research articles on social phobia

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Social anxiety disorder: a critical overview of neurocognitive research

Affiliations.

1 Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands.
2 Department of Psychiatry, The University of Chicago, Chicago, IL, USA.
3 Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.
4 Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.
PMID: 27240280
DOI: 10.1002/wcs.1390

Social anxiety is a common disorder characterized by a persistent and excessive fear of one or more social or performance situations. Behavioral inhibition is one of the early indicators of social anxiety, which later in life may advance into a certain personality structure (low extraversion and high neuroticism) and the development of maladaptive cognitive biases. While there are several effective psycho- and pharmacotherapy options, a large number of patients benefit insufficiently from these therapies. Brain and neuroendocrine research can help uncover both the biological basis of social anxiety and potentially provide indicators, 'biomarkers,' that may be informative for early disease detection or treatment response, above and beyond self-report data. Several large-scale brain networks related to emotion, motivation, cognitive control, and self-referential processing have been identified, and are affected in social anxiety. Social anxiety is further characterized by increased cortisol response and lower testosterone levels. These neuroendocrine systems are also related to altered connectivity patterns, such as reduced amygdala-prefrontal coupling. Much work is needed however to further elucidate such interactions between neuroendocrine functioning and large-scale brain networks. Despite the great promise of brain research in uncovering the neurobiological basis of social anxiety, several methodological and conceptual issues also need to be considered. WIREs Cogn Sci 2016, 7:218-232. doi: 10.1002/wcs.1390 For further resources related to this article, please visit the WIREs website.

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> Cognitive aspects of social phobia: a review of theories...

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Cognitive aspects of social phobia: a review of theories and experimental research.

Published online by Cambridge University Press: 16 April 2020

Cognitive theories of social phobia have largely been inspired by the information-processing models of anxiety. They propose that cognitive biases can, at least partially, explain the etiology and maintenance of this disorder. A specific bias, conceived as a tendency to preferentially process socially-threatening information, has been proposed. This bias is thought to intervene in cognitive processes such as attention, memory and interpretation. Research paradigms adopted from experimental cognitive psychology and social psychology have been used to investigate these hypotheses. The existence of a bias in the allocation of attentional resources and the interpretation of information seems to be confirmed. A memory bias in terms of better retrieval for threat-relevant information appears to depend on specific encoding activities.

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Volume 15, Issue 1
C.Z. Musa (a1) and J.P. Lépine (a1)
DOI: https://doi.org/10.1016/S0924-9338(00)00210-8

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Open access
Published: 19 July 2019

The prevalence and correlates of social phobia among undergraduate health science students in Gondar, Gondar Ethiopia

Getachew Tesfaw Desalegn 1 ,
Wondale Getinet 1 &
Getnet Tadie 1

BMC Research Notes volume 12 , Article number: 438 ( 2019 ) Cite this article

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Social phobia is highly prevalent among university students. The lowest and highest point prevalence of social phobia among undergraduate university students was estimated at 7.8% and 80%, respectively. However, research into social phobia and associated factors among undergraduate university students in low and middle-income countries has been limited. Therefore, this study aimed to assess social phobia and associated factors among university students in Ethiopia to contribute an attempt to ensure optimal care for students.

A total of 503 participants were interviewed with a response rate of 100%. The mean age of the respondents was 22.17 (± 10) years. The prevalence of social phobia symptoms among students was found to be 31.2% with (95% CI 27.3 to 35.6%). In the multivariable analysis, poor social support (AOR = 2.8, 95% CI 1.40, 5.60), female sex (AOR = 2.3; 95% CI 1.50, 3.60), 1st-year students (AOR = 5.5; 95% CI 1.80, 17.20), and coming from a rural residence (AOR = 1.6; 95% CI 1.00, 2.40) were factors significantly associated with social phobia symptoms.

Introduction

Social phobia (SP) is the fear of social situations that involved interaction with others with its prevalence ranges from 3 to 13% in the general population [ 1 ]. Globally, the lifetime and current prevalence of social anxiety disorder was estimated at 4% and 1.3%, respectively [ 2 ]. Its onset started in late childhood and associated with new demands for social interaction, younger age, female sex, lower educational status, lower income, and performing in public [ 1 , 3 ].

Social anxiety disorder was fearful in social gatherings, fear of public speaking, meeting new people, and avoidance of social situations [ 1 , 2 , 3 ]. Social fearful persons made bad images of their performance in social situations [ 4 ].

Social phobia was associated with problems within the siblings and the family [ 5 ]. The most common prevalence of social fear among the people was public speaking, and associated with female gender, low educational performance, psychiatric medication use, and absence of social support which led to low self-esteem, more distorted body image, and difficulty to interact with a social environment [ 4 , 6 , 7 , 8 ].

Social phobia was a high prevalence among high school, college, and university students [ 9 , 10 , 11 , 12 ]. Two studies were done among undergraduate university students: the point prevalence of social phobia estimated at 7.8% and 80%, respectively [ 9 , 13 ]. Different studies revealed that the major source of SP among university students was; exam, presentation, language, parental anger, criticism in front of others, exaggerated protection, maltreatment, and family provocation [ 12 , 14 ]. Contributing factors for SP among students were a problem with the peers, roommates, feel that campus environment uncomfortable for study, racial diversity, and too many classmates were making study difficult [ 4 ].

Why students feared situations to diagnosis SP were giving talks in front of the audience and trying to make someone’s intimate romantic relationship [ 15 , 16 ] and different studies reported risk factors of social phobia were; female sex, poor academic performances, psychoactive medication use, poor social support, freshmen, and spending more time thinking about face book [ 9 , 17 , 18 ].

The impact of social phobia among students decreased educational performance, dependence to take alcohol, avoid oral presentations, weak performance at clinical examinations, and develop depressive symptoms [ 13 , 19 ].

Even though social anxiety disorder/social phobia has a high prevalence among university students globally including Ethiopia, little attention is given to its diagnosis and treatment. To the best of our knowledge, there has been no published study on social anxiety symptoms and associated factors among university students in Ethiopia. This study, therefore, aimed to investigate the prevalence and associated factors of social phobia symptoms among undergraduate students with a view to informing the development of interventions.

An institution based cross-sectional study was conducted at the University of Gondar from April to May 2018, Gondar Ethiopia.

Regular undergraduate students at the University of Gondar College of Medicine and Health Sciences were included in the sample and excluded critically ill students.

The sample size was determined by using the single population proportion formula involving the use of Epi-info version 7 with a 95% CI, a 4% margin of error, and a social phobia of 27.5% from previous study conducted among high school adolescents in Ethiopia [ 20 ]. Assuming a 5% non-response rate, 503 students were recruited randomly by using the simple random sampling technique. The total number of students in the college with their identification number taken from the UoG CMHS registrar office; then the required sample was selected through lottery method. The lists of dormitory students took from the UoG CMHS Student’s union dormitory affairs.

Data were collected using a pre-tested self-administered questionnaire, which contained socio-demographic factors, social support, clinical factors, and substance use factors. Social support was collected by the Oslo 3-item social support scale, which had a 3-item questionnaire commonly used to assess social support and used in several studies. The sum score scale ranges from 3 to 14, and had three broad categories: “Poor support” 3–8, “moderate support” 9–11, and “strong support” 12–14 [ 21 ]. Social phobia was measured by using 17 items social phobia inventory (SPI) scale with cut-off point’s ≥ 21. Its score ranges from 0 to 68, which was rated from 0 (not at all) to 4 (extremely) [ 22 ]. Social phobia inventory scale validated in different countries among adults and adolescents [ 23 , 24 ].

Data were entered into Epi-info 7 software after checking for completeness and imported to SPSS version 21 for analysis. Univariate analysis was done to see the association of each independent variable with the outcome variable. Those variables a P-value less than 0.2 were entered into the multivariate logistic regression model to identify the effect of each independent variable with the outcome variables. The strength of the association evaluated by the adjusted odds ratio with a 95% CI, and less than 0.05 P-values were considered statistically significant.

Socio-demographic characteristics

A total of 503 students was included in the study with a response rate of 100%. The mean age of the respondents was 22.17 (± 10) years. Out of the participants, 362 (72%) were male, 472 (93.8%) were single, 289 (57.5%) were coming from the rural residence, and over two-fifth (43.3%) were between the ages of 18 and 21 years. Among the respondents, 185 (36.8%) were 3rd-year students and their grade scored between a range of 2.75 and 3.5 (Table 1 ).

Clinical, social, and substance characteristics

A small number, 13 (2.6%) of the participants had history of mental illness, 84 (16.7%) had a chronic physical illness, and about 3.2% had family history of mental illness. Of the participants, almost two in five (43.3%) students had moderate social support and nearly two in five (41.4%) had poor social support. Regarding the current use of the substance: over two-thirds (43.7%) of the students were drinking alcohol and 56 (11.1%) were taking khat at the movement (Additional file 1 ).

Prevalence of social phobia

The 17-items of social phobia inventory were summed and the single variable was generated. The new variable ranges from 0 to 68 in absolute value. A total of 84 (16.7%) students had mild social phobia (scored about 21 to 30) and 47 (9.3%) of the students had a moderate social phobia (scored 31 to 40). A small number, 19 (3.8%) and 7 (1.39%) of the students had severe and very severe social phobia, respectively (Fig. 1 ). We further categorized social phobia into two levels (no social phobia and social phobia). This study showed that the prevalence of social phobia symptoms among participants was 31.2% with (95%, CI 27.3, 35.6%) (Additional file 2 ).

Bar chart showing that the distribution SPI score for students at the University of Gondar, Northwest Ethiopia in, 2018 (N = 503)

Factors associated with social phobia

Among all covariates, female sex, students studying in the 1st year, family history of mental illness, and poor social support had less than 0.2 a P-value in the univariate logistic regression and were considered as the multiple logistic regression models.

In the multivariable analysis suggested that the odds of social phobia, increased by 2.8 times (95% CI 1.40, 5.60) for students had poor social support compared to students had good social support. Female students were about 2.3 times (95%, CI 1.50, 3.60) more likely risk of social phobia compared to counterparts. Students studying in the 1st year were 5.5 times (95%, CI 1.80, 17.20) more likely to develop social phobia compared to counterparts. Similarly, the risk of social phobia for students whose residence from the rural areas increased by 1.6 times (95%, CI 1.00, 2.40) compared to students whose residence from the urban areas (Table 2 ).

In this study, the prevalence of social phobia and possible association with various factors was assessed. The results of the present study revealed that a remarkable proportion of students had social phobia. The prevalence of social phobia among students was found to be 31.2%.

Regarding prevalence, our result is consistent with those of other studies carried out in Ethiopia, Nigeria, India, and Australia the prevalence was estimated at 27.5%, 31.1%, 28.6%, and 30%, respectively [ 20 , 25 , 26 , 27 ].

On the other hand, the current study finding was higher than those of other studies done in two areas of Saudi Arabia, Canada, Iran, and India, the prevalence was estimated at 14.1%, 16.3%, 7.9%, 17.2%, and 7.8%, respectively [ 5 , 7 , 9 , 11 , 28 ]. The variations might be the distinctions in sample sizes, measurement tools, rating scales, gender differences, and the socio-cultural contrast between Ethiopia and the other countries. In two areas of Saudi Arabia, the sample size was higher than in our study, while the measurement tool was the same [ 5 , 28 ]. Besides the above differences, in two areas of Saudi Arabia took male and female students in their studies respectively [ 6 , 27 ]. In Canada, Iran, and India, the diagnostic interview schedule III, Leibowitz questionnaires, and social interaction anxiety scale tools were used to assess the social phobia among university students, respectively.

However, our result was lower than those of other studies conducted in Saudi, India, Iran, two areas of Iraq and reported 60%, 46%, 78.9%, 58.5%, 80%, and 55.7%, respectively [ 12 , 13 , 19 , 29 , 30 ]. The discrepancy might be the sample size alterations and assessment tool differences. In Saudi, the study conducted among medical students and tested by using social phobia scale which differed from our assessment tool [ 19 ], in India, the study participants were only medical students but in our study all health science students included [ 30 ], in two areas of Iraq, college students and nursing students included in their studies respectively [ 13 , 29 ].

Regarding associated factors, female sex was 2.3 times more likely at risk of increasing social phobia compared to male students. This study supported by those of other studies, females are not equally participated in all activities because of cultural influence when compared to male in Ethiopia [ 20 ], and in Iran, female students had highly prevalence of social anxiety disorder compared to male students [ 11 ]. The rate of specific phobias in women was double those of men [ 1 ]. The prevalence of social phobia near to double in female students compared to male students and the difference might be neglectful parenting styles and authoritarian difference between female and male students. Cultural and biological factors that may underlie sex differences in anxiety disorders [ 31 , 32 ]. Social phobia has been faced comparatively high in female students compared to male students in our culture; males dominated and received special care from their parents. This is the major factors which affect the psychology of females and led to social anxiety symptoms and as a result, females have felt uncomfortable in social gatherings.

Poor social support was 2.8 times more likely to develop social phobia compared to good support this is comparable with the study done in Ethiopia [ 20 ], in Saudi Arabia, female students who had low income were exposed to social anxiety disorder [ 27 ], in India, medical students came from low socioeconomic class were a high risk of social phobia during their education [ 16 ], and school-age adolescents from urban residence had insufficient income families were more risk of social phobia [ 33 ].

Students studying in the 1st year were 5.5 times had social phobia compared to 5th-year students. This study was supported by other study was done in Indian medical college students compared to 2nd-year students but in our study the reference took from 5th-year students because most of the studies had low prevalent of social phobia in the last years of their study [ 17 ]. The 1st and 2nd-year students were highly risky for social phobia, the reason might be the University settings where they forced to live for away from their parents for the first time and expose for new environmental stressors including social situation [ 1 , 34 ].

In Turkish, the 1st and 2nd-year university students had higher anxiety stress scores than other students [ 35 ]. Stress and environmental factors play a role in interpersonal stressors and thus can contribute to the development of social anxiety and differences in background, appearance, language, social and emotional development, all can affect whether or not a student fits in the university [ 36 ].

