Prevalence
of social anxiety disorder among medical students: A cross-sectional descriptive
study
Motahareh Hamzei1, Mahdi Amiri2
, Kosar Ghaddaripouri3, Azam Kheirdoust4
, Malihe MohammadAbadi5,
Amir Ehsan Heidari4, Mohammad Reza Mazaheri Habibi1*
1Department of Health
Information Technology, Varastegan Institute for Medical Sciences, Mashhad,
Iran
2Department of
Clinical Psychology, Faculty of Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
3Department of Health
Information Management, School of Health Management and Information Sciences,
Shiraz University of Medical Sciences, Shiraz, Iran
4Department of
Medical Informatics, Faculty of Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
5Department of
Chemistry, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
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Article Info
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A B S T R A C T
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Article type:
Research
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Introduction:
Mental disorders, affecting around 800 million people globally, are a major
public health concern. These issues often peak during the youth years and can
impact individuals and their social lives. Social anxiety disorder (SAD) is a
mental health condition that can significantly impact academic performance by
leading to avoidance behaviors in essential social activities.
Material
and Methods: A validated Liebowitz Social Anxiety Scale questionnaire
was used to assess social anxiety disorder among the participants. A total of
200 students (131 females, 69 males) with a mean age of 22.87 ± 2.2 years
participated in the study.
Results:
The findings revealed that 37.5% of the respondents experienced some degree
of social anxiety. The prevalence of social anxiety disorder differed
significantly between genders and age groups, with younger students showing a
higher prevalence. However, no significant association was found between the
academic field and social anxiety disorder.
Conclusion:
The study highlighted the high prevalence of social anxiety disorder among
medical students, particularly in younger individuals. These findings
underscore the importance of early identification and tailored intervention
strategies to support affected students and improve their academic
performance and overall well-being, in line with the global public health
priority of focusing on the mental health of young people.
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Article
History:
Received: 2025-03-09
Accepted: 2025-03-30
Published: 2025-04-06
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* Corresponding
author:
Mohammad Reza Mazaheri Habibi
Department of Health Information Technology,
Varastegan Institute for Medical Sciences, Mashhad, Iran
Email: Mazaherim@Varastegan.ac.ir
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Keywords:
Mental Health
Social Anxiety Disorder
Medical Students
Prevalence
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Cite this paper as:
Hamzei M, Amiri M, Ghaddaripouri
K, Kheirdoust A, MohammadAbadi M, Heidari AE, Mazaheri Habibi MR. Prevalence
of social anxiety disorder among medical students: A cross-sectional
descriptive study. Adv Med Inform. 2025; 1: 2.
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Introduction
Mental disorders are recognized as a significant public
health issue, emphasizing the importance of prevention and the provision of
appropriate mental health care [1]. Around 800 million
people worldwide are affected by mental health problems [2].
These issues peak between the ages of 12 and 25 and can have serious
consequences on the individual and their social life. Therefore, one of the
global public health priorities is to focus on the mental health of young
people [3]. Early identification of mental disorders and
interventions can increase the likelihood of young individuals enjoying a
healthy future [4].
One of the most common mental disorders is anxiety
disorders. Social anxiety disorder (SAD), also known as social phobia, is a
specific type of anxiety disorder characterized by a persistent fear of social
situations involving interaction with others [5]. This
disorder can significantly impact an individual's quality of life [6]. The prevalence of social anxiety disorder is estimated to
be around 2-7% in adults and up to 25% in students [7]. Individuals
with social anxiety disorder tend to avoid activities that involve social
interactions and public tasks, such as public speaking, attending social events
alone, engaging in communication with others, and being the center of attention
[8].
Some individuals with social anxiety disorder may refrain
from seeking treatment due to the fear of negative evaluation by healthcare
professionals. Research has indicated that approximately half of mental
illnesses can be effectively treated with early recognition. Therefore, it is
essential to equip healthcare professionals with the skills for early detection
of social anxiety to prevent its progression into social anxiety disorder and
associated complications. Furthermore, studies have revealed that the absence
of follow-up and treatment for social anxiety among adolescents and younger age
groups can lead to impairment in their functional abilities.
Some of these may refrain from seeking treatment due to
the fear of negative evaluation by healthcare professionals [9].
Research has indicated that approximately half of mental illnesses can be
effectively treated with early recognition [10]. Therefore,
it is essential to equip healthcare professionals with the skills for early
detection of social anxiety to prevent its progression into social anxiety
disorder and associated complications [11]. Furthermore,
studies have revealed that the absence of follow-up and treatment for social
anxiety among adolescents and younger age groups can lead to impairment in
their functional abilities [12].
On the other hand, adapting to student life poses a
significant challenge for many students as they navigate new types of stress
and social demands [13]. Also, the fear of others'
judgment is a threat to the self-actualization of young people especially
students in educational environments [14]. Anxiety and
fear of public speaking can have a detrimental impact on academic performance.
