for psychiatric symptoms as a base on which to develop services in child and adolescent mental health in Iraq.