Finally, students coming from the rural areas were 1.6 times the risk of increasing social phobia compared to urban areas. Which was supported the studies done in India [ 14 ] and residence of students from the rural area in India medical college students developed social phobias which were consistency to our study [ 17 ]. Similar studies in Egypt, the prevalence of social phobia among male students were higher in urban areas but among female students were higher in rural areas [ 32 ] and the magnitude of social phobia was higher among rural areas’ students than urban and suburban students [ 37 ]. In Benin, the University of Parakou (UP) the impact of social phobia on academic performance among students living in rural areas were more risky to social phobia than those living in urban areas which means the prevalence of social phobia depends on the environment [ 34 ]. In Taiwan, rural adolescents were highly vulnerable to specific phobias compared to urban residences [ 38 ]. Another study conducted in India, risk factors of social anxiety in medical students were no significant difference between rural and urban residence [ 39 ]. The people living in rural areas were higher physical symptoms compared to those living in rural areas. The people belonging to urban areas had higher harm avoidance compared to those living in rural areas [ 36 ].

Conclusion and recommendations

In this study, the overall magnitude of social phobia was found to be 31.2%. Female sex, poor social support, students studying in the 1st year, and rural residence were explanatory variables significantly associated with social phobia. The ministry of education and the University of Gondar better to develop guidelines to solve the aforementioned factors. Further research on risk factors for social phobia should be conducted to strengthen and broaden these findings.

Limitations

A cross-sectional design cannot permit conclusions for some variables, for example, to decide whether social phobia symptoms are risks for or consequence. This finding is likely only to hint at the complex interactions between social phobia and explanatory variables (risk factors). The survey samples were a small number of students, the research work provided a summary of survey results. Another most important limitation of this study is the fact that the SPI scale was not validated in Ethiopia although it is widely used as a screening tool for social phobia in other countries. Further research should be considered on risk factors for social phobia to strengthen and broaden our results.

Availability of data and materials

No additional file is available for this study; all the data are included in the manuscript

Abbreviations

cognitive behavioral therapy

College of Medicine and Health Science

Diagnostic and Statistical Manual of Mental Disorders, 5th edition

National Co-morbidity Survey Revised

post traumatic stress disorder

social phobia inventory scale

social phobia scale

University of Gondar

World Health Organization

Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s synopsis of psychiatry behavioral sciences/clinical psychiatry. 11th ed. New York: Wolters Kluwer; 2015.

Google Scholar

Stein DJ, Lim CCW, Roest AM, Jonge PD, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The cross-national epidemiology of social anxiety disorder: data from the World Mental Health Survey Initiative. BMC Med. 2017;15:143.

Article PubMed PubMed Central Google Scholar

Dell’Osso L, Abelli M, Pini S, Carlini M, Carpita B, Macchi E, et al. Dimensional assessment of DSM-5 social anxiety symptoms among university students and its relationship with functional impairment. Neuropsychiatr Dis Treat. 2014;10:1325.

PubMed PubMed Central Google Scholar

Vitasaria P, Wahabb MNA, Herawanc T, Sinnaduraib SK. Representation of social anxiety among engineering students. Procedia Soc Behav Sci. 2011;30:620–4.

Article Google Scholar

Al-Qahtani AM. Prevalence and risk factors of social phobia among secondary school male students in Khamis Mushayt, Kingdom of Saudi Arabia. Med J Cairo Univ. 2012;80(1):871–6.

Furmark T. Social phobia. In: Psychology UU, editor. Sweden; 2000.

Izgiç F, Akyüz G, Doğan O, Kuğu N. Social phobia among university students and its relation to self-esteem and body image. Can J Psychiatry. 2004;49(9):630–4.

Article PubMed Google Scholar

Furmark T, Tillfors M, Everz P-O, Marteinsdottir I, Gefvert O, Fredrikson M. Social phobia in the general population: prevalence and sociodemographic pro ® le. Soc Psychiatry Epidemiol. 1999;34:416–24.

Article CAS Google Scholar

Honnekeria BS, Goelb A, Umatec M, Shahd N, Sousad AD. Social anxiety and Internet socialization in Indian undergraduate students: an exploratory study. Asian J Psychiatry. 2017;27:115–20.

Akram MS, Naik P, Nirgude AS. Study on social phobia and functional disability among University Students of Dakshina Kannada District. Natl J Community Med. 2016;7(12):909–13.

Asgari M, Amini K, Sahbaie F. Prevalence of social phobia disorder in high school students in Abhar city, Iran. J Fundam Ment Health. 2016;18(1):42–7.

AghaMohammadHasani P, Mokhtaree MR, Asadollahi Z, Fereidoni MJ, Student M. The prevalence of social phobia among students of Rafsanjan University of Medical Sciences, Iran, and its relation with personality traits in 2013. J Occup Health Epidemiol. 2016;5(2):72–82.

Ahmad RJ, Bayan H, Faque T, Mardan Seidi PA. Prevalence of social anxiety in students of college of education—University of Garmian. Int J Arts Technol. 2017;8(3):79–83.

Alkhathamia S, Kaviania H, Shorta E. Social anxiety among adolescents and its relation to quality of life. Eur Proc Soc Behav Sci. 2014(2357-1330).

Afifi DY. Social anxiety among Egyptian University Students. Cairo University; 2012.

Ghazwani JY, Khalil SN, Ahmed RA. Social anxiety disorder in Saudi adolescent boys: prevalence, subtypes, and parenting style as a risk factor. J Fam Community Med. 2016;23:25–31.

Ganapathi KC, Duraimurugan M, Kokila K, Gopal AM. A study on the prevalence of social anxiety disorder (SAD) among medical undergraduate students and its relation with self esteem. Community Med. 2016;3(4):31–5.

Ghezelbash S, Rahmani F, Peyrovi H, Inanloo M. Social anxiety in nursing students of Tehran Universities of Medical Sciences. Res Dev Med Educ. 2015;4(1):85–90.

Alqarni AA, Zalaa MA, El-Hadad AA, Al-Ghamdi RS, Asiri SA, Al-Thabet MM, et al. Prevalence of social phobia among Saudi Medical Students. Med J Cairo Univ. 2017;85(2):657–61.

Mekuria K, Mulat H, Derajew H, Mekonen T, Fekadu W, Belete A, et al. High magnitude of social anxiety disorder in school adolescents. Psychiatry J. 2017;2017:5.

Bøen H. Characteristics of senior centre users—and the impact of a group programme on social support and late-life depression. Norsk Epidemiol. 2012;22(2):261–9.

Connor KM, Davidson JRT, Churchill LE, Sherwood A, Foa E, Wesler RH. Psychometric properties of the social phobia inventory (SPIN). Br J Psychiatry. 2000;176:379–86.

Article CAS PubMed Google Scholar

Caballo VE, Salazar IC, Irurtia MJA, Hofmann BGS. Measuring social anxiety in 11 countries: development and validation of the Social Anxiety Questionnaire for Adults. Eur J Psychol Assess. 2010;26(2):95–107.

Garcia-Lopez LJ, Bermejo RM, Hidalgo MD. The social phobia inventory: screening and cross-cultural validation in Spanish adolescents. Span J Psychol. 2013;13(2):970–80.

Emmanuel A, Oyedele EA, Gimba SM, Gaji LD, Terdi KD. Does self-esteem influence social phobia among undergraduate nursing students in Nigeria. Int J Med Health Res. 2015;1(1):28–33.

Sridhar V, Surya Rekha SV. Social anxiety: prevalence and gender correlates among young adult urban college students. Int J Indian Psychol. 2017;4(4):2349–3429.

Wilson I. Screening for social anxiety disorder in first year university students: a pilot study. Reprinted from Aust Fam Physician. 2005;34(11).

Taha AA, El-shereef EA, Abdullah TIM, Abdullah RIM, Aldahasi WAM. Social anxiety disorder and its correlates among female students at Taif University, Saudi Arabia. Res Psychol Behav Sci. 2017;5(2):50–6.

Ali SK, Kareem MS, Al-Banna DA. Assessment of social phobia among students of nursing college in Hawler Medical University at Erbil City-Iraq. Kufa J Nurs Sci. 2016;6(2):130–6.

Jogdande AJ, Gupta A. Social anxiety disorder in medical students: socio-demographic correlates. Int J Community Med Public Health. 2017;4(9):3293–6.

Schry AR, Norberg MM, Maddox BB, White SW. Gender matters: the relationship between social anxiety and alcohol-related consequences. PLoS ONE. 2014;9(12):e115361.

Abdallah ES, ELzeiny HH, Abdel-hady RF, El-Sheikh. Association between social phobia and parenting styles among secondary school students. Am J Nurs Sci. 2016;5(3):96–105.

Chhabra V, Bhatia M, Gupta S, Kumar P, Srivastava S. Prevalence of social phobia in school-going adolescents in an urban area. Delhi Psychiatry J. 2009;12(1):18–25.

Djidonou A, Tchégnonsi FT, Adoukonou T, Ataïgba INE, Assa-Issa CN, Gandaho P. Associated factors and impacts of social phobia on academic performance among students from the University of Parakou (UP). Open J Psychiatry. 2016;6:151–7.

Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008;43:667–72.

Yen FC. Normative data on anxiety symptoms on the Multidimensional Anxiety Scale for children in Taiwanese children and adolescents: differences, in the sex, age, and residence and comparison with an American sample. Child Psychiatry. 2010;41(6):614–23.

Ragheb K, Abd El-Azem S, Abdel-wahab M, Attia H, Ismail R, Said M, et al. Prevalence of social anxiety symptoms among a sample of Egyptian adolescents. Egypt J Psychiatry. 2009;29(1):5–13.

Susan FS, Chong YM, et al. A 3-year panel study of mental disorders among adolescents in Taiwan. Am J Psychiatry. 2005;162:1344–50.

Upadhyaya SK, Raval CM, Sharma DK, Charan J. Risk factors of social anxiety in medical college students. J Health Spec. 2016;4:207–11.

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Acknowledgements

The authors acknowledge the University of Gondar Department of Psychiatry for funding. The authors appreciate the study institution and the study participants for their cooperation in providing the necessary information.

The funding was funded by the University of Gondar and the funders only involved by giving the funding for the design of a study, data collection, analysis, and interpretation only.

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Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Getachew Tesfaw Desalegn, Wondale Getinet & Getnet Tadie

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GTD conceived the study and was involved in the study design, reviewed the article, analysis, report writing, and drafted the manuscript. WG and GT were involved in the study design, analysis, and drafted the manuscript. All authors read and approved the final manuscript.

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Ethical approval was obtained from the Institutional Review Board (IRB) of the University of Gondar Department of Psychiatry. The objectives and demand of the study were explained carefully. To ensure confidentiality, participants’ data were linked to a code number and registered. All participants were given information sheets and were included in the study only after providing written consent. Confidentiality was maintained by using anonymous copes and who had a severe social phobia were considered for link a psychiatrist for further investigation and treatment.

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Additional files

Additional file 1..

Distribution of clinical, social, and substance characteristics of students at UoG, CMHS in, 2018 (n = 503).

Additional file 2.

Pie chart distribution of social phobia among students in the University of Gondar, Northwest Ethiopia in, 2018 (N = 503).

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Desalegn, G.T., Getinet, W. & Tadie, G. The prevalence and correlates of social phobia among undergraduate health science students in Gondar, Gondar Ethiopia. BMC Res Notes 12 , 438 (2019). https://doi.org/10.1186/s13104-019-4482-y

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DOI : https://doi.org/10.1186/s13104-019-4482-y

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Social anxiety disorder (social phobia)

It's normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinized or judged negatively by others.

In social anxiety disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your relationships, daily routines, work, school or other activities.

Social anxiety disorder can be a chronic mental health condition, but learning coping skills in psychotherapy and taking medications can help you gain confidence and improve your ability to interact with others.

Social anxiety disorder care at Mayo Clinic

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Feelings of shyness or discomfort in certain situations aren't necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.

Emotional and behavioral symptoms

Signs and symptoms of social anxiety disorder can include constant:

Fear of situations in which you may be judged negatively
Worry about embarrassing or humiliating yourself
Intense fear of interacting or talking with strangers
Fear that others will notice that you look anxious
Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
Avoidance of doing things or speaking to people out of fear of embarrassment
Avoidance of situations where you might be the center of attention
Anxiety in anticipation of a feared activity or event
Intense fear or anxiety during social situations
Analysis of your performance and identification of flaws in your interactions after a social situation
Expectation of the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety during speaking or performing in public but not in other types of more general social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

Fast heartbeat
Upset stomach or nausea
Trouble catching your breath
Dizziness or lightheadedness
Feeling that your mind has gone blank
Muscle tension

Avoiding common social situations

Common, everyday experiences may be hard to endure when you have social anxiety disorder, including:

Interacting with unfamiliar people or strangers
Attending parties or social gatherings
Going to work or school
Starting conversations
Making eye contact
Entering a room in which people are already seated
Returning items to a store
Eating in front of others
Using a public restroom

Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of changes, stress or demands in your life. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don't get treatment.

When to see a doctor

See your doctor or a mental health professional if you fear and avoid normal social situations because they cause embarrassment, worry or panic.

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Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include:

Inherited traits. Anxiety disorders tend to run in families. However, it isn't entirely clear how much of this may be due to genetics and how much is due to learned behavior.
Brain structure. A structure in the brain called the amygdala (uh-MIG-duh-luh) may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
Environment. Social anxiety disorder may be a learned behavior — some people may develop significant anxiety after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.

Risk factors

Several factors can increase the risk of developing social anxiety disorder, including:

Family history. You're more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
Negative experiences. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with this disorder.
Temperament. Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
New social or work demands. Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.
Having an appearance or condition that draws attention. For example, facial disfigurement, stuttering or tremors due to Parkinson's disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.

