The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review

Exploring COVID-19 Vaccine Decision Making: Insights from 'One-Shot Wonders' and 'Booster Enthusiasts'

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into "One-Shot Wonders" and "Booster Enthusiasts". Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals' needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes.

Loneliness and social isolation: exploring the experiences of older women during the pandemic in terms of social connection, feeling of loneliness, and the impact on mental health and wellbeing

Objectives

To investigate the unique challenges faced by older women during the COVID-19 pandemic regarding social connection, feelings of loneliness, and their subsequent impact on mental health and well-being.

Method

A qualitative research methodology is used to examine how older women experienced loneliness, social relationships, and mental health consequences during the COVID-19 pandemic.

Results

The results are discussed in terms of two main themes each with their sub-themes; 1. Social Connection amidst Physical Distancing Measures, 2. Impact on Mental Health and Well-being.

Conclusion

The study highlights the significant impact of loneliness and social isolation on the mental health of older women during the COVID-19 pandemic, emphasizing the need for targeted interventions and support systems.

Walk-in mental health: Bridging barriers in a pandemic

'Single Session Therapy' (SST) is a service delivery model that seeks to provide an evidence-based, solution-focused, brief intervention within a single therapy session. The stand-alone session affords the opportunity to provide brief psychological interventions while clients await access to longer-term services. The COVID-19 pandemic has adversely impacted individuals' mental health. However, the majority of research has investigated patient mental health within hospital settings and community organizations that offer long-term services, whereas minimal research has focused on mental health concerns during COVID-19 within an SST model. The primary aim of the study was to measure client experiences of a brief mental health service. The nature of client mental health concerns who access such services at various points during a pandemic was also investigated. The current study utilized client feedback forms and the Computerized Adaptive Testing-Mental Health (CAT-MH) to measure client experiences and mental health concerns. Qualitative analysis of client feedback forms revealed themes of emotional (e.g., safe space) and informational support (e.g., referrals). Clients also reported reduced barriers to accessing services (e.g., no appointment necessary, no cost), as well as limitations (e.g., not enough sessions) of the Walk-in clinic. Profile analysis of the CAT-MH data indicated that clients had higher rates of depression before COVID-19 (M = 64.2, SD = 13.07) as compared to during the pandemic (M = 59.78, SD = 16.87). In contrast, higher rates of positive suicidality flags were reported during the pandemic (n = 54) as compared to before (n = 29). The lower reported rates of depression but higher rate of suicidality during the pandemic was an unanticipated finding that contradicted prior research, to which possible explanations are explored. Taken together, the results demonstrate the positive experiences of clients who access a single session therapy.

Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder: A randomized controlled trial

Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD. In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively. Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT. In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD. The study was prospectively registered at ClinicalTrials (NCT05015166).

Subjective, behavioral and neurobiological effects of cannabis and cannabinoids in social anxiety

Social anxiety disorder (SAD) is a debilitating disorder, characterized by fear and anxiety in social situations. Evidence suggests that the levels of SAD are rising, in particularly after the COVID-19 pandemic. Serotonin and noradrenaline reuptake inhibitors and cognitive-behavioral therapy are effective treatments for SAD. Nevertheless, a significant number of patients do not respond well to these therapeutic options. During the last years, Cannabis and cannabinoid-containing products have been investigated for the treatment of different neuropsychiatric disorders. Nevertheless, their efficacy for the treatment of anxiety disorders is still a matter of debate. The purpose of this review was to investigate subjective, behavioral, and neurobiological effects of Cannabis and cannabinoids in social anxiety and SAD. A search in the PubMed database for articles published between the years of 2003-2023 was conducted. One hundred and seventeen (117) original studies were identified. After the exclusion criteria, eighteen (18) studies were selected. The studies investigated the effects of the cannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in patients or healthy volunteers submitted to tasks that assessed social anxiety. Results showed that CBD decreases social anxiety, producing an inverted U-shaped curve, with anxiety measurements being reduced at intermediate doses administered orally (300-600 mg), but not at lower or higher doses. THC either reduces (lower doses, 6-7.5 mg) or increases (higher doses) social anxiety measurements. CBD attenuates the anxiogenic effects of THC. The effects of THC and CBD in anxiety are associated to the modulation of fronto-limbic regions. Further clinical trials, conducted with male and female patients and larger cohorts are still necessary to consolidate these results.

