Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale

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Abstract

Objective: We sought to determine optimal cutoff values for the Liebowitz Social Anxiety Scale (LSAS) total and subscale scores for the diagnosis of social anxiety disorder (SAD) and designation of the generalized subtype of SAD. Method: Three hundred and sixty-four patients from a multi-site sample who met criteria for SAD according to structured diagnostic interview, 262 of whom met criteria for the generalized subtype, and 34 control participants free of current Axis I disorders participated in this study. All participants were given the Liebowitz Social Anxiety Scale by an independent assessor. Results: Receiver Operating Characteristics analysis revealed that the LSAS performed well in identifying individuals who met criteria for SAD and for the generalized subtype of SAD. Cutoffs of 30 for SAD and 60 for its generalized subtype on the LSAS total score represented the best balance of specificity and sensitivity. Conclusions: These findings provide support for the use of the Liebowitz Social Anxiety Scale for the identification of individuals with SAD and its generalized subtype in clinical settings. Identification of patients with SAD should increase the percentage of these patients who receive appropriate treatment for this impairing disorder.

Section snippets

Participants

Participants, aged 18–65, were obtained from a large multi-site sample of patients seeking treatment for social anxiety. One hundred and eighty-five participants sought treatment at the Center for Stress and Anxiety Disorders of the University at Albany, State University of New York (CSAD). One hundred and fourteen participants sought treatment at the Anxiety Disorders Clinic of the New York State Psychiatric Institute (NYSPI). Sixty-five participants sought treatment at the Adult Anxiety

Diagnosis of SAD

The total sample (N=398) of SAD patients (n=364) and NAC participants (n=34) was submitted to ROC analysis. The AUC for this ROC analysis was .98 and was significant versus chance or the random ROC line (P<.0001) (Fig. 1). A LSAS-T score of 30 provided the best balance between Sn and Sp. The vast majority (93.28%) of patients with SAD were correctly identified, and only 5.88% (1-Sp) of persons without SAD were misclassified with a LSAS-T score of 30. A score of 10 (maximizing Sn) correctly

Discussion

The present study sought to determine optimal cutoff values for the LSAS in making the diagnosis of SAD and determining GSAD subtype. In fact, the LSAS performed very well for these purposes. Using the LSAS total score, scores of 30 for SAD and 60 for GSAD provided the best balance between sensitivity and specificity.

Cutoff values were also presented that maximized either sensitivity or specificity for SAD and GSAD. These values were provided to demonstrate that the appropriate cutoff score

Acknowledgements

This study was supported by grants from the National Institute of Mental Health to Drs. Heimberg (MH44119) and Liebowitz (MH40121), and to the New York State Psychiatric Institute MHCRC (PO5 MH30906).

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    A preliminary version of this paper was presented at the Annual Meeting of the Anxiety Disorders Association of America, March 1999, San Diego, CA.

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