Complications

Left untreated, social anxiety disorder can control your life. Anxieties can interfere with work, school, relationships or enjoyment of life. This disorder can cause:

Low self-esteem
Trouble being assertive
Negative self-talk
Hypersensitivity to criticism
Poor social skills
Isolation and difficult social relationships
Low academic and employment achievement
Substance abuse, such as drinking too much alcohol
Suicide or suicide attempts

Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder.

There's no way to predict what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what's causing you stress and what seems to help you feel better.
Set priorities in your life. You can reduce anxiety by carefully managing your time and energy. Make sure that you spend time doing things you enjoy.
Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your health care provider or find a treatment program or support group to help you.

Social anxiety disorder (social phobia) care at Mayo Clinic

Social anxiety disorder (social phobia). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed May 21, 2021.
Gabbard GO, ed. Social anxiety disorder (social phobia). In: Gabbard's Treatments of Psychiatric Disorders. 5th ed. American Psychiatric Association; 2014. http://psychiatryonline.org/doi/book/10.1176/appi.books.9781585625048. Accessed May 21, 2021.
Schneier FR. Social anxiety disorder in adults: Epidemiology, clinical manifestations, and diagnosis. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
Stein MB, et al. Approach to treating social anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
Hofmann SG. Psychotherapy for social anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
Stein MB. Pharmacotherapy for social anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medications. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Physical, cognitive, and spiritual interventions. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
Social anxiety disorder: More than just shyness. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml. Accessed April 8, 2021.
Natural medicines in the clinical management of anxiety. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed April 8, 2021.
Sawchuk CN (expert opinion). Mayo Clinic. April 29, 2021.
AskMayoExpert. Anxiety disorders. Mayo Clinic; 2020. Accessed April 8, 2021.
Brown A. Allscripts EPSi. Mayo Clinic. Sept. 11, 2020.
Valerian. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed April 12, 2021.
Sarris J, et al., eds. Anxiety. In: Clinical Naturopathy. 3rd ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed April 12, 2021.

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Social Anxiety Disorder (Social Phobia)

Reviewed by Psychology Today Staff

Social anxiety disorder, formerly referred to as social phobia, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social anxiety disorder have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work, school, or other activities. While many people with social anxiety disorder recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation. In addition, they often experience low self-esteem and depression .

Social anxiety disorder can be limited to only one type of situation—such as a fear of public speaking —or a person can experience symptoms whenever they are around other people. If left untreated, social phobia can have severe consequences. For example, it may keep people from work or school or prevent them from making friends.

Physical symptoms, which often accompany the intense stress of social anxiety disorder, include blushing , sweating, trembling, nausea, and difficulty speaking. Because these visible symptoms heighten the fear of disapproval, they themselves can become an additional focus of fear, creating a vicious cycle: As people with social anxiety disorder worry about experiencing these symptoms, the greater their chances are of developing them.

Social anxiety disorder often runs in families and may be accompanied by depression or other anxiety disorders, such as panic disorder or obsessive-compulsive disorder. Some people with social anxiety disorder self-medicate with alcohol or other drugs, which can lead to addiction .

A diagnosis of social anxiety disorder is made only if this avoidance, fear, or anxious anticipation of a social or performance situation interferes with daily routine, occupational functioning, and social life or if there is marked distress as a result of the anxiety . The DSM-5 provides the following criteria for diagnosing social anxiety disorder:

The individual fears one or more social or performance situations in which he or she is exposed to possible scrutiny by others. Examples include meeting unfamiliar people, being observed eating or drinking, or giving a speech or performance.
The individual fears behaving in a manner that causes embarrassment or being negatively evaluated.
Exposure to social situations almost always causes intense anxiety.
The feared situation is avoided or endured with anxiety and distress.
The fear or anxiety is out of proportion to the actual threat posed by the social situation.
The fear or anxiety is persistent and typically lasts for six months or longer.
The avoidance, anxious anticipation, or distress interferes significantly with the person's social, academic, or occupational functioning.

The physical symptoms of social anxiety disorder include the following:

Blushing, sweating, trembling, experiencing a rapid heart rate, or feeling the “mind going blank”
Nausea or upset stomach
Displaying a rigid body posture, poor eye contact, or speaking too quietly

Additionally, the diagnosis can specify whether the anxiety or fear is present only when the person is speaking or performing in public.

According to the National Institute of Mental Health, about 7 percent of the U.S. population is estimated to have social anxiety disorder within a given 12-month period. Social anxiety disorder occurs about twice as often in women as in men, although a higher proportion of men seek help for the condition. The disorder typically begins in childhood or early adolescence and rarely develops after age 25.

For some people, just starting a simple conversation is anxiety-provoking. Other situations include:

• Picking up the phone

• Giving a speech or any form of public speaking

• Speaking up in a group

• Meeting new people

• Speaking to a teacher or other authority figure

While research to better understand the causes of social anxiety disorder is ongoing, some investigations implicate a small structure in the brain called the amygdala. The amygdala is believed to be a central site in the brain that controls fear responses.

Social anxiety disorder is heritable. In fact, first-degree relatives have a two to six times higher chance of developing social anxiety disorder. Research supported by the National Institute of Mental Health (NIMH) has also identified the site of a gene in mice that affects learned fearfulness. Scientists are exploring the idea that heightened sensitivity to disapproval may be physiologically or hormonally based. Other researchers are investigating the environment 's influence on the development of social phobia . Childhood maltreatment and adversity are risk factors for social anxiety disorder.

Children living in high-conflict homes can develop social anxiety disorder; trauma or abuse are also associated with SAD in children. In addition, a child who experiences bullying , rejection, humiliation, or teasing may also develop SAD.

Most anxiety disorders can be treated successfully by a trained mental healthcare professional. Social anxiety disorder is often treated effectively with two forms of treatment: psychotherapy and medications.

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that is very effective in treating severe social anxiety. A major aim of CBT and behavioral therapy is to reduce anxiety by eliminating beliefs or behaviors that help to maintain the anxiety disorder. For example, avoidance of a feared object or situation prevents a person from learning that it is harmless.

A key element of CBT for anxiety is exposure, in which people confront the things they fear. The exposure process generally involves three stages. First, a person is introduced to the feared situation. The second step is to increase the risk for disapproval in that situation so a person can build confidence that he or she can handle rejection or criticism. The third step involves teaching a person techniques for coping with disapproval. In this stage, people are asked to imagine their worst fear and are encouraged to develop constructive responses to this fear and perceived disapproval.

These stages are often accompanied by anxiety management training—for example, teaching people techniques such as deep breathing to control their anxiety. If this is done carefully and with support from a therapist, it may be possible to defuse the anxiety associated with feared situations. If you undergo CBT or behavioral therapy, exposure will be carried out only when you are ready; it will be done gradually and only with your permission. You will work with the therapist to determine how much you can handle and at what pace you can proceed.

CBT and behavioral therapy have no adverse side effects other than the temporary discomfort of increased anxiety, but the therapist must be well-trained in the techniques of the treatment for it to work as desired. During treatment, the therapist will likely assign homework—specific problems that the patient will need to work on between sessions. CBT or behavioral therapy generally lasts about 12 weeks. It may be conducted in a group, provided the people in the group have sufficiently similar problems. Supportive therapy, such as group, couples, or family therapy can be helpful to educate significant others about the disorder. Sometimes people with social anxiety also benefit from social skills training.

Medications

Proper and effective medications may also play a role in treatment, along with psychotherapy. Medications include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepines. Some people with a form of social anxiety that presents itself only when they have to perform in front of others have been helped by beta-blockers, which lower heart rate and reduce physical symptoms of anxiety.

Treatments for social anxiety disorder do not work instantly and that no one plan works well for all patients. Treatment must be tailored to the needs of each individual. A therapist and patient should work together to determine which treatment plan will be most effective and to assess whether the approach seems to be on track. Adjustments to the plan are sometimes necessary because patients respond differently to any one type of treatment.

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‘Cyclic sighing’ can help breathe away anxiety

Feeling anxious? You're far from alone. During the pandemic, rates of anxiety and depression soared around the globe, resulting in a shortage of mental health care providers and long wait times for therapy.

But, according to a new study from Stanford Medicine , there's an easy, at-home way to help lower your stress level: It's called cyclic sighing, a controlled breathing exercise that emphasizes long exhalations. What's more, it can take as little as five minutes to experience less anxiety, a better mood and even decreased rates of breathing at rest, a sign of overall body calmness.

"What's interesting about the breath is that it's right on the edge of conscious control," said David Spiegel , MD, the Jack, Lulu, and Sam Willson Professor in Medicine and associate chair of psychiatry and behavioral sciences, who co-led the study with Stanford Medicine neurobiologist Andrew Huberman , PhD, and Melis Yilmaz Balban, PhD, former Stanford Medicine senior research scientist. "Most of the time breathing is automatic, like digestion, heartbeat and other bodily functions, but you can very easily take over and control your breath, which then affects your overall physiology and stress response."

Breaking the anxiety spiral

Imagine you've just experienced something stressful -- maybe a critical email from your boss or a phone call from your child's school principal. As soon as you start to worry, your heart rate speeds, and you breathe a little more quickly. Your muscles tighten, your armpits get sweaty and you suddenly feel restless and fidgety.

For many people, especially those with anxiety disorders, these physical changes trigger a chain reaction of thoughts and fears, said Spiegel, who is the director of the Center on Stress and Health at Stanford Medicine. "As soon as you notice what's going on in your body, your brain thinks, 'Oh no, this must be really bad,' and you get more anxious. It's like a snowball rolling downhill."

But taking charge of your breathing can break the cycle, Spiegel said. "When we teach people to control the physical effects of a stressor on their body, it puts them in a better position to deal with the stressor itself."

The instructions are simple: Breathe in through your nose. When you've comfortably filled your lungs, take a second, deeper sip of air to expand your lungs as much as possible. Then, very slowly, exhale through your mouth until all the air is gone.

After one or two of these deep sighs, you may already feel calmer, but to get the full effect, Spiegel recommends repeating these deep sighs for about five minutes. Exhalation activates the parasympathetic nervous system, he said, which slows down heart rate and has an overall soothing effect on the body.

Putting cyclic sighing to the test

There's a long history of using controlled breathing in traditional practices like yoga, tai chi and meditation, but scientists are just beginning to study how these breathing exercises work and which ones are most beneficial.

Huberman and Spiegel recently led a randomized, controlled trial of cyclic sighing compared to two other types of breathing exercises, one emphasizing inhalation and another asking participants to breathe in and out for equal amounts of time. Each of the 111 healthy volunteers were asked to perform their assigned exercise for five minutes a day over the course of one month. (People with moderate to severe psychiatric conditions were not a part of this preliminary study.)

Before and after completing their daily breathing exercises, participants answered two online questionnaires: the State Anxiety Inventory, a standardized measurement of current anxiety levels, and the Positive and Negative Affect Schedule, a common research tool used to assess good and bad feelings on a scale from 1 to 5.

The trial also included a control group of participants who passively observed their breath during five minutes of mindfulness meditation.

"In mindfulness meditation, we instruct people to be aware of their breath but not try to control it," Spiegel said. "For the other groups, we asked participants to directly control an activity that normally goes on more or less automatically."

Hundreds of studies have demonstrated the benefits of mindfulness meditation for reducing stress and anxiety, and as expected, the mindfulness group reported lower anxiety and improved mood. But in this study , published Jan. 17 in Cell Reports Medicine , the controlled breathing groups reported even more improvements, with significantly greater increases in positive affect -- good feelings such as energy, joy and peacefulness.

On average, participants in the controlled breathing groups experienced a daily increase in positive affect of 1.91 points on the Positive and Negative Affect Schedule scale, compared to 1.22 points for the mindfulness meditation group, an improvement that's greater by about one-third.

"Controlled breathing exercises may have a more rapid, more direct effect on physiology than mindfulness," Spiegel said, noting that people typically meditate for 20 to 30 minutes at a time. "We wanted to see whether a quicker intervention, repeated for just five minutes over the course of 30 days, could still have lasting effects."

The researchers also hypothesized that cyclic sighing, with its focus on slow exhalation, might be more effective than the other two types of controlled breathing.

Indeed, while all three controlled breathing interventions decreased anxiety and negative mood, participants in the cyclic sighing group had the greatest daily improvement in positive feelings on the Positive and Negative Affect Schedule questionnaire. The effect increased as the study went on, suggesting that the more consecutive days they practiced cyclic sighing, the more it helped their mood.

Slower breathing rate, calmer body

In addition to tracking anxiety and mood, participants wore sensors to monitor their resting breathing rate and heart rate. Although no changes to heart rate were observed in any of the groups, participants in the cyclic sighing group significantly lowered their resting breathing rate, more than the mindfulness or other controlled breathing groups.

"They were breathing more slowly not just during the exercise, but throughout the day, indicating a lasting effect on physiology," Spiegel said.

Respiratory rate was also inversely correlated with a change in positive affect, suggesting that the participants whose breathing slowed down the most were also the ones who experienced the greatest improvement in mood.

"We know that people who are breathing very rapidly feel more anxious, such as during a panic attack," Spiegel said. "Controlled breathwork seems to be a straightforward way to do the opposite: lower physiologic arousal and regulate your mood."

Simple, quick and free

One of the best parts of cyclic sighing is that it can be done anytime, anywhere -- with zero cost and zero side effects. In fact, due to the pandemic, the team conducted the entire trial remotely.

"Now we know we can reach a much bigger and more diverse population than if we'd done everything in the lab," said Spiegel.

In the future, Spiegel and Huberman plan to use functional MRI to measure brain activity during the controlled breathing exercises, and they hope to conduct treatment studies in specific populations with anxiety or mood disorders.

"There's a growing interest in nonpharmacological ways of helping people regulate their mood," Spiegel said. "We may be able to identify certain kinds of anxiety that respond substantially to this simple treatment."

In the meantime, Spiegel says there's no harm in trying cyclic sighing for yourself.