Prescriptions of antidepressants and anxiolytics in France 2012-2022 and changes with the COVID-19 pandemic: interrupted time series analysis

BACKGROUND

Depression and anxiety have increased in prevalence since the start of the COVID-19 pandemic.

OBJECTIVE

To evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic's potential impact in France.

METHODS

We conducted an interrupted time series analysis of routine drug sales data (Medic'AM) from all French outpatient pharmacies from 2012 to 2022. We investigated trends in defined daily doses of antidepressants and anxiolytics sold per 1000 inhabitants (DDD/TID) and related expenditures before and after pandemic onset and in relation with stringency of pandemic mitigation measures. Analyses were performed descriptively and using segmented linear regression, autoregressive and autoregressive integrated moving average models.

FINDINGS

From 2012 to 2019, overall monthly antidepressant sales increased (+0.02 DDD/TID) while monthly anxiolytic sales decreased (-0.07 DDD/TID). With pandemic onset, there was a relevant and persisting trend increase (+0.20 DDD/TID per month) for antidepressant sales overall, with an estimated excess of 112.6 DDD/TID sold from May 2020 until December 2022. Anxiolytic sales were elevated from February 2020 throughout the pandemic but returned to expected levels by December 2022, with an estimated excess of 33.8 DDD/TID. There was no evident association between stringency and antidepressant or anxiolytic sales.

CONCLUSIONS

This study showed a protracted trend increase in the consumption of antidepressants since pandemic onset, while increases in anxiolytic consumption were temporary.

CLINICAL IMPLICATIONS

We provide evidence that the COVID-19 pandemic may have had long-lasting consequences on the prevalence and treatment of depression and anxiety disorders, requiring further actions by researchers and policy-makers to address this potential public mental health crisis.

Temporal Landmarks and Nostalgic Consumption: The Role of the Need to Belong

This study investigates the influence of temporal landmarks on nostalgic consumption through the mediating role of the need to belong. In particular, the study identifies end landmarks as one of the triggers of landmarks, a phenomenon that has not been studied in the existing nostalgic consumption literature. The research is composed of one pilot study and three experiments to test our research hypotheses. The results show that end temporal landmarks trigger feelings of nostalgia, which leads to nostalgic consumption through the need to belong. This study underscores the mediating role of the need to belong, which plays an important role in leading to nostalgic consumption. Building upon theoretical perspectives on the need to belong, our study enriches the research literature by linking extreme consumer emotional statuses, such as social anxiety, to the consumer need to belong, showing that consumer nostalgic consumption can become a coping strategy that counteracts these negative feelings and helps in regaining connection and supporting social relationship networks. Marketers may use the signs of end temporal landmarks to increase consumers' nostalgia, which, in turn, will enhance consumers' need to belong and thus lead to the purchasing and consumption of nostalgic products.

COVID-19-related stress response among adult females: Relevance of sociodemographics, health-related behaviors and COVID-19 contact

Women were more affected than men during the COVID-19 pandemic. This study aimed to investigate COVID-19-related stress response in adult women and its association with the relevant socioeconomic, lifestyle and COVID-19-related factors. This research was carried out in eight randomly chosen cities from September 2020 to October 2021. To examine stress, we distributed the COVID Stress Scales (CSS) and the Perceived Stress Scale (PSS). Women also fulfilled a general socio-epidemiologic questionnaire. The study included 1,264 women. Most women were healthy, highly educated, employed, married, nonsmokers who consumed alcohol. The average total CSS score suggested a relatively low COVID-19 related stress), while 1.7% of women had CSS ≥ 100. The mean PSS was around the mid-point value of the scale. Older women, who were not in a relationship, didn't smoke, didn't drink alcohol, but used immune boosters, had chronic illnesses and reported losing money during the pandemic had higher CSS scores. A higher level of stress was also experienced by women exposed to the intense reporting about COVID-19, had contact with COVID-19 positive people or took care of COVID-19 positive family members. In this sample of predominantly highly educated women few women experienced very high stress level, probably due to the study timing (after the initial wave) when the pandemic saw attenuated stress levels. To relieve women from stress, structural organization and planning in terms of health care delivery, offsetting economic losses, controlled information dissemination and psychological support for women are needed.

