Risk for Social Anxiety Disorder in Youth Influenced by Parental Psychopathology

Sad child crying on the playground
A two year old is down covering his face with his hands while on a game at the playground
The study highlights the significant burden of social anxiety disorder among youth, particularly those with a parental history of psychiatric symptoms.

Cross-sectional study data published in the Journal of Affective Disorders identified parental history of psychiatric conditions as a significant risk factor for social anxiety disorder (SAD) in children and adolescents. In a nationally representative cohort of Iranian youth, the lifetime prevalence of SAD was estimated at 1.8%.

As part of the Iranian Children and Adolescents Psychiatric Disorders program, researchers conducted a cross-sectional, nationwide survey of pediatric patients in Iran. Brief household interviews were administered by clinical psychologists to individuals aged 6 to 18 years as well as their parents. The researchers captured clinical personality patterns and psychopathology in parents with the self-administered Millon Clinical Multiaxial Inventory, 3rd edition (MCM-III) and assessed demographics, including age, sex, area of residence, and parental education and employment. They also identified risk factors for SAD with multivariate regression modeling and estimated comorbidity rates. For analyses, 3 age strata were constructed: 6-9 years, 10-14 years, and 15-18 years.

Out of 29,878 children and adolescents who completed the survey, 585 were diagnosed with SAD. Half (51.1%) of all participants were girls. The weighted prevalence of SAD was calculated at 1.8%, and comorbid psychiatric conditions were highly prevalent in the study cohort, with additional anxiety disorders observed in 54.9% of participants.

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Compared with children aged 6-9 years, adolescents aged 15-18 years had a significantly higher prevalence of SAD (odds ratio [OR], 1.47; 95% CI, 1.11-1.95). Paternal history of psychiatric hospitalization was associated with 3-fold increased risk for pediatric SAD (OR, 2.96; 95% CI, 1.29-6.79). Additional parental risk factors for SAD were persistent depression disorder (OR, 1.009; 95% CI, 1.000-1.018) and a melancholic personality trait (OR, 1.007; 95% CI, 1.001-1.014) in mothers and schizophrenia spectrum disorder (OR, 1.009; 95% CI, 1.001-1.027) and anxiety (OR, 1.010; 95% CI, 1.010-1.021) in fathers.

The study highlights the significant burden of SAD among youth, particularly those with a parental history of psychiatric symptoms. However, the study was limited by the lack of a control group and the cross-sectional nature of the study. The researchers called for future research to examine the impact of SAD on life quality, as well as the assessment of current therapies and pathophysiology of SAD, “an important public health issue.”


Mohammadia MR, Salehia M, Khaleghi A, et al. Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and comorbidities [published online December 9, 2019]. J Affect Disord. doi: 10.1016/j.jad.2019.12.015