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Addressing the unprecedented behavioral-health challenges facing Generation Z

Nearly two years after the COVID-19 pandemic began in the United States, Gen Zers, ranging from middle school students to early professionals, are reporting higher rates of anxiety, depression, and distress than any other age group. 1 Ages for Generation Z can vary, with some analysis including ages as young as nine. In this article, we focus on those between the ages of 16 and 24, and define millennials as 25 to 40; Ramin Mojtabai and Mark Olfson, “National trends in mental health care for US adolescents,” JAMA Psychiatry , March 25, 2020, Volume 77, Number 7; Martin Seligman, The Optimistic Child: A Revolutionary Approach to Raising Resilient Children , Boston, MA: Mariner Books, 2007; Gen Z respondents are 1.5 times as likely to report having felt anxious or depressed, compared with the average respondent, according to the McKinsey Consumer Health Insights Survey, conducted in June 2021—a nationally representative survey of 2,906 responses, including 316 Gen Z responses. The mental-health challenges among this generation are so concerning that US surgeon general Vivek Murthy issued a public health advisory on December 7, 2021, to address the “youth mental health crisis” exacerbated by the COVID-19 pandemic. 2 Protecting youth mental health: US surgeon general’s advisory , Office of the Surgeon General, December 7, 2021.

About the authors

The article is a collaborative effort by Erica Coe , Jenny Cordina , Kana Enomoto , Raelyn Jacobson , Sharon Mei, and Nikhil Seshan, representing views of the McKinsey’s Healthcare Systems & Services and Public & Social Sector Practices.

A series of consumer surveys and interviews conducted by McKinsey indicate stark differences among generations, with Gen Z reporting the least positive life outlook, including lower levels of emotional and social well-being than older generations. One in four Gen Z respondents reported feeling more emotionally distressed (25 percent), almost double the levels reported by millennial and Gen X respondents (13 percent each), and more than triple the levels reported by baby boomer respondents (8 percent). 3 These research efforts have been focused on Gen Zers between the ages of 16 and 24 when compared with samples of millennials (aged 25 to 40), Gen Xers (aged 41 to 56), and baby boomers (aged 57 to 76). And the COVID-19 pandemic has only amplified this challenge (see sidebar, “The disproportionate impact of the COVID-19 pandemic”). While consumer surveys are, of course, subjective and Gen Z is not the only generation to experience distress, employers, educators, and public health leaders may want to consider the sentiment of this emerging generation as they plan for the future.

The disproportionate impact of the COVID-19 pandemic

While Gen Z is less vulnerable to the physical impacts of the COVID-19 pandemic, they bear unique burdens due to their life stage, including emotional stress and grief from the pandemic, high rates of job loss and unemployment, and educational challenges from remote or interrupted learning. The effects of the pandemic may be especially felt by recent college graduates, many of whom have encountered difficulties finding jobs, had their previously secured job offers rescinded, or were unable to apply to graduate school due to the timing of the lockdowns in March 2020. In April 2020, workers aged 18 to 24 faced 27 percent unemployment, with 13 percent of this segment ceasing to look for work. While employment has largely recovered, this segment has exited the workforce at twice the rate of other age groups since the start of the pandemic. The inequitable impact of the pandemic by race extends to Gen Z employment as well, where Black, Hispanic/Latino, and Asian American and Pacific Islander (AAPI) workers aged 18 to 24 faced up to 1.8 times the unemployment rates of their White counterparts. 1 McKinsey analysis of the US Census Bureau Current Population Survey as of November 2020.

In our sample, Gen Z respondents were more likely to report having been diagnosed with a behavioral-health condition (for example, mental or substance use disorder) than either Gen Xers or baby boomers. 4 Gen Z respondents were 1.4 to 2.3 times more likely to report that they had been diagnosed with a mental-health condition and 1.9 to 4.1 times more likely to be diagnosed with a substance-use disorder than both Gen Xers and baby boomers. Based on the McKinsey Consumer Behavioral Health Survey conducted in November–December 2020—a nationally representative survey of 1,523 responses, including an oversample of Gen Z respondents (aged 16 to 24, n = 874). Gen Z respondents were also two to three times more likely than other generations to report thinking about, planning, or attempting suicide in the 12-month period spanning late 2019 to late 2020.

Gen Z also reported more unmet social needs than any other generation. 5 Also referred to as social determinants of health or social needs, including income, employment, education, food, housing, transportation, social support, and safety. These basic needs, if unmet, can negatively affect health. In addition, factors such as race, ethnicity, gender and sexual orientation, disability, and age can influence health status. Fifty-eight percent of Gen Z reported two or more unmet social needs, compared with 16 percent of people from older generations. These perceived unmet social needs, including income, employment, education, food, housing, transportation, social support, and safety, are associated with higher self-reported rates of behavioral-health conditions. As indicated in a recent nationwide survey, people with poor mental health were two times as likely to report an unmet basic need as those with good mental health, and four times as likely to have three or more unmet basic needs. 6 2019 McKinsey Social Determinants of Health Survey, n = 2,010, where respondents included those with Medicare or Medicaid coverage, individuals with coverage through the individual market who had household incomes below 250 percent of the federal poverty level, and individuals who were uninsured and had household income below 250 percent of the federal poverty level.

As these young adults work to develop their resilience, Gen Zers may seek out the holistic approach to health they have come to expect, which includes physical health, behavioral health, and social needs, as future students, employees, and customers.

Characteristics of Gen Z consumers in the healthcare ecosystem

Gen Z’s specific needs suggest that improving their behavioral healthcare will require stakeholders to increase access and deliver appropriate, timely services.

Gen Z is less likely to seek help

Gen Z respondents were more likely to report having a behavioral-health diagnosis but less likely to report seeking treatment compared with other generations (Exhibit 1). For instance, Gen Z is 1.6 to 1.8 times more likely to report not seeking treatment for a behavioral-health condition than millennials. There are several factors that may account for Gen Z’s lack of seeking help: developmental stage, disengagement from their healthcare, perceived affordability, and stigma associated with mental or substance use disorders within their families and communities. 7 Before age 25, the human brain is not fully developed. Awareness of long-term consequences and the ability to curb impulsive behavior are some of the last functions to mature. Thus, adolescents and young adults, across generations and not just Gen Z, may be less likely to engage in activities such as routine or preventive healthcare. For more, see Investing in the health and well-being of young adults , Institute of Medicine and National Research Council, 2015.

Gen Z respondents identified as less engaged in their healthcare than other respondents (Exhibit 2). About two-thirds of Gen Z respondents fell into lower engagement segments of healthcare consumers, compared with one-half of respondents from other generations. Gen Z and other people in these less engaged segments reported that they feel less in control of their health and lifespan, are less health-conscious, and are less proactive about maintaining good health. One-third of Gen Z respondents fell into the least engaged segment, who reported the lowest motivation to improve their health and the least comfort talking about behavioral-health challenges with doctors. 8 Disadvantaged, disconnected users are more resigned to their health and less engaged and active in improving it. They value convenience but are often not engaged digitally.

Another driver for Gen Z’s reduced help-seeking may be the perceived affordability of mental-health services. One out of four Gen Z respondents said they could not afford mental-health services, which had the lowest perceived affordability of all services surveyed. 9 Services surveyed include healthcare, health insurance, internet services, necessary transportation, financial services, housing, and nutritious food. Across the board, Americans with mental and substance use disorders bear a disproportionate share of out-of-pocket healthcare costs for a range of reasons, including the fact that many behavioral-health providers do not accept insurance . “I found the perfect therapist for me but I couldn’t afford her, even with insurance,” said one Gen Z respondent. “The absolute biggest barrier to gaining mental-health treatment has been financial,” added another.

In addition, stigma associated with mental and substance use disorders and a lack of family support may be a substantial barrier in seeking mental healthcare. Many Gen Zers rely on parents for transportation or health insurance and may fear interacting with their parents about mental-health topics. This factor is particularly relevant for communities of color, who report perceiving a higher level of stigma associated with behavioral-health conditions. 10 Mental health: Culture, race, and ethnicity; A supplement to mental health; A report of the surgeon general , US Department of Health and Human Services, August 2001: A 1998 study cited in the supplement found that only 12 percent of Asians would mention their mental-health problems to a friend or relative (compared with 25 percent of Whites), only 4 percent of Asians would seek help from a psychiatrist or specialist (compared with 26 percent of Whites), and only 3 percent of Asians would seek help from a physician (compared with 13 percent of Whites). Children of immigrants also may internalize guilt because of their parents’ sacrifices or may have behavioral-health concerns minimized by their parents, who may state or think their children “have it much easier” than they did growing up. 11 Mental Health America , “To be the child of an immigrant,” blog entry by Kenna Chick, accessed December 1, 2021.

Gen Z relies on emergency care, social media, and digital tools when they do seek help

When they do seek support for behavioral-health issues, Gen Z may not be turning to regular outpatient mental-health services and instead may rely on emergency care, social media, and digital tools .

Gen Zers rely on acute sites of care more often than older generations, with Gen Z respondents one to four times more likely to report using the ER, and two to three times more likely to report using crisis services or behavioral-health urgent care in the past 12 months. Gen Z also makes up nearly three-quarters of Crisis Text Line’s users. 12 Everybody hurts 2020: What 48 million messages say about the state of mental health in America , Crisis Text Line, February 10, 2020. One Gen Z respondent expressed her frustration, saying, “Seems [like the] only option is an emergency room visit, otherwise I have to wait weeks to see a psychiatrist.”

Almost one in four Gen Zers also reported that it is “extremely” or “very” challenging to get help during a behavioral-health crisis. This lack of access is concerning for a generation two to three times more likely to report seeking treatment in the past 12 months for suicidal ideation or attempted suicide, than any other generation.

Many Gen Zers also indicated their first step in managing behavioral-health challenges was going to TikTok or Reddit for advice from other young people, following therapists on Instagram, or downloading relevant apps. This reliance on social media may be due, in part, to the provider shortages in many parts of the country: 64 percent of counties in the United States have a shortage of mental-health providers. Furthermore, 56 percent of counties in the United States are without a psychiatrist (corresponding to 9 percent of the total population), and 73 percent of counties are without a child and adolescent psychiatrist (corresponding to 19 percent of the total population). 13 Oleg Bestsennyy, Greg Gilbert, Alex Harris, and Jennifer Rost, “ Telehealth: A quarter-trillion-dollar post-COVID-19 reality ?,” McKinsey, July 9, 2021; Vulnerable Populations dashboard, McKinsey’s Center for Societal Benefit through Healthcare, accessed December 1, 2021.

Gen Z is less satisfied with the behavioral-health services they receive

Gen Zers say the behavioral healthcare system overall is not meeting their expectations—Gen Zers who received behavioral healthcare were less likely to report being satisfied with the services they received than other generations. For example, compared with older generations, Gen Z reports lower satisfaction with behavioral-health services received through outpatient counseling/therapy (3.7 out of 5.0 for Gen Z, compared with 4.1 for Gen X) or intensive outpatient (3.1 for Gen Z, compared with 3.8 for older generations). 14 Mean differences are significantly different, at a 90 percent confidence level. One Gen Z respondent said, “Struggling to find a psychologist whom I was comfortable with and cared enough to remember my name and what we did the week before” was the most significant barrier to care. Another said, “I have trust issues and find it difficult to talk with therapists about my problems. I also had a very bad experience with a therapist, which made this problem worse.”

Although we have seen high penetration of telehealth in psychiatry (share of telehealth outpatient and office visits claims were at 50 percent in February 2021), 15 Vulnerable Populations: Data Over Time Database, McKinsey Center for Societal Benefit through Healthcare, April 2021. Gen Z has the lowest satisfaction with tele-behavioral health (Gen Z rates their satisfaction with telehealth at a 3.8 out of 5.0, compared with older generations, who rate it 4.1) and digital app/tools (3.5 out of 5.0 for Gen Z, compared with 4.0 for older generations). 16 Mean differences are significantly different, at a 90 percent confidence level. Around telehealth, Gen Zers cited reasons for dissatisfaction such as telehealth therapy feeling “less official” or “less professional,” as well as more difficult to form a trusting connection with a therapist. For apps, Gen Z respondents noted a lack of personalization, as well as a lack of diversity—both in terms of the racial and ethnic diversity of the stories they presented, and in the problems that the apps offered tools to address. In creating and improving behavioral-health tools, it is crucial to employ a user-centered design approach to develop functionality and experiences that Gen Zers actually want.

In creating and improving behavioral-health tools, it is crucial to employ a user-centered design approach to develop functionality and experiences that Gen Zers actually want.

Gen Z cares about diversity when choosing a healthcare provider

Racial and ethnic diversity in the behavioral-health workforce is also important. According to McKinsey’s COVID-19 Consumer Survey, racial and ethnic minority respondents reported valuing racial and ethnic diversity when choosing a physician, citing their physician’s race more frequently than White respondents as a consideration. 17 Thirteen percent of Black respondents, 9 percent of Asian respondents, and 8 percent of Hispanic/Latino respondents cited their physician’s race when selecting the physicians that they see, compared with 4 percent of Whites. Because Gen Z cares deeply about diversity, there are opportunities to integrate care and early intervention by offering a more racially and ethnically diverse behavioral-health workforce and culturally relevant digital tools. 18 According to surveys conducted by the Pew Research Center, most Gen Zers see the country’s growing racial and ethnic diversity as a good thing: Ruth Igielnik and Kim Parker, “On the cusp of adulthood and facing an uncertain future: What we know about Gen Z so far,” Pew Research Center, May 14, 2020.

Potential stakeholder actions to address the needs of Generation Z

In our article “ Unlocking whole person care through behavioral health ,” we outline six potential actions integral to improving the quality of care and experience for millions with behavioral-health conditions. Many of those levers apply to Gen Z, but further tailoring is needed to best meet the needs of this emerging generation. Promising areas to explore could include the emerging role of digital and telehealth; the need for stronger community-based response to behavioral-health crises; better meeting the needs of Gen Z where they live, work, and go to school; promoting mental-health literacy; investing in behavioral health at parity with physical health; and supporting a holistic approach that embraces behavioral, physical, and social aspects of health.