The cycle of solitude and avoidance: a daily life evaluation of the relationship between internet addiction and symptoms of social anxiety

A consistent association has been observed between internet addiction and symptoms of social anxiety. However, there is a lack of empirical research that delves into potential explanations for this relationship and its directionality, making it difficult to translate findings into development of interventions for social anxiety that account for technology-related behaviors. The present study aimed to evaluate the longitudinal dynamics between internet addiction, symptoms of social anxiety, avoidance of social interactions, and using the internet to cope with loneliness. By means of an ecological momentary assessment study, we evaluated a sample of 122 young adults from Chile using intensive self-report measurements five times a day, for a period of 10 days. Using mixed-effects models, we examined the directionality between internet addiction and symptoms of social anxiety, together with an explanation of their relationship. Results indicate that internet addiction antecedes symptoms of social anxiety; however, the reverse relationship was not observed. Furthermore, instances where individuals avoided social interactions or used the internet to cope with loneliness were predictive of later increases in levels of internet addiction, suggesting a vicious cycle. Significant heterogeneity was observed in these effects, highlighting the need for a more personalized approach when including technology-related behaviors in social anxiety interventions. Theoretical and clinical implications are discussed.

A positive side effect of wearing face coverings for socially anxious females: Findings from a speech task

Background

Wearing face masks has become more common due to the COVID-19 pandemic. Until now, it has not been investigated whether socially anxious individuals can reduce their acute anxiety symptoms by wearing face masks during a speech task.

Method

Fifty-nine socially anxious females were asked to prepare and give an oral presentation. Participants were randomly allocated either to a group that was asked to wear a face mask during the task, or to a group that was not asked to wear a face mask during the task. Dependent variables included physiological parameters (systolic/diastolic blood pressure, heart rate) and self-reports (valence and arousal at baseline, as well as directly before and after the presentation).

Results

The analyses showed that the group without face masks had a higher systolic blood pressure than the group with face masks, directly before as well as after the presentation. The two groups did not differ in the other measures.

Conclusion

Wearing face masks has a small stress-reducing effect on socially anxious females.

Prevalence and predictors of social anxiety disorders among Malaysian secondary school students during the COVID-19 pandemic: Exploring the influence of internet gaming disorder and impulsivity

This study aimed to investigate the prevalence of social anxiety disorder (SAD) among Malaysian secondary school students during the COVID-19 pandemic and to explore its correlations with demographic variables, impulsivity behavior, and internet gaming disorder (IGD). A total of 1574 participants from 12 government secondary schools across five Malaysian states, comprising 569 males and 1005 females, completed an online questionnaire containing validated Malay versions of the Social Interaction Anxiety Scale, Barratt Impulsiveness Scale, and Internet Gaming Disorder Scale - Short Form. The findings revealed a notable SAD prevalence rate of 40.53% among Malaysian adolescents. Logistic regression analysis unveiled significant associations between SAD and factors such as attention impulsiveness (OR = 2.58, p < .001), motor impulsiveness (OR = 1.47, p = .03), female gender (OR = 2, p < .001), Malay ethnicity, and IGD (OR = 1.08, p < .001). In conclusion, this study provides valuable insights into the extent of social anxiety experienced by Malaysian secondary school students during the pandemic, shedding light on the demographic and psychosocial factors linked to its emergence. Furthermore, the research underscores a robust link between IGD and SAD, emphasizing the need for comprehensive interventions addressing both issues concurrently. By recognizing the multifaceted nature of these associations, future interventions can be tailored to provide holistic support for adolescents' mental well-being.