For instance, individuals with this disorder may avoid situations that involve
speaking with others, which is essential in educational environments. Alternatively,
when individuals are compelled to speak in such situations, they may exhibit
avoidance behaviors such as speaking rapidly and avoiding eye contact [15]. Consequently, this disorder can impede an individual's
academic advancement [16].
Therefore, recognizing and understanding this anxiety,
its various manifestations, and severity levels are essential steps in
addressing these challenges. Accordingly, this study aimed to examine the
prevalence of social anxiety disorder among students at the Varastegan
Institute for Medical Sciences in Mashhad.
Material and Methods
Study design
This cross-sectional descriptive study was conducted in
2023. After the description of the research, the students entered the study
with informed consent, and all their information was used confidentially and
without revealing their names. This study was approved by the ethics committee
of Mashhad University of Medical Sciences (approval number
IR.MUMS.REC.1402.124). All methods were performed according to the guidelines,
regulations, and declaration of Helsinki.
Participants
The research population included all students of Varastegan
Institute for Medical Sciences, including four fields nutrition science,
laboratory science, health information technology, and food industry (number:
625). An available sampling method was used.
Data collection
The prevalence of social anxiety disorder among students
was investigated using the self-report version of the Leibowitz Social Anxiety
Scale (LSAS) questionnaire. This scale is the first clinical tool designed to
assess a wide range of social situations that individuals with SAD find
challenging. The questionnaire comprised 24 items, including a performance
anxiety scale (13 items) and anxiety related to social situations (11 items).
Each statement was rated and scored separately for anxiety and fear (0=not at
all, 1=low, 2=moderate, 3=severe) and avoidance behavior (0=never, 1=rarely,
2=often, 3=always) [17]. In a study by Suryaningrum et
al., the reliability of this questionnaire was assessed (Cronbach's alpha:
0.90-0.96) [18].
To enhance accessibility for students and streamline data
collection, the questionnaire was developed in an online format and shared with
the students through a provided link. The questionnaire included items to
calculate a general social anxiety score, a performance anxiety subscale, and a
social situation anxiety subscale. The overall score was computed by
aggregating the scores from each subscale, enabling an assessment of each
individual's level of social anxiety based on the total score. Interpretation
of the total scores obtained from Leibowitz’s social anxiety scale as is:
Mild social anxiety: 55-65
Moderate social anxiety: 65-80
Severe social anxiety: 80-95
Very severe social anxiety: ≥ 95
Statistical analysis
Standard deviation and mean were utilized to describe
continuous variables, while percentage and frequency were employed for
analyzing descriptive data. ANOVA and independent T-tests were conducted to
examine the relationships between classification variables, and Pearson's
correlation coefficient was used to assess the relationship between the social
anxiety variable and three other variables. A P-value <0.05 was considered
statistically significant. The data analysis was performed using SPSS version
22.
Results
A total of 200 participants, comprising 131 women (65%)
and 69 men (35%), responded to the questionnaire, resulting in a response rate
of 100%. The average age of women was 22.66 ± 2.31 years, while the average age
of men was 23.28 ± 1.92 years. The majority of the students (65%) were women.
The distribution of students' fields of study included nutrition science (39%),
laboratory science (33%), health information technology (28%), and food
industry (0%) respectively (Table 1).
Table 1: Demographic information of students
participating in the study
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Variable
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N (%)/Mean ± SD
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Age
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22.87 ± 2.2
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Gender
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Male
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69 (35)
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Female
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131 (65)
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Field of Study
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Nutrition Sciences
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78 (39)
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Laboratory Sciences
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66 (33)
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Health Information Technology
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56 (28)
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Food Industry
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0 (0)
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Based on the data presented in Table 2, a notable
proportion of women (40.63%) reported never experiencing social anxiety
disorder among the participants in the study.
Table 2: Prevalence of anxiety (%) field of
study (undergraduate)
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Prevalence of anxiety (%)
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Field of Study
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N (%)
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Gender
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Very Severe
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Moderate
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Mild
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Low
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Not at All
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Laboratory Sciences
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Nutrition Sciences
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Health Information Technology
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2.93
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3.57
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6.82
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11.05
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40.63
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22%
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25%
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18%
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131 (65)
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Female
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1.57
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1.92
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3.68
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5.95
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21.87
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12%
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14%
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10%
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69(35)
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Male
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The prevalence of social anxiety among the study
participants is depicted in Table 3. It indicates that 37.5% of students
reported experiencing some degree of social anxiety.