Need for action now

Gen Z is our next generation of leaders, activists, and politicians; many of them have already taken on adult responsibilities as they start climate movements, lead social justice marches, and drive companies to align more closely with their values. Healthcare leaders, educators, and employers all have a role to play in supporting the behavioral health of Gen Z. By taking a tailored, generational approach to designing messages, products, and services, stakeholders can meaningfully improve the behavioral health of Gen Z and help them achieve their full potential. This investment could be viewed as a down payment on our future that will bear social and economic returns for years to come.

Erica Coe is a partner in McKinsey’s Atlanta office and coleads the Center for Societal Benefit through Healthcare, Jenny Cordina is a partner in the Detroit office and leads McKinsey’s Consumer Health Insights research, Kana Enomoto is a senior expert in the Washington, DC, office and coleads the Center for Societal Benefit through Healthcare, Raelyn Jacobson is an associate partner in the Seattle office, Sharon Mei is an expert in the New York office, and Nikhil Seshan is a consultant in the Philadelphia office.

The authors wish to thank Tamara Baer, Eric Bochtler, Emma Dorn, Erin Harding, Brad Herbig, Jimmy Sarakatsannis, and Boya Wang for their contributions to this paper.

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Published: 15 June 2024

Assessment of the impact of social media addiction on psychosocial behaviour like depression, stress, and anxiety in working professionals

Vaishnavi Jahagirdar 1 ,
Lenisha Ashlyn Sequeira 1 ,
Nabeel Kinattingal 1 ,
Tamsheel Fatima Roohi 1 ,
Sultan Alshehri 2 ,
Faiyaz Shakeel 2 &
Seema Mehdi 1

BMC Psychology volume 12 , Article number: 352 ( 2024 ) Cite this article

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Social media (SM), with its addictive nature and the accompanying psychosocial challenges such as stress, anxiety, and depression, is the primary factor exacerbating mental health problems and adversely impacting individuals’ wellbeing. Our study’s goal was to determine how SM affects employees’ psychosocial behaviours and assess the various factors that contributed to the employee’s excessive use of SM.

A cross-sectional correlational analysis was conducted. Using a relevant questionnaire on employees, the study was assessed to establish the relationship or association between SM addiction and psychosocial disorders like depression, anxiety, and stress. 200 people with a minimum age of 24 were enrolled in the study. The questionnaire contained the social networking addiction scale (SNAS) and the depression, anxiety, and stress-21 (DASS-21) scales; the data were statistically assessed.

The association between SM addiction and psychosocial behaviours has been examined using statistical tools including descriptive statistics and the Chi-square analysis. SM addiction has a strong, statistically significant correlation with depression ( p = 0.001), stress ( p = 0.001), and anxiety ( p = 0.001).

This study discovered a connection between SM use and depression, stress, and anxiety among working employees, raising questions regarding worries about overuse and addiction to SM. Various factors influencing excessive usage included revealed that employees also majorly over used SM for entertainment, boredom avoidance, constant knowledge sharing, and relationship-building.

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Introduction

A web-based tool called social media (SM) facilitates the development of social networks and interpersonal relationships between people who have similar experiences, passions, pursuits, and connections. The increase in the availability of gadgets like laptops, smartphones, and tablets is driving the use of SM networking sites. There is much potential for people to use these digital gadgets without regard to time or space constraints and virtually communicate [ 1 ]. Over 59% of the global population, totalling 4.76 billion people, engages in SM, with 137 million new users in the past year. The average daily time spent on these platforms is 2 h and 31 min as of January 2023. Over the last decade, browsing and swiping on social networking sites have become increasingly common. While SM use is largely harmless, a tiny proportion of Americans—between 5 and 10%—show addicted behaviours and use it obsessively [ 2 ] social media addiction (SMA) is characterized by excessive concern about SM, an insatiable urge to access or use SM, and a commitment of more time and energy to SM to the point that it interferes with other significant elements of life [ 3 ]. 36.6% of 16-24-year-olds spend their leisure time on SM, and 47.5% use it to communicate with friends and family. While 34.8% of users click on to read news stories, 31% of users log on to search for articles or videos.

Users use multiple social networks. Around the world, 7.4 platforms are utilized on a monthly average. The average number of SM platforms used per person is 8.7 in India, compared to 3.7 in Japan. Each platform is utilized for various purposes by users, Facebook (71.1%) for messaging, TikTok (77.4%) and Reddit (37.8%) for fun, and Snapchat (40.3%) and Instagram (69.9%) for sharing pictures and videos [ 4 ]. The average time a person spends on these channels daily is Facebook (33 min), LinkedIn (<1 min), Instagram (29 min), Whatsapp (28 min), Snapchat (31 min) and Twitter (31 min). Previous studies found that the main predictor of mental health problems was not age but rather gender, with women being far more likely than men to develop mental health issues [ 5 ].

Excessive SM use is linked to participants’ fear of missing out (FOMO), the desire for up-to-date information, and the cycle of notifications [ 6 ]. The time lost as a result of this over-engagement is sometimes overlooked [ 7 ]. SMA among workers adversely affects productivity by causing them to miss deadlines, compromise the quality of their work, and become easily distracted from their tasks [ 8 , 9 ]. Additionally damaging to their career and personal relationships, SMA makes people feel insecure and develop an inferiority complex [ 10 , 11 ]. The impact of SMA on employees’ physical and emotional welfare are depicted in Fig. 1 [ 12 ]. Excessive SM use is increasingly recognized as a behavioural addiction, sharing similarities with other addictive disorders [ 13 ]. Due to the similarities such as withdrawal, conflict, relapse, tolerance, and mood alteration, excessive SM use has lately been considered a behavioural addiction [ 14 , 15 ].

The impact of addiction to social media on employees’ physical and emotional welfare (Created with BioRender.com )

SM triggers dopamine, the ultimate feel-good chemical, in order to take advantage of our brain’s reward system. Our brains release the neurotransmitter dopamine whenever we have a happy experience. It’s how our brain remembers that engaging in certain activities will make us feel good, which encourages us to keep doing them. When we exercise, consume delicious cuisine, or get a notification that someone liked our photo, dopamine is released [ 16 ]. Our dopamine levels spike in response to a phone notification, which encourages us to check and use our phones longer than we otherwise would. The most extreme form of this drive is known by scientists as “phantom text syndrome”, in which a user perceives or hears a ringtone or alert even when none is there. The brain creates a false excuse—a phantom SMS—because it wants you to check your phone. This phenomenon bears resemblance to both addiction and wants [ 17 ]. It has been shown that there is a stronger correlation between depression and passively browsing SM posts as opposed to actively viewing them [ 18 , 19 ].

Extended use of social networking sites such as Facebook may be associated with negative symptoms of depression, anxiety, and stress [ 20 , 21 ]. Face-to-face interaction with others is necessary to release the hormones that lower stress and improve your mood, physical health, and outlook on life [ 22 ]. Ironically, for a platform designed to foster community, excessive use of SM can exacerbate mental health conditions like anxiety and depression and leave you feeling alone and isolated [ 23 , 24 ].

This study aims to assess the impact of SMA on psychosocial behaviours including depression, stress, and anxiety in employees [97 teaching staffs (Lecturers, Assistant Professors, Associate Professors, and Professors and 108 non-teaching staffs), and identify the key factors influencing SMA characteristics.

Study design

The study conducted is a cross-sectional, correlational type of research. The study was conducted to assess the relationship or association of SMA with psychosocial problems like depression, anxiety, and stress using a suitable questionnaire, on employees/working professionals (97 teaching staffs and 108 non-teaching staffs) [ 25 ].

The study was conducted at JSS Academy of Higher Education and Research (JSS AHER) in Mysuru, Karnataka, India.

Participants

The study included N = 200 participants of both genders. Among them, there were 200 employees/working professionals (97 teaching staffs and 108 non-teaching staffs) of > 24 years. The sample size of 200 was calculated using the Slovin or Yamane formula, where the standard of deviation, P = 0.5; margin of error, e = 0.04; confidence interval is 95%; population size, N = 2500 was considered [ 26 ]. The enrollment was not based on the history of depression, stress, and anxiety. However, the depression, stress, and anxiety were evaluated based on SMA. Inclusion criteria included employees/working professionals of either gender (age > 24), and participants willing to give their consent and participate in the study. Exclusion criteria included employees suffering from chronic diseases like heart disease, asthma, and cancer. This study was carried out in accordance with the Declaration of Helsinki. All study procedures were approved by the Institutional Ethics Committee (IEC Registration ECR/387/Inst/KA/2023/RR-19) at JSS Medical College, Mysuru, and obtained informed consent from all employees which was included in the Google Forms depicted in supplementary materials .

An online survey had been conducted for the assessment of the impact of SMA on psychosocial behaviours such as depression, stress, and anxiety. A link to a structural questionnaire created with ‘Google Forms’, was sent to employees via WhatsApp and email. The response collection tool was built by a combination of two scales: the DASS-21 and social networking addiction scale (SNAS). Demographical information was also included in the questionnaire. Before participation, consent was obtained from employees, and all information provided was assured of confidentiality. The process of the study is depicted in Fig. 2 . The questionnaire took an average of 5–10 min to complete. The form was completed by 205 employees (96 males and 109 females). When the forms were examined after the study, 5 forms were not evaluated due to incomplete data. Therefore, the data collection process was completed with 200 forms. The validity and reliability of questionnaire using the above-mentioned methods have been validated in the previous studies [ 17 , 27 , 28 ]. Therefore, the validity studies were not performed in the present study.

A pathway model analysis in the investigative study

Data collection tools

Sociodemographic characteristics.

The survey sought questions about age, gender, and courses of employees (teaching and non-teaching), area of residence (Urban, suburban and rural), family type (joint and nuclear), marital status (married and unmarried), family income (lower, lower middle, upper class, upper lower, upper middle), social history (alcohol, tobacco), and mental health conditions and general health conditions, to create a profile of the participants’ sociodemographic characteristics.

The DASS-21, which has been used to assess mental health, was used to assess respondents’ mental health status. Three self-report measures are included in the DASS-21, which is intended to evaluate anxiety, stress, and depression. The seven elements on each of the three DASS-21 scales are broken down into subscales containing relevant data. According to Lovibond and Lovibond depression severity ratings range from 0 to 9, with 0 representing normal, 10–13 representing mild, 14–20 representing moderate, 21–27 representing severe, and 28 representing extremely severe. Anxiety has severity levels ranging from 0 to 7, with 0 being normal, 8–9 being mild, 10–14 being moderate, 15–19 being severe, and 20 or more being extremely severe. Stress is classified as 0–14 normal, 15–18 mild, 19–25 Moderate, 26–33 severe, and 34 or more extremely severe [ 29 , 30 ].

A 21-item Likert scale with seven possible responses was presented by Shahnawaz and Rehman in order to gauge how much a person experiences social network addiction. The possible range of the score is 21–147. A score of more than 84 denotes addiction, which is diagnosed at three different levels: mild, moderate, and severe. Factorial analysis of the scale is necessary to identify and evaluate the cultural and environmental factors that may influence these levels. People’s level of SMA can be determined and evaluated using the SNAS [ 31 ].

Statistical analysis

The data was statistically analysed using the SPSS Statistics Base V 28 version of the Statistical Package for the Social Sciences software which is used to perform meta-analysis. Descriptive statistical methods (frequency, percentage, mean) were used to evaluate the study’s data which included the demographic details and SNAS and DASS-21 severity scoring; Chi-square analysis also called Pearson Chi-square analysis (a statistical test used to examine the differences between the categorical variables) which is a non-parametric test, was used to find the association of SMA with depression, stress, and anxiety. The results were assessed using a 95% confidence interval [ 32 ].

Preliminary analysis

By using descriptive statistics like frequency and percentage of categorical data, a summary of the preliminary investigations on the demographic characteristics of the employees demonstrated potential covariates. The study population included majorly subjects of age above 25 years, as the most active demographics on SM. Responses received from the female subjects were more as compared to male respondents. Table 1 provides the summary of sociodemographic characteristics among the employee covariates and Table 2 provides a summary of the demographic details among employees in association with disorders.

SNAS and DASS-21 severity scoring

Descriptive statistics on SMA revealed that 30.2% of employees are addicted to SM. Cut-off scores for conventional severity labels (normal, moderate, severe) for depression, stress, and anxiety are statistically represented using frequency and percentage (Table 3 ).

Main analysis

Association of depression, anxiety and stress with sma.

A χ² test was run to compare depression, anxiety and stress with SNAS. Since all predicted cell frequencies were higher than 5, the χ² test’s assumptions were satisfied.

Association of depression with SMA

Between SMA and depression, there was no statistically significant correlation (χ² (4) = 4.09, p = 0.394). The calculated p -value of 0.394 is above z the defined significance level of 5%. As seen in Table 4 , the null hypothesis is not rejected and the χ² test is not significant.

Association of anxiety with SMA

Between SMA and anxiety, there was no statistically significant correlation (χ² (4) = 2.02, p = 0.732). The calculated p -value of 0.732 is above the defined significance level of 5%. As seen in Table 5 , the null hypothesis is not rejected and the χ² test is not significant.

Association of stress with SMA

Between SMA and stress, there was no statistically significant correlation (χ² (4) = 0.39, p = 0.983). The calculated p -value of 0.983 is above the defined significance level of 5%. As seen in Table 6 , the null hypothesis is not rejected and the χ² test is not significant.

Conceptual structure of factors influencing the overuse of SM in employees

It was found that employees excessively overused SM for enjoyment, to build relationship, to prevent boredom, loneliness and avoid exhaustion, for satisfaction, peer/parent influence and for continual knowledge and information exchange. This has been denoted in Table 7 .

Recent years have witnessed a significant expansion in the use of SM, impacting daily life globally [ 1 , 3 ]. Recent studies highlight a sharp rise in SM usage, sparking interest in this subject and potential drawback [ 3 ]. Increased use, particularly on social networking sites, raises the risk of addiction, termed “problematic social media use” [ 1 , 2 , 3 ]. This overuse hinders regular functioning, characterized by addictive traits [ 4 ]. This is true despite the many benefits of technology, such as easy access to information, effortless interaction with communities around the world, entertainment, and business development. When utilising SM platforms, people may experience a wide range of emotions both positive and negative, which may have an effect on their mental health [ 1 , 2 , 3 , 4 , 5 ].

