Prevalence and correlates of social fears in Hong Kong Sing Lee a, *, King Lam Ng b , Kathleen P.S. Kwok b , Adley Tsang b a Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong b Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong 1. Introduction Although people with social anxiety often do not present in clinical settings, social fears are common in the community. The lifetime prevalence of the fear of at least one social situation has ranged from 24.1% to 38.6% (Kessler, Stein, & Berglund, 1998; Ruscio et al., 2008; Wittchen, Stein, & Kessler, 1999). Western studies have shown that the number of social fears among socially anxious individuals was positively associated with impairment, DSM-IV diagnosis of social anxiety disorder (SAD), comorbid mental disorder, and lifetime treatment (Kessler et al., 1998; Ruscio et al., 2008; Stein, Torgrud, & Walker, 2000; Vriends, Becker, Meyer, Michael, & Margraf, 2007). Although the manifestation of social fears may vary by cultural context, the vast majority of studies on the topic have come from the U.S. and European countries. Studies of social fears and their relationship with social anxiety are limited in Chinese commu- nities, where there is a two-sided argument as to how common and pathological social fears should be. Chinese culture emphasizes social hierarchy, interpersonally defined identity, and reticence. These cultural factors should render social fear a tolerated or even normative phenomenon (Hsu & Alden, 2007), thereby reducing the pathologization of social fears as SAD. This line of reasoning is supported by very low prevalence estimates of SAD found during face-to-face community surveys in Taiwan (lifetime prevalence 0.6% DSM-III SAD; Hwu, Yeh, & Chang, 1990), urban China (12- month prevalence 0.2% DSM-IV SAD; Shen et al., 2006), and Hong Kong (lifetime prevalence 0% DSM-III SAD; Chen et al., 1993). Nonetheless, the above-mentioned cultural factors can also be construed to predispose Chinese and other Asian people to heightened interpersonal sensitivity and hence higher levels of social anxiety. This possibility may be supported by cross-cultural studies demonstrating higher levels of self-reported social anxiety among Asian than Western people. Thus, a cross-national study of undergraduates in eight Western and East Asian countries found that greater acceptance of attention-avoiding behaviors was associated with higher levels of self-reported society anxiety. Specifically, social anxiety was found to be more common in ‘‘collectivistic’’ (Japan, Spain, and Korea) than ‘‘individualistic’’ (USA, Australia, Canada, Germany, and the Netherlands) countries (Heinrichs et al., 2006). Using the social anxiety subscale of a Chinese version of the Self-Consciousness Scale, Chan (1996) found that social anxiety was more common among Chinese under- graduates in Hong Kong than their counterparts in France, Germany, Sweden, and the Netherlands. Another study further suggested that higher social anxiety in Korean than Canadian subjects was mediated by the interpersonally dependent nature of identity construction among Asians (Hong & Woody, 2007). The above studies, nonetheless, did not examine the types of social fears and the clinical significance of the number of social fears in affected individuals. Moreover, they did not draw on representa- tive general population samples, thereby limiting the general- izability of the findings. As pointed out by Furmark (2002), the epidemiological study of social fears is useful for distinguishing between normal and pathological social fears. Journal of Anxiety Disorders 23 (2009) 327–332 ARTICLE INFO Article history: Received 18 July 2008 Received in revised form 24 December 2008 Accepted 12 January 2009 Keywords: Social phobia Social anxiety disorder Subtypes Epidemiology ABSTRACT This study examined the 12-month prevalence of social fears and their correlates in Hong Kong. A random telephone survey of 3006 Chinese individuals aged 15–45 years was conducted using a questionnaire that covered sociodemographic information, 14 social fears, age of onset, duration of fear, DSM-IV diagnostic features of social anxiety disorder and other psychosocial features. The prevalence of any social fear was 28.7%. The most common fear was talking to a person of higher status. Respondents with social fears were more likely to be younger and female than those without. A two-step cluster analysis revealed three subgroups with 1–3 (34.0%), 4–7 (43.9%) and 8–13 (22.0%) fears, respectively. As the number of social fears increased across these subgroups, respondents exhibited younger age of onset, more physical symptoms, avoidance behavior, impairment, and suicidality. The prevalence and profile of social fears among Chinese people resembled those of their Western counterparts. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author at: Hong Kong Mood Disorders Center, 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, N.T., Hong Kong. Tel.: +852 2144 6996; fax: +852 2144 5129. E-mail address: singlee@cuhk.edu.hk (S. Lee). Contents lists available at ScienceDirect Journal of Anxiety Disorders 0887-6185/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2009.01.005