Social Anxiety and Bullying Victimization in Children and Early Adolescents: The Role of Developmental Period and Immigrant Status

Research reveals that social anxiety may be predictive of bullying victimization, but it is not clear whether this relation stands for different groups of youth. The present study examines this association by employing a longitudinal design over 1 year and including the moderating role of developmental period (childhood vs. early adolescence) and students' immigrant status (native vs. non-native). T1 sample included 506 children (46.44% girls, mean age M = 8.55 years, SD = 0.55) and 310 early adolescents (50% girls, mean age = 12.54 years, SD = 0.59) recruited in schools in Northern Italy. Due to missing cases and drop-outs from T1 to T2, the final sample comprised 443 and 203 students from primary and middle school, respectively. Social anxiety and peer victimization were assessed through self-reported questionnaires. Results indicated that victimization at T2 was predicted by a 3-way interaction between T1 social anxiety, immigrant status, and developmental period. In particular, socially anxious early adolescents with an immigrant background were the most victimized. The results are discussed in terms of group dynamics and intergroup processes. The findings highlight the importance of personal variables in the cumulation of risks: social anxiety is more predictive of bullying victimization for immigrant early adolescents than for children or native early adolescents.

Societal influence and psychological distress among Indonesian adults in Java on the early Omicron wave of COVID-19

Aim

Changes during the COVID-19 pandemic might create pressure on different people, thus this study aimed to measure respondents' psychological distress during the early phase of the Omicron wave in Java Island.

Methods

A web-based survey on societal influence and COVID-19-related psychological distress was distributed through social media in November-December 2021, and received 396 responses.

Results

This study showed that almost 50% of respondents faced psychological distress during the early phase of the Omicron variant, especially concerning hypervigilance and avoidance. Several sociodemographic factors might contribute to the incidence of psychological distress including comorbidity, age and education.

Conclusion

Taken together, the incidence of COVID-19-related psychological distress was still found in the early phase of the Omicron variant, especially among young adults.

Factors affecting social phobia among Chinese college students in the context of COVID-19 pandemic: a cross-sectional study

Social phobia (SP) refers to excessive anxiety about social interactions. College students, with their exposure to academic, familial, and job-related pressures, are an ideal population for early screening and intervention of social phobia. Additionally, COVID-19 prevention measures including keeping social distance may further impact social phobia. This study aims to investigate the influencing factors of social phobia among Chinese college students and to tentatively explore the impact of COVID-19 prevention measures on social phobia. Respondents were recruited through Chinese Internet social platforms for an online survey. College students' social phobia scores in pre- and early-COVID-19 periods were measured using Peters' short form of the Social Interaction Anxiety Scale and Social Phobia Scale (SIAS-6/SPS-6). Demographic information, family information, social relations, self-evaluation, and subjective feelings regarding the impact of COVID-19 preventive measures on social phobia were collected. A multivariable logistic regression model was used to analyze the influencing factors. A total of 1859 valid questionnaires were collected, revealing that the social phobia scores increased from 12.3 ± 11.9 to 13.4 ± 11.9 between pre- and early-COVID-19 periods, with an increase of 1.0 ± 6.4 (p < 0.001). Low GPA rank, mobile phone dependence, distant family relationships, indulgent parents, childhood adversity, and childhood bullying were risk factors for social phobia among Chinese college students. Female gender, being a senior university student or postgraduate, satisfaction with physical appearance, self-reported good mental health and high level of interpersonal trust were protective factors for social phobia. Although most respondents believed that COVID-19 prevention measures (e.g., mask wearing and social distancing rules) reduced their social phobia, these measures were not significantly associated with social phobia levels in the multivariable analyses. In conclusion, Chinese college students' social phobia was widely influenced by diverse factors and warrants increased attention, with early intervention aimed at high-risk individuals being crucial for their mental health. Additional research is necessary to understand the impact of COVID-19 preventive measures on social phobia among college students.

