The Relationship Between Perceived Parenting Style and Social Anxiety: A Meta-analysis of Mainland Chinese Students

Previous research on the relationship between parenting style and social anxiety in Chinese youth has been inconsistent, which has made it difficult to consider whether improving parenting may serve as a preventative intervention for social anxiety. The current study aimed to clarify these inconsistencies by examining the strength of the association between positive/negative parenting style and social anxiety among Chinese students and the role of certain moderators in those associations. A meta-analysis was conducted on 53 studies with a total sample of 26,024 Chinese mainland students. Separate analyses were conducted for positive parenting style and social anxiety (N = 24,081), and negative parenting style and social anxiety (N = 24,933). Findings suggest a small negative association exists between positive parenting style and social anxiety, and a small positive association exists between negative parenting style and child social anxiety. Analyses suggested type of social anxiety measures, developmental stage, and gender all moderated the relationships between parenting style and social anxiety. Results clarify the direction of the relationship between parenting and social anxiety amongst Chinese youth and point to particular implications and future directions for policy, practice, and research.

Nationally representative epidemiological study of social anxiety disorder from India

Background

Social anxiety disorder (SAD), also termed as social phobia, is a disabling psychiatric condition with limited epidemiological research on it in India. This study, using data from the National Mental Health Survey (NMHS), 2016, is the first to explore its current prevalence and associated factors in India.

Materials and Methods

The NMHS in India used a comprehensive population-based study with subjects selected through a multistage stratified random cluster sampling technique across 12 states. The study included 34,802 adults interviewed with the Mini-International Psychiatric Interview 6.0.0. Firth penalized logistic regression (FPLR) was used to estimate covariate odds ratios (ORs), and the treatment gap for SAD and disability measured using Sheehan's disability scale was calculated.

Results

The study found a 0.47% prevalence of SAD, with an average age of 35.68 years (standard deviation (SD) = 15.23) among those affected. Factors, such as male gender, unemployment, and living in urban areas, were associated with higher odds of SAD, while the elderly had lower odds. A significant proportion of individuals with SAD experienced disability in work (63%), social life (77%), and family life (68%). They spent a median of ₹ 2500 per month on treatment and had a high rate of comorbid psychiatric disorders (58%). The treatment gap was substantial at 82%.

Conclusions

A considerable portion of India's population (approximately >65 lakhs) is affected by SAD. Surprisingly, the NMHS 2016 report indicates a higher risk of SAD among males compared with females, a trend that warrants further investigation. SAD in India is linked to significant disability and a considerable treatment gap, emphasizing the need for innovative approaches to address this large, affected population, especially in light of the scarcity of mental health professionals.

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses

This evolutionary concept analysis explores the meaning of diagnostic overshadowing within the context of physical health care for individuals with mental illness. Diagnostic overshadowing, the misattribution of symptoms of one illness to an already diagnosed comorbidity, leads to compromised patient care and likely contributes to increased mortality experienced by individuals with mental illness. A systematic literature search led to identification of a sample of 25 publications on the topic. Following Rodgers' Evolutionary Concept Analysis methodology, this literature sample yielded unifying definitions, shared themes, factors contributing to the action of diagnostic overshadowing, outcomes caused by this type of misdiagnosis, and possible interventions available to nurses and other healthcare providers. Understanding of the concept diagnostic overshadowing may help prevent its occurrence and its adverse results.

Alexithymia is a mediating factor in the relationship between adult attachment and severity of depression and social anxiety

BACKGROUND

Major depressive disorder (MDD) and social anxiety disorder (SAD) are commonly occurring conditions, either alone or together (MDD-SAD). Recent research linked insecure attachment and alexithymia to MDD and/or SAD, indicating that the way affected individuals relate interpersonally and their ability to identify and communicate emotions are pertinent issues. The current study investigated the mediating role of alexithymia in the relationship between insecure attachment and severity of MDD and SAD symptoms.

METHOD

Using the SCID-I, participants (N=159) were identified as MDD-only (n=43), MDD-SAD (n=56), or a healthy control (n=60). Participants completed measures of adult attachment, depression, social anxiety and alexithymia (defined as difficulty identifying and describing feelings). A two-step mediation analysis approach recommended by Shrout and Bolger determined if alexithymia mediates the relationship between attachment-depression and attachment-social anxiety.

RESULTS

While alexithymia was high in MDD-only and MDD-SAD groups, individuals with MDD-SAD had significantly greater difficulty describing feelings. Alexithymia was a full mediator between attachment avoidance and depression, but only a partial mediator between attachment anxiety and depression. Meanwhile, alexithymia was a partial mediator for both attachment dimensions and social anxiety.

LIMITATIONS

Causal inferences regarding insecure attachment, alexithymia, and MDD and SAD cannot be assumed given the cross-sectional data. The 'externally oriented thinking' component in alexithymia was also excluded from analyses due to low reliability.