In primary care settings, depression, stress, and anxiety are all common illnesses with a high risk of co-occurrence [ 3 , 10 , 13 ]. Depression and anxiety have been connected to negative emotional SM experiences [ 10 ]. There is significant discussion over the impact of pleasant feelings and distraction on users’ mental health [ 12 ]. While some researchers caution against the potential harms of online use, others advise against overstating its effects on mental health [ 13 , 14 , 15 ]. Therefore, this study’s outcomes may help in some manner to clarify the important controversy over inappropriate SM consumption. A few of the significant issues that depression is linked to are incomplete education, a higher incidence of unwanted pregnancies, significantly fewer affluent interpersonal connections, and an increased risk of drug abuse and suicidality. Depressed people are also more susceptible to being ingested by SM [ 15 , 16 , 17 ]. Stress is a defence mechanism that humans have developed as a means of enabling us to act quickly in the face of acute threats. On the other side, persistent stress can result in physical and mental chronic disorders [ 29 ]. Stress is defined as a sensation accompanied with predictable biochemical, physiological, and behavioural changes [ 29 , 30 ]. There are several hypotheses explaining how using SM may lead to stress, and these changes in the body’s psychological makeup might be brought on by doing so [ 29 , 30 , 31 , 32 ]. This study examined the relationship between SMA and psychosocial behaviours including depression, stress, and anxiety in employees, and identified the key characteristics that led the group to use SM excessively. SM usage and mental health issues are often linked, even if our study’s results were not totally consistent.

Due to the fact that employees tend to overuse cell phones, we gathered the data using the DASS-21 and SNAS. Second, this study examine how SM affected employees’ psychosocial behaviours. Due to the fact that any individual’s demographic traits have a significant impact on the study’s findings, we have gathered a variety of demographic information from employees. First, more female employees gave replies than male employees did (Table 1 ), and most of the respondents were from metropolitan areas. A nuclear family made up 70% of them. Additionally, this study included a list of general health issues, which also includes mental health issues. Psychological issues may be attributed to people with any number of mental diseases, which may turn out to be the primary cause of SMA.

The SNAS was used to gauge the extent of addiction among the employees, and the findings showed that roughly 77.6% of the staff members had severe SM addiction (Table 3 ). This must have been caused due to onset of social anxiety. Health line recommends certain therapies for a such population to overcome their addiction. The therapies include; cognitive behavioural therapy, motivational interviewing, and group counselling sessions. The DASS-21 answers revealed that the majority of employees fell into the normal range, indicating that the rest of the population had depression scores ranging from mild to severely severe (Table 3 ). Numerous factors, including FOMO, academic pressure, poor sleep, financial difficulties, drug abuse, and loneliness, among others, may contribute to this. The findings of the Chi-square test used to analyse the link between depression, stress, anxiety, and SMA showed that the level of depression, stress, and anxiety, as well as the range of addiction to SM observed in employees, has been high and has demonstrated statistical significance ( p = 0.001). These observations were in good agreement with those pointed out in the previous studies [ 2 , 6 , 9 , 11 , 27 , 28 ].

Additionally, it was found that employees heavily overused SM for enjoyment, to prevent boredom, and for continual knowledge and information exchange. To provide a more focused assessment, further future research is needed to look into the etiological pathways connecting SMA with psychological issues. Additionally, more investigation is required to determine the effect of SM on sleep quality and semantic memory.

In conclusion, this study demonstrated a significant association between SMA and psychosocial factors like depression, stress, and anxiety among the employee population. The health line elucidates certain therapies to treat these conditions; such as Psychotherapies, Alternative therapies like herbal remedies, massage, acupuncture, yoga, and medication. Additionally, to overcome addiction to SM, employees are recommended to seek help by obtaining preventive therapies. Responses collected from the population has shed information that the prime factors that led them to overuse SM were entertainment and to avoid boredom.

SM facilitates the development of relationships among individuals with similar backgrounds and interests. SMA is characterized by excessive worry, an insatiable need for access, and a commitment that interferes with other life aspects. While most users engage harmlessly, a small percentage exhibits addictive behaviour, leading to negative impacts on productivity and mental health, including depression, anxiety, and stress. The impact of excessive SM use is explored, including its link to the productivity issues among workers, and its negative effects on mental health, such as depression, anxiety, and stress. This study demonstrated a significant association between SMA and psychosocial factors like depression, stress, and anxiety among the employee population.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Social media

Social media addiction

Social networking addiction scale

Depression, anxiety, and stress scale-21

Statistical product and service solutions

Fear of missing out

JSS Academy of Higher Education and Research

Priyadarshini C, Dubey RK, Kumar YLN, Jha RR. Impact of social media addiction on employees’ wellbeing and work productivity. Qual Rep. 2020;25:181–96.

Google Scholar

Elhai JD, Levine JC, Dvorak RD, Hall BJ. Fear of missing out, need for touch, anxiety and depression are related to problematic smartphone use. Comput Hum Behav. 2016;63:509–16.

Article Google Scholar

Karim F, Oyewande A, Abdalla LF, Chaudhry Ehsanullah R, Khan S. Social media use and its connection to mental health: a systematic review. Cureus. 2020;12:E8627.

PubMed PubMed Central Google Scholar

Jojo CE, Sundaramoorthy J. Personality traits associated with internet addiction among college students in South India. Cog Edu. 2022;9:E2142455.

Muris P, Steerneman P. The revised version of the screen for child anxiety related emotional disorders (SCARED-R): first evidence for its reliability and validity in a clinical sample. Br J Clin Psychol. 2001;40:35–44.

Article PubMed Google Scholar

Hunt MG, Marx R, Lipson C, Young J. No more FOMO: limiting social media decreases loneliness and depression. J Soc Clin Psychol. 2018;37:751–68.

Zivnuska S, Carlson JR, Carlson DS, Harris RB, Harris KJ. Social media addiction and social media reactions: the implications for job performance. J Soc Psychol. 2019;159:746–60.

Chen Q, Hu J, Zhang W, Evans R, Ma X. Employee use of public social media: theories, constructs and conceptual frameworks. Behav Inf Technol. 2021;40:855–79.

Aydin S, Koçak O, Shaw TA, Buber B, Akpinar EZ, Younis MZ. Investigation of the effect of social media addiction on adults with depression. Healthcare. 2021;9:E450.

Eka Prasetya TA, Kusuma Wardani RW. Systematic review of social media addiction among health workers during the pandemic Covid-19. Heliyon. 2023;9:E16784.

Article PubMed PubMed Central Google Scholar

Tunc-Aksan A, Akbay SE. Smartphone addiction, fear of missing out, and perceived competence as predictors of social media addiction of adolescents. Eur J Edu Res. 2019;8:559–66.

Tandon A, Kaur P, Dhir A, Mäntymäki M. Sleepless due to social media? Investigating problematic sleep due to social media and social media sleep hygiene. Comput Hum Behav. 2020;113:E106487.

Hou Y, Xiong D, Jiang T, Song L, Wang Q. Social media addiction: its impact, mediation, and intervention. Cyberpsychol. 2019;13:E4.

Yoon S, Wee S, Lee VSY, Lin J, Thumboo J. Patterns of use and perceived value of social media for population health among population health stakeholders: a cross-sectional web-based survey. BMC Public Health. 2021;21:E1312.

Keles B, McCrae N, Grealish A. A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. Int J Adoles Youth. 2020;25:79–93.

Berridge KC, Robinson TE. Liking, wanting, and the incentive-sensitization theory of addiction. Am Psychol. 2016;71:670–9.

Lin YH, Chang LR, Lee YH, Tseng HW, Kuo TBJ, Chen SH. Development and validation of the smartphone addiction inventory (SPAI). PLoS ONE. 2014;9:E98312.

Baltacı Ö. The predictive relationships between the social media addiction and social anxiety, loneliness, and happiness. Int J Prog Edu. 2019;15:73–82.

Brunelli M, Niu L, Soghomonian C, Salandy A. Studying adolescent athletes for evaluation of mental health and substance use in an urban setting. Asp J Pediatr Child Health. 2021;3:18–29.

O’reilly M, Dogra N, Hughes J, Reilly P, George R, Whiteman N. Potential of social media in promoting mental health in adolescents. Health Promot Int. 2019;34:981–91.

Escobar-Viera CG, Whitfield DL, Wessel CB, Shensa A, Sidani JE, Brown AL, et al. For better or for worse? A systematic review of the evidence on social media use and depression among lesbian, gay, and bisexual minorities. JMIR Men Health. 2018;5:E10496.

Fardouly J, Magson NR, Rapee RM, Johnco CJ, Oar EL. The use of social media by Australian preadolescents and its links with mental health. J Clin Psychol. 2020;76:1304–26.

Brailovskaia J, Schillack H, Margraf J. Tell me why are you using social media (SM)! Relationship between reasons for use of SM, SM flow, daily stress, depression, anxiety, and addictive SM use–An exploratory investigation of young adults in Germany. Comput Hum Behav. 2020;113:E106511.

Haand R, Shuwang Z. The relationship between social media addiction and depression: a quantitative study among university students in Khost, Afghanistan. Int J Adolesc Youth. 2020;25:780–6.

Cao X, Yu L. Exploring the influence of excessive social media use at work: a three-dimension usage perspective. Int J Inf Manage. 2019;46:83–92.

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35:121–6.

Cuadrado E, Rojas R, Tabernero C. Development and validation of the social network addiction scale (SNAddS-6S). Eur J Invetig Psychol Educ. 2020;10:763–78.

Bi S, Yuan J, Luo L. The social networking addiction scale: translation and validation study among Chinese college students. Int J Mental Health Promot. 2024;26:51–60.

González-Rivera JA, Pagán-Torres OM, Pérez-Torres EM. Depression, anxiety and stress scales (Dass-21): construct validity problem in hispanics. Eur J Investig Health Psychol Educ. 2020;10:375–89.

Ahmed O, Faisal RA, Alim S, Sharker T, Hiramoni FA. The psychometric properties of the Depression anxiety stress Scale-21 (DASS-21) Bangla version. Acta Psychol. 2022;223:E103509.

Shahnawaz MG, Rehman U. Social networking addiction scale. Cogent Psychol. 2020;7:E1832032.

McHugh ML. The Chi-square test of independence. Biochem Med. 2013;23:143–9.

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Acknowledgements

The authors are thankful to the Researchers Supporting Project number (RSP2024R146), King Saud University, Riyadh, Saudi Arabia for supporting this work. The authors also thank to JSS college of Pharmacy, and JSS Hospital, Mysuru for providing facilities and constant support for the completion of this research work.

This work was funded by the Researchers Supporting Project number (RSP2024R146), King Saud University, Riyadh, Saudi Arabia.

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Vaishnavi Jahagirdar was involved in designing the study, collecting, analysing and interpreting the data. Lenisha Ashlyn Sequeira was involved in analysing and interpreting the data along with statistical analysis, drafting the article, critical revision of the article for important intellectual content. Nabeel Kinattingal was involved in designing the study, collecting the data, analysing and interpreting the data, provision of the study materials or patients, administrative, technical or logistic support and final approval of article. Tamsheel Fatima Roohi was involved in analysing and interpreting the data, drafting the article and statistical expertise. Sultan Alshehri was involved in validating, editing, funding, visualization of the article. Faiyaz Shakeel was involved in the analysis and interpretation of data, critical revision of the article for important intellectual content, administrative, technical or logistic support and final approval of article. Seema Mehdi was involved in supervision, conceptualization, project administration, and validation of the studies. Finally, all authors have read, edited, and approved the final version of the article.

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Surgeon General Issues New Advisory About Effects Social Media Use Has on Youth Mental Health

Surgeon General Dr. Vivek Murthy Urges Action to Ensure Social Media Environments are Healthy and Safe, as Previously-Advised National Youth Mental Health Crisis Continues

Today, United States Surgeon General Dr. Vivek Murthy released a new Surgeon General’s Advisory on Social Media and Youth Mental Health . While social media may offer some benefits, there are ample indicators that social media can also pose a risk of harm to the mental health and well-being of children and adolescents. Social media use by young people is nearly universal, with up to 95% of young people ages 13-17 reporting using a social media platform and more than a third saying they use social media “almost constantly.”

With adolescence and childhood representing a critical stage in brain development that can make young people more vulnerable to harms from social media, the Surgeon General is issuing a call for urgent action by policymakers, technology companies, researchers, families, and young people alike to gain a better understanding of the full impact of social media use, maximize the benefits and minimize the harms of social media platforms, and create safer, healthier online environments to protect children. The Surgeon General’s Advisory is a part of the Department of Health and Human Services’ (HHS) ongoing efforts to support President Joe Biden’s whole-of-government strategy to transform mental health care for all Americans.

“The most common question parents ask me is, ‘is social media safe for my kids’. The answer is that we don't have enough evidence to say it's safe, and in fact, there is growing evidence that social media use is associated with harm to young people’s mental health,” said U.S. Surgeon General Dr. Vivek Murthy . “Children are exposed to harmful content on social media, ranging from violent and sexual content, to bullying and harassment. And for too many children, social media use is compromising their sleep and valuable in-person time with family and friends. We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.”

Usage of social media can become harmful depending on the amount of time children spend on the platforms, the type of content they consume or are otherwise exposed to, and the degree to which it disrupts activities that are essential for health like sleep and physical activity. Importantly, different children are affected by social media in different ways, including based on cultural, historical, and socio-economic factors. Among the benefits, adolescents report that social media helps them feel more accepted (58%), like they have people who can support them through tough times (67%), like they have a place to show their creative side (71%), and more connected to what’s going on in their friends’ lives (80%).

