Impact of Social Anxiety Disorder on Employment among Women Receiving Welfare Benefits

Background and Purpose: Social anxiety disorder, also known as social phobia, involves persistent fear of one or more social or performance situations in which a person is exposed to unfamiliar people or to possible scrutiny by others. Fear focuses on the potential for embarrassment or humiliation, and impairing avoidance often results. Social anxiety disorder is the most common anxiety disorder and third most common psychiatric disorder, following depression and alcohol abuse with a lifetime prevalence of 12.1%. Studies in clinical and community samples document that social anxiety disorder is common, disabling, and costly. It reduces educational attainment and job success, and thus may undermine economic self-sufficiency. We examined social anxiety disorder as an obstacle to successful employment in a longitudinal epidemiological study of women receiving welfare in an urban Michigan county, testing the hypothesis that social anxiety disorder would predict reduced work attainment.

Method: Psychiatric diagnoses were established using the Composite International Diagnostic Interview (CIDI) Short Forms. We conducted a survey linear fixed effects regression analysis with 624 respondents who completed the study's fourth wave to explore obstacles to employment among welfare mothers. The dependent variable in these analyses was the percentage of months worked between waves of data collection. Predictors were lagged, that is, measured at the interview prior to each assessment of work, in order to ensure that the measurement of predictors, such as onset of mental health disorders and experience of work barriers, preceded the measurement of work outcomes (e.g., social anxiety disorder assessed at Wave 2 predicted work outcomes that occurred in the 12 months between Waves 2 and 3 and were reported in the Wave 3 interview). Structuring the analysis in this way served to clarify the temporal direction of influence. We controlled for other relevant mental health disorders, demographic, and human capital variables (e.g. job skills and experience) relevant to work attainment

Results: Analyses demonstrated that respondents with social anxiety disorder worked fewer months than those without social anxiety disorder. The impact of social anxiety disorder was independent of and more striking than the effects of depression.

Conclusions: By undermining efforts to obtain or maintain employment, social anxiety disorder poses a significant, unrecognized impediment to efforts to reduce welfare reliance and help recipients achieve economic self-sufficiency. Because recipients may lose benefits if they fail to enter the workforce rapidly and exceed time limits for support, those suffering from social anxiety disorder are at risk of extreme economic hardship. Improved access to effective treatments in this population could have significant public health and economic benefits. As one example of the type of innovative interventions that could be used to address social anxiety disorder for unemployed women, we will briefly discuss our pilot intervention that integrates evidence-based social anxiety interventions in a vocational training setting.