The role of loneliness and negative schemas in the moment-to-moment dynamics between social anxiety and paranoia

Social anxiety and paranoia often co-occur and exacerbate each other. While loneliness and negative schemas contribute to the development of social anxiety and paranoia separately, their role in the development of the two symptoms co-occurring is rarely considered longitudinally. This study examined the moment-to-moment relationship between social anxiety and paranoia, as well as the effects of loneliness and negative schemas on both experiences individually and coincidingly. A total of 134 non-clinical young adults completed experience sampling assessments of momentary social anxiety, paranoia, and loneliness ten times per day for six consecutive days. Participants' negative-self and -other schemas were assessed with the Brief Core Schema Scale. Dynamic structural equation modelling revealed a bidirectional relationship between social anxiety and paranoia across moments. Loneliness preceded increases in both symptoms in the next moment. Higher negative-self schema was associated with a stronger link from paranoia to social anxiety; whereas higher negative-other schema was associated with a stronger link from social anxiety to paranoia. Our findings support the reciprocal relationship between social anxiety and paranoia. While loneliness contributes to the development of social anxiety and paranoia, negative self and other schemas appear to modify the relationships between the two symptoms.

Pre-COVID brain network topology prospectively predicts social anxiety alterations during the COVID-19 pandemic

Background

Social anxiety (SA) is a negative emotional response that can lead to mental health issues, which some have experienced during the coronavirus disease 2019 (COVID-19) pandemic. Little attention has been given to the neurobiological mechanisms underlying inter-individual differences in SA alterations related to COVID-19. This study aims to identify neurofunctional markers of COVID-specific SA development.

Methods

110 healthy participants underwent resting-state magnetic resonance imaging and behavioral tests before the pandemic (T1, October 2019 to January 2020) and completed follow-up behavioral measurements during the pandemic (T2, February to May 2020). We constructed individual functional networks and used graph theoretical analysis to estimate their global and nodal topological properties, then used Pearson correlation and partial least squares correlations examine their associations with COVID-specific SA alterations.

Results

In terms of global network parameters, SA alterations (T2-T1) were negatively related to pre-pandemic brain small-worldness and normalized clustering coefficient. In terms of nodal network parameters, SA alterations were positively linked to a pronounced degree centrality pattern, encompassing both the high-level cognitive networks (dorsal attention network, cingulo-opercular task control network, default mode network, memory retrieval network, fronto-parietal task control network, and subcortical network) and low-level perceptual networks (sensory/somatomotor network, auditory network, and visual network). These findings were robust after controlling for pre-pandemic general anxiety, other stressful life events, and family socioeconomic status, as well as by treating SA alterations as categorical variables.

Conclusions

The individual functional network associated with SA alterations showed a disrupted topological organization with a more random state, which may shed light on the neurobiological basis of COVID-related SA changes at the network level.

Self-Reported Anxiety and Depression among Parents of Primary School Children during the COVID-19 Pandemic in Thailand, 2022

One significant concern during the COVID-19 pandemic is parents' mental health, which may consequently affect children's health and well-being. The objective of this study is to investigate generalized anxiety and depression in parents of primary-school-aged children and identify risk factors for mental health problems. A cross-sectional survey comprising 701 parents of primary school children in five of Thailand's major provinces was carried out from January to March 2022. Generalized anxiety and depression levels were assessed using the GAD-7 and PHQ-9. Logistic regression was performed to determine the effects of independent variables on anxiety and depression. Results showed that the prevalence of generalized anxiety and depression was 42.7% and 28.5%, respectively, among Thai parents. Three strong associative factors included: (1) having a youngest child with mental health problems; (2) not assisting their children every day; and (3) drinking alcohol. These findings show that the parents must deal with several difficulties when trying to maintain work and parenting duties while being confined at home during emergency situations. The government should provide sufficient assistance to parents who lack skills in handling children with emotional and behavioral problems. Meanwhile, health promotion to reduce alcohol consumption should continue to be an area of focus.