However, social media use can be excessive and problematic for some children. Recent research shows that adolescents who spend more than three hours per day on social media face double the risk of experiencing poor mental health outcomes, such as symptoms of depression and anxiety; yet one 2021 survey of teenagers found that, on average, they spend 3.5 hours a day on social media. Social media may also perpetuate body dissatisfaction, disordered eating behaviors, social comparison, and low self-esteem, especially among adolescent girls. One-third or more of girls aged 11-15 say they feel “addicted” to certain social media platforms and over half of teenagers report that it would be hard to give up social media. When asked about the impact of social media on their body image, 46% of adolescents aged 13-17 said social media makes them feel worse, 40% said it makes them feel neither better nor worse, and only 14% said it makes them feel better. Additionally, 64% of adolescents are “often” or “sometimes” exposed to hate-based content through social media. Studies have also shown a relationship between social media use and poor sleep quality, reduced sleep duration, sleep difficulties, and depression among youth.

While more research is needed to determine the full impact social media use has on nearly every teenager across the country, children and adolescents don’t have the luxury of waiting years until we know the full extent of social media’s effects. The Surgeon General’s Advisory offers recommendations stakeholders can take to help ensure children and their families have the information and tools necessary to make social media safer for children:

Policymakers can take steps to strengthen safety standards and limit access in ways that make social media safer for children of all ages, better protect children’s privacy, support digital and media literacy, and fund additional research.
Technology companies can better and more transparently assess the impact of their products on children, share data with independent researchers to increase our collective understanding of the impacts, make design and development decisions that prioritize safety and health – including protecting children’s privacy and better adhering to age minimums – and improve systems to provide effective and timely responses to complaints.
Parents and caregivers can make plans in their households such as establishing tech-free zones that better foster in-person relationships, teach kids about responsible online behavior and model that behavior, and report problematic content and activity.
Children and adolescents can adopt healthy practices like limiting time on platforms, blocking unwanted content, being careful about sharing personal information, and reaching out if they or a friend need help or see harassment or abuse on the platforms.
Researchers can further prioritize social media and youth mental health research that can support the establishment of standards and evaluation of best practices to support children’s health.

In concert with the Surgeon General’s Advisory, leaders at six of the nation’s medical organizations have expressed their concern on social media’s effects on youth mental health:

“Social media can be a powerful tool for connection, but it can also lead to increased feelings of depression and anxiety – particularly among adolescents. Family physicians are often the first stop for parents and families concerned about the physical and emotional health of young people in their lives, and we confront the mental health crisis among youth every day. The American Academy of Family Physicians commends the Surgeon General for identifying this risk for America's youth and joins our colleagues across the health care community in equipping young people and their families with the resources necessary to live healthy, balanced lives.” – Tochi Iroku-Malize, M.D., MPH, MBA, FAAFP, President, American Academy of Family Physicians

“Today’s children and teens do not know a world without digital technology, but the digital world wasn’t built with children’s healthy mental development in mind. We need an approach to help children both on and offline that meets each child where they are while also working to make the digital spaces they inhabit safer and healthier. The Surgeon General’s Advisory calls for just that approach. The American Academy of Pediatrics looks forward to working with the Surgeon General and other federal leaders on Youth Mental Health and Social Media on this important work.” – Sandy Chung, M.D., FAAP, President, American Academy of Pediatrics

“With near universal social media use by America’s young people, these apps and sites introduce profound risk and mental health harms in ways we are only now beginning to fully understand. As physicians, we see firsthand the impact of social media, particularly during adolescence – a critical period of brain development. As we grapple with the growing, but still insufficient, research and evidence in this area, we applaud the Surgeon General for issuing this important Advisory to highlight this issue and enumerate concrete steps stakeholders can take to address concerns and protect the mental health and wellbeing of children and adolescents.We continue to believe in the positive benefits of social media, but we also urge safeguards and additional study of the positive and negative biological, psychological, and social effects of social media.”— Jack Resneck Jr., M.D., President, American Medical Association

“The first principle of health care is to do no harm – that’s the same standard we need to start holding social media platforms to. As the Surgeon General has pointed out throughout his tenure, we all have a role to play in addressing the youth mental health crisis that we now face as a nation. We have the responsibility to ensure social media keeps young people safe. And as this Surgeon General’s Advisory makes clear, we as physicians and healers have a responsibility to be part of the effort to do so.” – Saul Levin, M.D., M.P.A., CEO and Medical Director, American Psychiatric Association

“The American Psychological Association applauds the Surgeon General's Advisory on Social Media and Youth Mental Health, affirming the use of psychological science to reach clear-eyed recommendations that will help keep our youth safe online. Psychological research shows that young people mature at different rates, with some more vulnerable than others to the content and features on many social media platforms. We support the advisory's recommendations and pledge to work with the Surgeon General's Office to help build the healthy digital environment that our kids need and deserve.” – Arthur Evans, Jr., Ph.D., Chief Executive Officer and Executive Vice President, American Psychological Association.

“Social media use by young people is pervasive. It can help them, and all of us, live more connected lives – if, and only if, the appropriate oversight, regulation and guardrails are applied. Now is the moment for policymakers, companies and experts to come together and ensure social media is set up safety-first, to help young users grow and thrive. The Surgeon General’s Advisory about the effects of social media on youth mental health issued today lays out a roadmap for us to do so, and it’s critical that we undertake this collective effort with care and urgency to help today’s youth.” – Susan L. Polan, Ph.D., Associate Executive Director, Public Affairs and Advocacy, American Public Health Association

The National Parent Teacher Association shared the following:

“Every parent’s top priority for their child is for them to be happy, healthy and safe. We have heard from families who say they need and want information about using social media and devices. This Advisory from the Surgeon General confirms that family engagement on this topic is vital and continues to be one of the core solutions to keeping children safe online and supporting their mental health and well-being.” – Anna King, President of the National Parent Teacher Association .

In December 2021, Dr. Murthy issued a Surgeon General’s Advisory on Protecting Youth Mental Health calling attention to our national crisis of youth mental health and well-being. Earlier this month, he released a Surgeon General’s Advisory on Our Epidemic of Loneliness and Isolation , where he outlined the profound health consequences of social disconnection and laid out six pillars to increase connection across the country, one of which being the need to reform our digital environments. The new Surgeon General’s Advisory on Social Media and Youth Mental Health is a continuation of his work to enhance the mental health and well-being of young people across the country.

The full Surgeon General’s Advisory can be read here . For more information about the Office of the Surgeon General, visit www.surgeongeneral.gov/priorities .

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Six distinct types of depression identified in Stanford Medicine-led study

Brain imaging, known as functional MRI, combined with machine learning can predict a treatment response based on one’s depression “biotype.”

June 17, 2024 - By Rachel Tompa

Researchers have identified six subtypes of depression, paving the way toward personalized treatment. Damerfie - stock.adobe.com

In the not-too-distant future, a screening assessment for depression could include a quick brain scan to identify the best treatment.

Brain imaging combined with machine learning can reveal subtypes of depression and anxiety, according to a new study led by researchers at Stanford Medicine. The study , published June 17 in the journal Nature Medicine , sorts depression into six biological subtypes, or “biotypes,” and identifies treatments that are more likely or less likely to work for three of these subtypes.

Better methods for matching patients with treatments are desperately needed, said the study’s senior author, Leanne Williams , PhD, the Vincent V.C. Woo Professor, a professor of psychiatry and behavioral sciences, and the director of Stanford Medicine’s Center for Precision Mental Health and Wellness . Williams, who lost her partner to depression in 2015, has focused her work on pioneering the field of precision psychiatry .

Around 30% of people with depression have what’s known as treatment-resistant depression , meaning multiple kinds of medication or therapy have failed to improve their symptoms. And for up to two-thirds of people with depression, treatment fails to fully reverse their symptoms to healthy levels.

That’s in part because there’s no good way to know which antidepressant or type of therapy could help a given patient. Medications are prescribed through a trial-and-error method, so it can take months or years to land on a drug that works — if it ever happens. And spending so long trying treatment after treatment, only to experience no relief, can worsen depression symptoms.

“The goal of our work is figuring out how we can get it right the first time,” Williams said. “It’s very frustrating to be in the field of depression and not have a better alternative to this one-size-fits-all approach.”

Biotypes predict treatment response

To better understand the biology underlying depression and anxiety, Williams and her colleagues assessed 801 study participants who were previously diagnosed with depression or anxiety using the imaging technology known as functional MRI, or fMRI, to measure brain activity. They scanned the volunteers’ brains at rest and when they were engaged in different tasks designed to test their cognitive and emotional functioning. The scientists narrowed in on regions of the brain, and the connections between them, that were already known to play a role in depression.

Using a machine learning approach known as cluster analysis to group the patients’ brain images, they identified six distinct patterns of activity in the brain regions they studied.

Leanne Williams

The scientists also randomly assigned 250 of the study participants to receive one of three commonly used antidepressants or behavioral talk therapy. Patients with one subtype, which is characterized by overactivity in cognitive regions of the brain, experienced the best response to the antidepressant venlafaxine (commonly known as Effexor) compared with those who have other biotypes. Those with another subtype, whose brains at rest had higher levels of activity among three regions associated with depression and problem-solving, had better alleviation of symptoms with behavioral talk therapy. And those with a third subtype, who had lower levels of activity at rest in the brain circuit that controls attention, were less likely to see improvement of their symptoms with talk therapy than those with other biotypes.

The biotypes and their response to behavioral therapy make sense based on what they know about these regions of the brain, said Jun Ma, MD, PhD, the Beth and George Vitoux Professor of Medicine at the University of Illinois Chicago and one of the authors of the study. The type of therapy used in their trial teaches patients skills to better address daily problems, so the high levels of activity in these brain regions may allow patients with that biotype to more readily adopt new skills. As for those with lower activity in the region associated with attention and engagement, Ma said it’s possible that pharmaceutical treatment to first address that lower activity could help those patients gain more from talk therapy.

“To our knowledge, this is the first time we’ve been able to demonstrate that depression can be explained by different disruptions to the functioning of the brain,” Williams said. “In essence, it’s a demonstration of a personalized medicine approach for mental health based on objective measures of brain function.”

In another recently published study , Williams and her team showed that using fMRI brain imaging improves their ability to identify individuals likely to respond to antidepressant treatment. In that study, the scientists focused on a subtype they call the cognitive biotype of depression, which affects more than a quarter of those with depression and is less likely to respond to standard antidepressants. By identifying those with the cognitive biotype using fMRI, the researchers accurately predicted the likelihood of remission in 63% of patients, compared with 36% accuracy without using brain imaging. That improved accuracy means that providers may be more likely to get the treatment right the first time. The scientists are now studying novel treatments for this biotype with the hope of finding more options for those who don’t respond to standard antidepressants.

Further explorations of depression

The different biotypes also correlate with differences in symptoms and task performance among the trial participants. Those with overactive cognitive regions of the brain, for example, had higher levels of anhedonia (inability to feel pleasure) than those with other biotypes; they also performed worse on executive function tasks. Those with the subtype that responded best to talk therapy also made errors on executive function tasks but performed well on cognitive tasks.

One of the six biotypes uncovered in the study showed no noticeable brain activity differences in the imaged regions from the activity of people without depression. Williams believes they likely haven’t explored the full range of brain biology underlying this disorder — their study focused on regions known to be involved in depression and anxiety, but there could be other types of dysfunction in this biotype that their imaging didn’t capture.

Williams and her team are expanding the imaging study to include more participants. She also wants to test more kinds of treatments in all six biotypes, including medicines that haven’t traditionally been used for depression.

Her colleague Laura Hack , MD, PhD, an assistant professor of psychiatry and behavioral sciences, has begun using the imaging technique in her clinical practice at Stanford Medicine through an experimental protocol . The team also wants to establish easy-to-follow standards for the method so that other practicing psychiatrists can begin implementing it.

“To really move the field toward precision psychiatry, we need to identify treatments most likely to be effective for patients and get them on that treatment as soon as possible,” Ma said. “Having information on their brain function, in particular the validated signatures we evaluated in this study, would help inform more precise treatment and prescriptions for individuals.”

Researchers from Columbia University; Yale University School of Medicine; the University of California, Los Angeles; UC San Francisco; the University of Sydney; the University of Texas MD Anderson; and the University of Illinois Chicago also contributed to the study.

Datasets in the study were funded by the National Institutes of Health (grant numbers R01MH101496, UH2HL132368, U01MH109985 and U01MH136062) and by Brain Resource Ltd.

Rachel Tompa Rachel Tompa is a freelance science writer.

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Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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What is generalized anxiety disorder (GAD)?

The difference between "normal" worry and GAD

Signs and symptoms of GAD

Gad symptoms in children, generalized anxiety disorder self-help tip 1: connect with others, tip 2: learn to calm down quickly, tip 3: get moving, tip 4: look at your worries in new ways, tip 5: practice relaxation techniques for gad, tip 6: adopt anxiety-busting habits, treatment for generalized anxiety disorder, medication for anxiety, generalized anxiety disorder (gad).

Do you worry excessively or feel tense and anxious all day long? Learn about the signs, symptoms, and treatment of GAD.

Everyone gets anxious sometimes, but if your worries and fears are so constant that they interfere with your ability to function and relax, you may have generalized anxiety disorder (GAD). GAD is a common anxiety disorder that involves constant and chronic worrying, nervousness, and tension. Unlike a phobia, where your fear is connected to a specific thing or situation, the anxiety of GAD is diffused—a general feeling of dread or unease that colors your whole life. This anxiety is less intense than a panic attack, but much longer lasting, making normal life difficult and relaxation impossible. Generalized anxiety disorder is mentally and physically exhausting. It drains your energy, interferes with sleep, and wears your body out.

If you have GAD you may worry about the same things that other people do, but you take these worries to a new level. A co-worker’s careless comment about the economy becomes a vision of an imminent pink slip; a phone call to a friend that isn’t immediately returned becomes anxiety that the relationship is in trouble. Sometimes just the thought of getting through the day produces anxiety. You go about your activities filled with exaggerated worry and tension, even when there is little or nothing to provoke them.