Table 3: The overall level of social anxiety of
students participating in the study
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Degrees
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N
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%
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Mild
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34
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17
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Average
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21
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10.5
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Intense
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11
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5.5
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Very Intense
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9
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4.5
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Without Anxiety
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125
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62.5
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Total
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200
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100
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To explore the association between the variables under
study (gender, field of study, and age) and the level of social anxiety, the
Kolmogorov-Smirnov normality test was initially employed. Following the
assessment of data normality, an independent t-test (T-test) was utilized to
examine the correlation between gender and social anxiety. With a P-value of
0.022, a significant difference was found between gender and social anxiety,
indicating that gender influenced the level of social anxiety. An analysis of
variance (ANOVA) was conducted to examine the association between academic
field and social anxiety, revealing a non-significant P-value of 0.588.
Therefore, there was no significant difference observed between the academic
fields of students about social anxiety. In other words, there was no
significant association between academic fields and social anxiety. Pearson's
correlation coefficient was employed to explore the relationship between age
and social anxiety. The findings revealed a significant correlation between the
two variables (r=-0.289, P<0.001), indicating that as age increases, the
level of social anxiety decreases.
Discussion
Social anxiety disorder, a mental health condition that
can detrimentally affect an individual's well-being and prospects, was the
focus of this study conducted among students at Varastegan Institute for
Medical Sciences. The results indicated that more than 37% of students reported
experiencing varying levels of social anxiety, underscoring the considerable
prevalence of social anxiety disorder within this student cohort.
Suryaningrum et al. conducted a study to identify the
level of social anxiety of students on 364 students, based on their findings,
more than 50% of students have experienced some level of social anxiety, and it
indicates that social anxiety disorder has a high prevalence among students [18]. Ahmad et al. conducted a study in 1980 to explore the
prevalence of social anxiety disorder and its associated factors among students
of educational sciences. The study findings revealed that the prevalence of
social anxiety disorder exceeded 80% among the student population [15]. Furthermore, in a study conducted by Ablao et al. to
assess the severity of social anxiety disorder and its correlates among nursing
students, they found that approximately 40% of nursing students are affected by
this disorder, potentially impacting their academic performance and education [19]. The results of these three studies align with the
outcomes of our research.
In this context, technology-based interventions can be
utilized for their accessibility, distance reduction, and cost-effectiveness,
aiming to promote self-management and empower patients [20,
21]. For example, Ghaddaripour et al. concluded that
utilizing virtual reality technology to reduce children's anxiety is a safe and
effective intervention [22].
In the current study, a significant difference was
observed between gender and social anxiety disorder, with a higher prevalence
of this disorder in women compared to men. In line with this, Al-Johani noted
that the incidence of social anxiety disorder was higher among females [23]. Ejaz et al. also observed in their study that the
prevalence of this anxiety was higher in women than in men [8].
In a study conducted by Alhujaili et al. to investigate the prevalence of
social anxiety disorder among medical students, it was found that the
prevalence of this disorder was higher in women [24].
According to the findings of our study, this disorder
decreases with age. Al-Hazmi et al. conducted a study to investigate the
prevalence and factors related to social anxiety disorder and its effect on
academic performance among 504 medical students. The results showed that
although the prevalence of this disorder was high among students, it was even
higher in younger age groups [25].
One
of the strengths of this study is the use of the valid Liebowitz Social Anxiety
Scale (LSAS) questionnaire to assess the prevalence of social anxiety disorder
among students. However, this study was limited to undergraduate students in
four specific fields at the university, which restricts the generalizability of
the results. Additionally, the study only included participants who were
willing to take part, potentially excluding individuals with social anxiety
disorder who may have chosen not to participate. Despite these constraints, the
study yielded valuable findings that may be beneficial for individuals living
with social anxiety disorder.
Conclusion
The results of this survey indicate a relatively high
prevalence of social anxiety disorder among students. Given the importance of
early prediction and treatment of mental disorders, it is recommended that
universities and educational institutions identify and provide treatment for
individuals with social anxiety disorder.
Acknowledgement
We would like to thank all the participants who helped us
carry out this research. Also, we are
grateful to the Varastegan Institute of Medical Sciences for supporting this
research.
Author’s contribution
MH: Acquisition, analysis, and
interpretation of data, and drafting the work; MA: Design of the work,
revising it critically for important intellectual content; KG: Drafting the
work, revising it critically for important intellectual content; AK: Drafting
the work, revising it critically for important intellectual content; MMA:
Acquisition, analysis, and interpretation of data, and drafting the work; AEH:
Acquisition, analysis, and interpretation of data, and drafting the work; MRMH:
Design of the work, revising it critically for important intellectual content.
All authors contributed to the literature review, design,
data collection, drafting the manuscript, read and approved the final
manuscript.
Conflicts of interest
The authors declare no conflicts of interest regarding
the publication of this study.
Ethical Approval
All participants voluntarily participated in this
research and were orally informed of the confidentiality of their data. Verbal
informed consent was obtained from all the participants before each interview.
This study was approved by the ethics committee of Mashhad University of
Medical Sciences (IR.MUMS.REC.1402.124).
Financial disclosure
No financial interests related to the material of this
manuscript have been declared.
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