Specific phobia (SP) is prevalent in the population but its clinical relevance is unclear.

There are few prospective population studies of SP.

To study the prognosis of SP in a sample of elderly with special reference to SP as a risk factor for depression.

A representative sample of 70-year old men and women (N=558) without dementia were examined by psychiatric nurses, using a semi-structured interview based on the Comprehensive Psychopathological Rating Scale (CPRS). Symptom algorithms were used to diagnose SP and other disorders of mood and anxiety according to DSM-IV. At a 5-year follow-up 418 (74.9%) persons were re-examined.

The prevalence of SP had declined significantly from 10.2% to 6.1% at follow-up. Of those with SP at baseline, 28.6% met diagnostic criteria also at follow-up, 52.4% had sub-clinical symptoms and 19.0% had no symptoms at follow-up. The prognosis of SP was not influenced by psychiatric comorbidity or type of fear. SP at baseline increased the risk for depression at follow-up in a logistic regression model also including gender and other anxiety disorders.

Less than a third of those with SP meet criteria at a 5-year follow-up, indicating substantial fluctuation of symptom levels of SP. The marked reduction in prevalence of SP over time suggests that age in itself may have a positive influence on the prognosis. The increased risk for depression in this study calls for more prospective studies in younger samples.