CONCLUSION

The results suggest emotional awareness and expression play a role in the illness severity for MDD and SAD-particularly in those with high attachment avoidance, offering a possible target for treatment and prevention strategies.

“Being Unfilial Condemns You to Hell”: Integrative Treatment for Social Anxiety Shaped by Domestic Abuse, Confucian Values, and Taoist Beliefs

Social anxiety is a common and treatable condition but less is known about how to adapt evidence-based approaches in a culture-sensitive way to Asian clients. We present the case of “Sally,” a 25-year-old Chinese Singaporean female who suffered from severe and long-standing social anxiety disorder (SAD), and secondary low mood. Contributing factors included a history of domestic abuse, as well as culturally influenced authoritarian parenting emphasizing the Confucian value of filial piety and reinforced by Taoist beliefs of karmic retribution and supernatural punishment. Treatment was based on Clark and Wells’s cognitive model of SAD with a focus on behavioral experiments, and was enhanced using a schema mode formulation and imagery rescripting to address relevant early memories that were at the origin of the social anxiety. Sally received a total of 42 sessions over the course of 21 weeks, during which she made steady progress toward recovery. Her self-reported depression and social phobia fell from the “severe clinical” range pretreatment to the “non-clinical” range posttreatment; these gains were maintained at 6 months follow-up. Sally’s functioning fully recovered, and she returned to work and school. While behavioral experiments for dropping safety behaviors were useful for overcoming the social anxiety, schema formulation was important for providing Sally with insight to her thought process, and imagery rescripting was crucial for weakening her self-criticism and internalized black and white thinking on filial piety. The significance of culture and religion in SAD, and the potential of adapting cognitive therapy in a culture-sensitive way is discussed.

The Role of Sexual and Gender Identity in Long-Term Psychodynamic Therapy for Comorbid Social Anxiety and Depression in an Adolescent Female

Adolescence is a time of significant change with social, cognitive, and emotional alternations, and growth of autonomy and identity. This is a single clinical case study that uses long-term psychodynamic psychotherapy with an adolescent female diagnosed with comorbid social anxiety and persistent depression. The treatment initially focused on addressing the patient’s self-esteem, perfectionism, and self-criticism. During the treatment it was revealed that the patient’s sexual and gender identity contributed to social anxiety and depressive symptoms, and the therapy conceptualized the role of these identities as contributing to social discomfort which perpetuated her depressive symptoms. Through accepting her budding sexual and gender identity, the patient successfully became more comfortable in social settings which ultimately alleviated her depressive symptoms. This treatment highlights the unique nature of working with an adolescent apart of the sexual and gender minority, and how these identities contributed to her experience of social anxiety and depression.

Social anxiety apps: a systematic review and assessment of app descriptors across mobile store platforms

QUESTION

The aim of this systematic review is twofold: (1) to characterise the purpose and description of available social anxiety apps and (2) to review the evidence on the effectiveness of social anxiety apps.

STUDY SELECTION AND ANALYSIS

A search was conducted on three major mobile platforms: Apple iTunes, Google Play and Windows Store. Apps were included if they addressed social anxiety and used an English language interface. A systematic review of the literature from MEDLINE, EMBASE, PsycINFO, Cochrane, Scopus and Web of Science to identify evidence-based evaluations of social anxiety apps was also undertaken.

FINDINGS

Of the 1154 apps identified, 38 apps met the inclusion criteria: iTunes (n=18), Google Play (n=16) and Windows Store (n=4). Over 60% of apps were exclusively focused on social anxiety, while the remainder targeted social anxiety and related conditions. Most developers did not provide information on their organisational affiliations or their content source. Most apps used multimedia while 17 apps used text only. Finally, although the systematic review of the literature identified 94 articles, none of which met inclusion criteria.

CONCLUSIONS

Social anxiety apps have the potential to overcome barriers to accessing treatment; however, none of the apps identified have had studies on their effectiveness published. As the evidence base is lacking, it is therefore not currently possible to recommend their use.

Social Anxiety among Chinese People

The experience of social anxiety has largely been investigated among Western populations; much less is known about social anxiety in other cultures. Unlike the Western culture, the Chinese emphasize interdependence and harmony with social others. In addition, it is unclear if Western constructed instruments adequately capture culturally conditioned conceptualizations and manifestations of social anxiety that might be specific to the Chinese. The present study employed a sequence of qualitative and quantitative approaches to examine the assessment of social anxiety among the Chinese people. Interviews and focus group discussions with Chinese participants revealed that some items containing the experience of social anxiety among the Chinese are not present in existing Western measures. Factor analysis was employed to examine the factor structure of the more comprehensive scale. This approach revealed an “other concerned anxiety” factor that appears to be specific to the Chinese. Subsequent analysis found that the new factor—other concerned anxiety—functioned the same as other social anxiety factors in their association with risk factors of social anxiety, such as attachment, parenting, behavioral inhibition/activation, and attitude toward group. The implications of these findings for a more culturally sensitive assessment tool of social anxiety among the Chinese were discussed.