Adolescent Safety Behaviors and Social Anxiety: Links to Psychosocial Impairments and Functioning with Unfamiliar Peer Confederates

Socially anxious adolescents often endure anxiety-provoking situations using safety behaviors: strategies for minimizing in-the-moment distress (e.g., avoiding eye contact, rehearsing statements before entering a conversation). Studies linking safety behaviors to impaired functioning have largely focused on adults. In a sample of one hundred thirty-four 14 to 15 year-old adolescents, we tested whether levels of safety behaviors among socially anxious adolescents relate to multiple domains of impaired functioning. Adolescents, parents, and research personnel completed survey measures of safety behaviors and social anxiety, adolescents and parents reported about adolescents' evaluative fears and psychosocial impairments, and adolescents participated in a set of tasks designed to simulate social interactions with same-age, unfamiliar peers. Relative to other adolescents in the sample, adolescents high on both safety behaviors and social anxiety displayed greater psychosocial impairments, evaluative fears, and observed social skills deficits within social interactions. These findings have important implications for assessing and treating adolescent social anxiety.

Unfamiliar Untrained Observers' Ratings of Adolescent Safety Behaviors Within Social Interactions with Unfamiliar Peer Confederates

Adolescents experiencing social anxiety often engage in safety behaviors-covert avoidance strategies for managing distress (e.g., avoiding eye contact)-that factor into the development and maintenance of their concerns. Prior work supports the psychometric properties of the Subtle Avoidance Frequency Examination (SAFE), a self-report survey of safety behaviors. Yet, we need complementary methods for assessing these behaviors within contexts where adolescents often experience concerns, namely, interactions with unfamiliar peers. Recent work indicates that, based on short, direct social interactions with adolescents, individuals posing as unfamiliar peers (i.e., peer confederates) and without assessment training can capably report about adolescent social anxiety. We built on prior work by testing whether we could gather valid SAFE reports from unfamiliar untrained observers (UUOs), who observed adolescents within archived recordings of these short social interactions. A mixed clinical/community sample of 105 adolescents self-reported on their functioning and participated in a series of social interaction tasks with peer confederates, who also provided social anxiety reports about the adolescent. Based on video recordings of these tasks, trained independent observers rated adolescents' observed social skills, and an additional set of UUOs completed SAFE reports of these same adolescents. Unfamiliar untrained observers' SAFE reports (a) related to adolescents' SAFE self-reports, (b) distinguished adolescents on clinically elevated social anxiety concerns, (c) related to trained independent observers' ratings of adolescent social skills within interactions with peer confederates, and (d) related to adolescents' self-reported arousal within these same interactions. Our findings support use of unfamiliar observers' perspectives to understand socially anxious adolescents' interpersonal functioning.

The psychiatric sequelae of the COVID-19 pandemic in adolescents, adults, and health care workers

BACKGROUND

The COVID-19 pandemic is the most serious global public health crisis since the 1918 influenza pandemic. This study is the first to assess its mental health impact across the lifespan in the United States in adolescents, adults, and health care workers.

METHODS

We recruited 4909 participants through an online survey advertising on Facebook and Instagram to assess exposure to COVID-19 and psychiatric symptoms from April 27 to July 13. We also recruited through the University of Pittsburgh, University of Pittsburgh Medical Center, and other health care systems around Pittsburgh. The primary outcomes were clinically significant depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, suicidal ideation or behavior, and grief reactions since COVID-19.

RESULTS

Adolescents were significantly more likely to report moderate to severe symptoms of depression (55% vs. 29%; χ²  = 122, df = 1; p < .001), anxiety (48% vs. 29%; χ²  = 73; df = 1; p < .001), PTSD (45% vs. 33%; χ²  = 12; df = 1; p < .001), suicidal ideation or behavior (38% vs. 16%; χ²  = 117; df = 1; p < .001), and sleep problems (69% vs. 57%; χ²  = 26; df = 1; p < .001) compared to adults. The rates of intense grief reactions among those who lost someone to COVID-19 was 55%. Loneliness was the most common predictor across outcomes and higher number of hours spent on social media and exposure to media about COVID-19 predicted depression symptoms and suicidal ideation or behavior in adolescents.

CONCLUSIONS

The COVID-19 pandemic is associated with increased rates of clinically significant psychiatric symptoms. Loneliness could put individuals at increased risk for the onset of psychiatric disorders.