Whether you realize that your anxiety is more intense than the situation calls for, or believe that your worrying protects you in some way, the end result is the same. You can’t turn off your anxious thoughts. They keep running through your head, on endless repeat. But no matter how overwhelming things seem now, you can break free from chronic worrying, learn to calm your anxious mind, and regain your sense of hope.

Sound familiar?

“I can’t get my mind to stop… it’s driving me crazy!”
“He’s late—he was supposed to be here 20 minutes ago! Oh my God, he must have been in an accident!”
“I can’t sleep—I just feel such dread… and I don’t know why!”

The difference between “normal” worry and GAD

Worries, doubts, and fears are a normal part of life. It’s natural to be anxious about an upcoming test or to worry about your finances after being hit by unexpected bills. The difference between “normal” worrying and generalized anxiety disorder is that the worrying involved in GAD is:

Persistent.
Disruptive.

“Normal” Worry vs. Generalized Anxiety Disorder

“Normal” Worry:	Generalized Anxiety Disorder:
Your worrying doesn’t get in the way of your daily activities and responsibilities.	Your worrying significantly disrupts your job, activities, or social life.
You’re able to control your worrying.	Your worrying is uncontrollable.
Your worries, while unpleasant, don’t cause significant distress.	Your worries are extremely upsetting and stressful.
Your worries are limited to a specific, small number of realistic concerns.	You worry about all sorts of things, and tend to expect the worst.
Your bouts of worrying last for only a short time period.	You’ve been worrying almost every day for at least six months.

Not everyone with generalized anxiety disorder has the same symptoms, but most people experience a combination of emotional, behavioral, and physical symptoms that often fluctuate, becoming worse at times of stress.

Emotional Symptoms of GAD include:

Constant worries running through your head
Feeling like your anxiety is uncontrollable ; there is nothing you can do to stop the worrying
Intrusive thoughts about things that make you anxious; you try to avoid thinking about them, but you can’t
An inability to tolerate uncertainty ; you need to know what’s going to happen in the future
A pervasive feeling of apprehension or dread

Behavioral symptoms include:

Inability to relax , enjoy quiet time, or be by yourself
Difficulty concentrating or focusing on things
Putting things off because you feel overwhelmed
Avoiding situations that make you anxious

Physical symptoms include:

Feeling tense ; having muscle tightness or body aches
Having trouble falling asleep or staying asleep because your mind won’t quit
Feeling edgy , restless, or jumpy
Stomach problems , nausea, diarrhea

In children, excessive worrying centers on future events, past behaviors, social acceptance, family matters, personal abilities, and school performance. Unlike adults with GAD, children and teens often don’t realize that their anxiety is disproportionate to the situation, so adults need to recognize their symptoms. Along with many of the symptoms that appear in adults, some red flags for GAD in children are:

“What if” fears about situations far in the future.
Perfectionism , excessive self-criticism, and fear of making mistakes.
Feeling that they’re to blame for any disaster , and their worry will keep tragedy from occurring.
The conviction that misfortune is contagious and will happen to them.
Need for frequent reassurance and approval.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Support from other people is vital to overcoming GAD. Social interaction with someone who cares about you is the most effective way to calm your nervous system and diffuse anxiety, so it’s important to find someone you can connect with face to face on a regular basis—your significant other, a family member, or a friend, perhaps. This person should be someone you can talk to for an uninterrupted period of time, someone who will listen to you without judging, criticizing, or continually being distracted by the phone or other people.

Build a strong support system. Human beings are social creatures. We’re not meant to live in isolation. But a strong support system doesn’t necessarily mean a vast network of friends. Don’t underestimate the benefit of a few people you can trust and count on to be there for you.

Talk it out when your worries start spiraling. If you start to feel overwhelmed with anxiety, meet with a trusted family member or friend. Just talking face to face about your worries can make them seem less threatening.

Know who to avoid when you’re feeling anxious. Your anxious take on life may be something you learned when you were growing up. If your mother is a chronic worrier, she is not the best person to call when you’re feeling anxious—no matter how close you are. When considering who to turn to, ask yourself whether you tend to feel better or worse after talking to that person about a problem.

Be aware that having GAD can get in the way of your ability to connect with others. Anxiety and constant worrying can leave you feeling needy and insecure, causing problems in your relationships. Think about the ways you tend to act when you’re feeling anxious, especially anxious about a relationship. Do you test your partner? Withdraw? Make accusations? Become clingy? Once you’re aware of any anxiety-driven relationship patterns, you can look for better ways to deal with any fears or insecurities you’re feeling.

While socially interacting with another person face-to-face is the quickest way to calm your nervous system, it’s not always realistic to have a friend close by to lean on. In these situations, you can quickly self-soothe and relieve anxiety symptoms by making use of one or more of your physical senses :

Sight – Look at anything that relaxes you or makes you smile: a beautiful view, family photos, cat pictures on the Internet.

Sound – Listen to soothing music, sing a favorite tune, or play a musical instrument. Or enjoy the relaxing sounds of nature (either live or recorded): ocean waves, wind through the trees, birds singing.

Smell – Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Spritz on your favorite perfume.

Taste – Slowly eat a favorite treat, savoring each bite. Sip a hot cup of coffee or herbal tea. Chew on a stick of gum. Enjoy a mint or your favorite hard candy.

Touch – Give yourself a hand or neck massage. Cuddle with a pet. Wrap yourself in a soft blanket. Sit outside in the cool breeze.

Movement – Go for a walk, jump up and down, or gently stretch. Dancing, drumming, and running can be especially effective.

Exercise is a natural and effective anti-anxiety treatment. It relieves tension, reduces stress hormones, boosts feel-good chemicals such as serotonin and endorphins, and physically changes the brain in ways that make it less anxiety-prone and more resilient.

For maximum relief of GAD, try to get at least 30 minutes of physical activity on most days. Exercise that engages both your arms and legs—such as walking, running, swimming, or dancing—are particularly good choices.

For even greater benefits, try adding mindfulness element to your workouts. Mindfulness is a powerful anxiety fighter—and an easy technique to incorporate into your exercise program. Rather than spacing out or focusing on your thoughts during a workout, focus on how your body feels as you move. Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin. Not only will you get more out of your workout—you’ll also interrupt the flow of constant worries running through your head.

The core symptom of GAD is chronic worrying. It’s important to understand what worrying is, since the beliefs you hold about worrying play a huge role in triggering and maintaining GAD. You may feel like your worries come from the outside—from other people, events that stress you out, or difficult situations you’re facing. But, in fact, worrying is self-generated. The trigger comes from the outside, but your internal running dialogue keeps it going.

When you’re worrying, you’re talking to yourself about things you’re afraid of or negative events that might happen. You run over the feared situation in your mind and think about all the ways you might deal with it. In essence, you’re trying to solve problems that haven’t happened yet, or worse, simply obsessing on worst-case scenarios.

All this worrying may give you the impression that you’re protecting yourself by preparing for the worst or avoiding bad situations. But more often than not, worrying is unproductive—sapping your mental and emotional energy without resulting in any concrete problem-solving strategies or actions.

How to distinguish between productive and unproductive worrying

If you’re focusing on “what if” scenarios, your worrying is unproductive.

Once you’ve given up the idea that your worrying somehow helps you, you can start to deal with your worry and anxiety in more productive ways. This may involve challenging irrational worrisome thoughts, learning how to stop worrying , and learning to accept uncertainty in your life.

Anxiety is more than just a feeling. It’s the body’s physical “fight or flight” reaction to a perceived threat. Your heart pounds, you breathe faster, your muscles tense up, and you feel light-headed. When you’re relaxed, the complete opposite happens. Your heart rate slows down, you breathe slower and more deeply, your muscles relax, and your blood pressure stabilizes. Since it’s impossible to be anxious and relaxed at the same time, strengthening your body’s relaxation response is a powerful anxiety-relieving tactic.

Effective relaxation techniques for relieving anxiety include:

Deep breathing. When you’re anxious, you breathe faster. This hyperventilation causes symptoms such as dizziness, breathlessness, lightheadedness, and tingly hands and feet. These physical symptoms are frightening, leading to further anxiety and panic. But by breathing deeply from the diaphragm, you can reverse these symptoms and calm yourself down.

Progressive muscle relaxation can help you release muscle tension and take a “time out” from your worries. The technique involves systematically tensing and then releasing different muscle groups in your body. As your body relaxes, your mind will follow.

Meditation. Research shows that mindfulness meditation can actually change your brain. With regular practice, meditation boosts activity on the left side of the prefrontal cortex, the area of the brain responsible for feelings of serenity and joy. Try the Ride the Wild Horse meditation, part of HelpGuide’s free Emotional Intelligence Toolkit .

A healthy, balanced lifestyle plays a big role in keeping the symptoms of GAD at bay. In addition to regular exercise and relaxation, try adopting these other lifestyle habits to tackle chronic anxiety and worry:

Get enough sleep. Anxiety and worry can cause insomnia , as anyone whose racing thoughts have kept them up at night can attest. But lack of sleep can also contribute to anxiety. When you’re sleep deprived, your ability to handle stress is compromised. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety and stopping worry. Improve your sleep at night by changing any daytime habits or bedtime routines that can contribute to sleeplessness.

Limit caffeine. Stop drinking or at least cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine is a stimulant that can trigger all kinds of jittery physiological effects that look and feel a lot like anxiety—from pounding heart and trembling hands to agitation and restlessness. Caffeine can also make GAD symptoms worse, cause insomnia, and even trigger panic attacks.

Avoid alcohol and nicotine. Having a few drinks may temporarily help you feel less anxious, but alcohol actually makes anxiety symptoms worse as it wears off. While it may seem like cigarettes are calming, nicotine is actually a powerful stimulant that leads to higher, not lower, levels of anxiety.

Eat right. Food doesn’t cause anxiety, but a healthy diet can help keep you on an even keel. Going too long without eating leads to low blood sugar—which can make you feel anxious and irritable—so start the day right with breakfast and continue with regular meals. Eat plenty of fruits, and vegetables, which stabilize blood sugar and boost serotonin, a neurotransmitter with calming effects. Reduce the amount of refined carbs and sugar you eat, too. Sugary snacks and desserts cause blood sugar to spike and then crash, leaving you feeling emotionally and physically drained.

If you’ve given self-help a fair shot, but still can’t seem to shake your worries and fears, it may be time to see a mental health professional. But remember that professional treatment doesn’t replace self-help. In order to control your GAD symptoms, you’ll still want to make lifestyle changes and look at the ways you think about worrying

Cognitive-behavioral therapy (CBT) is one type of therapy that is particularly helpful in the treatment of GAD. CBT examines distortions in our ways of looking at the world and ourselves. Your therapist will help you identify automatic negative thoughts that contribute to your anxiety. For example, if you catastrophize—always imagining the worst possible outcome in any given situation—you might challenge this tendency through questions such as, “What is the likelihood that this worst-case scenario will actually come true?” and “What are some positive outcomes that are more likely to happen?”.

The five components of CBT for anxiety are:

Education. CBT involves learning about generalized anxiety disorder. It also teaches you how to distinguish between helpful and unhelpful worry. An increased understanding of your anxiety encourages a more accepting and proactive response to it.

Monitoring. You learn to monitor your anxiety, including what triggers it, the specific things you worry about, and the severity and length of a particular episode. This helps you get perspective, as well as track your progress.

Physical control strategies. CBT for GAD trains you in relaxation techniques to help decrease the physical over-arousal of the “fight or flight” response.

Cognitive control strategies teach you to realistically evaluate and alter the thinking patterns that contribute to generalized anxiety disorder. As you challenge these negative thoughts, your fears will begin to subside.

Behavioral strategies. Instead of avoiding situations you fear, CBT teaches you to tackle them head on. You may start by imagining the thing you’re most afraid of. By focusing on your fears without trying to avoid or escape them, you will feel more in control and less anxious.

Medication for GAD is generally recommended only as a temporary measure to relieve symptoms at the beginning of the treatment process, with therapy as the key to long-term success.

There are three types of medication prescribed for generalized anxiety disorder:

Buspirone. This anti-anxiety drug, known by the brand name Buspar, is generally considered to be the safest drug for generalized anxiety disorder. Although buspirone will take the edge off, it will not entirely eliminate anxiety.

Benzodiazepines. These anti-anxiety drugs act very quickly (usually within 30 minutes to an hour), but physical and psychological dependence are common after more than a few weeks of use. They are generally recommended only for severe, paralyzing episodes of anxiety.

Antidepressants. The relief antidepressants provide for anxiety is not immediate, and the full effect isn’t felt for up to six weeks. Some antidepressants can also exacerbate sleep problems and cause nausea or other side effects.

Hotlines and support

NAMI Helpline – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)

Find a Therapist – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)

Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)

Anxiety UK – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)

Anxiety Canada – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)

SANE Help Centre – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).

Helpline (India) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330.

More Information

Generalized Anxiety Disorder: When Worry Gets Out of Control - (PDF) Symptoms and treatment of GAD. (National Institute for Mental Health)
Anxiety - Worksheet to help you cope with GAD and worry. (Centre for Clinical Interventions)
Anxiety and Stress Disorders - Special health report from Harvard Medical School. (Harvard Health Publishing)
Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and Anticipation in Anxiety. Nature Reviews. Neuroscience, 14(7), 488–501. Link
Baldwin, D. S., Waldman, S., & Allgulander, C. (2011). Evidence-based pharmacological treatment of generalized anxiety disorder. International Journal of Neuropsychopharmacology, 14(5), 697–710. Link
Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician, 91(9), 617–624. Link
Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059. Link
Borza, L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in Clinical Neuroscience, 19(2), 203–208. Link
Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. – PsycNET. (n.d.). APA PsycNET. Link
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of Internal Medicine, 170(7), ITC49–ITC64. Link
Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421. Link
Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. Link
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. Link
Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. Link
Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. Link
Anxiety Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link

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The prevalence and correlates of social phobia among undergraduate health science students in Gondar, Gondar Ethiopia

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