Cultural differences in perceived social norms and social anxiety

Conflicting patterns of cardiovascular reactivity, self-report, and behavior associated with social anxiety during a conversation with a close friend

Social anxiety (SA) is characterized by anxious symptomology and fear during social situations, but recent work suggests that SA may not necessarily be associated with negative interpersonal and intrapersonal outcomes in support contexts. The current research investigates the discrepancies between self-perceptions, behavior, and physiological responses associated with SA in social support conversations with close friends. Specifically, we examined the associations between SA and positive and negative affect, perceptions of demands and resources, and responsiveness. Additionally, we used the biopsychosocial model of challenge and threat to understand the physiological responses associated with SA. Participants (79.9% White, 9.8% Black or African American, 10.3% Multiple races or other; 78.7% Female), totaling 172 undergraduate friend dyads, completed self-report measures and had physiological responses recorded while they discussed a problem unrelated to the friendship. Trained coders rated responsive behaviors exhibited during the conversation. Results revealed that greater SA was associated with greater negative perceptions of social interactions (greater negative affect, fewer perceived resources, and greater perceived demands). However, cardiovascular reactivity and behavioral responses within the conversation, as well as perceptions of partners' behavior after the conversation, contrasted with these negative perceptions. Indeed, greater SA was associated with greater sympathetic arousal (indicative of greater task engagement), but not with greater challenge or threat, and SA was not associated with perceived partner responsiveness or responsive behaviors. These results add to the growing body of research that suggests people with greater SA show inconsistencies between their conscious appraisals of social situations and their physiological responses.

How do social networks, perception of social isolation, and loneliness affect depressive symptoms among Japanese adults?

OBJECTIVE

This study aims to elucidate the complex relationship among social isolation, loneliness, and perception of social isolation and its influence on depressive symptoms by evaluating a hypothetical model. This understanding is essential for the formulation of effective intervention strategies.

METHODS

We conducted an online survey on Japanese adults (N = 3,315) and used the six-item Lubben Social Network Scale to assess the size of their social networks. We employed a single question to gauge their perception of social isolation. Loneliness was assessed using the three-item UCLA Loneliness Scale, and depressive symptoms were examined using the Patient Health Questionnaire-9. Structural equation modeling was employed to test the hypothesized model.

RESULTS

The final model demonstrated satisfactory fit with data (χ2 (1) = 3.73; not significant; RMSEA = 0.03; CFI = 1.00; TLI = 1.00). The size of social network demonstrated a weak negative path to loneliness and depressive symptoms (β = -.13 to -.04). Notably, a strong positive association existed between perception of social isolation and loneliness (β = .66) and depressive symptoms (β = .27). Additionally, a significant positive relationship was found between loneliness and depressive symptoms (β = .40). Mediation analysis indicated that perception of social isolation and loneliness significantly intensified the relationships between social networks and depressive symptoms.

CONCLUSIONS

Results indicate that interventions of psychological approaches, such as cognitive-behavioral therapy, are effective in reducing the perception of social isolation and loneliness, which may lead to the prevention of depressive symptoms. Future longitudinal studies are expected to refine and strengthen the proposed model.

Thirty-year trends of anxiety disorders among adolescents based on the 2019 Global Burden of Disease Study

Background

Anxiety disorders are the most common psychiatric problems, affecting approximately 1 in 12 children and 1 in 4 adolescents. Understanding the incidence, burden and correlated risks of anxiety disorders among children and adolescents can help identify areas of success, stagnation and emerging threats, thereby facilitating effective improvement strategies.

Aims

To estimate the incidence and burden trends of anxiety disorders in children and adolescents from 1990 to 2019 in 204 countries and compare the incidence and disease burden in different countries. To examine the association between anxiety disorders and social indicators (healthcare access and quality of life).

Methods

Data were obtained from the Global Burden of Disease Study 2019. The age-standardised incidence rates (ASIRs) and disability-adjusted life years (DALYs) were reported to assess the burden of anxiety disorders, and the estimated annual percentage change was calculated to quantify the temporal trends. Pearson's correlation was used to investigate country-level risk factors for incidence and DALYs.

Results

Globally, there were 932 million incident cases of anxiety disorders in children and adolescents, 739.29 per 100 000 ASIRs and 380.62 million DALYs in 2019. From 1990 to 2019, the estimated annual percentage change of incidence of anxiety disorders decreased by 2.2%. Significant variations were observed in the age-standardised burden rate and the changing trend of anxiety disorders among countries. Portugal reported the highest ASIR of anxiety disorders, while Mexico had the largest increase rate of ASIR. In 2019, Portugal reported the highest number of DALYs (1001.71 million), and India (212.09 million) reported the lowest number of DALYs. The burden of anxiety disorders was positively correlated with the average number of psychiatrists, psychologists and nurses in the mental health sector (per 100 000), and quality of life and the correlation coefficients were 0.58, 0.67, 0.43 and 0.53, respectively.

Conclusions

The incidence and global burden of anxiety disorders in adolescents have continued to decrease over the past 30 years. However, the incidence and disease burden in developed countries are still increasing steadily. Policymakers should design and implement mental health strategies for adolescents based on their specific developmental status, as well as the cultural and regional characteristics of each country.

Anxiety and coping strategies among dyslexics in Ethiopia

Individuals with dyslexia have been shown to have an increased risk for developing internalizing problems. Various studies have revealed the powerful role that culture plays in determining the type of anxiety and coping strategies adopted by various groups of individuals. However, compared to the vast number of studies conducted in individualistic cultures, knowledge on collectivistic cultures with respect to this issue is still limited. This study examined anxiety and coping strategies of children with and without dyslexia in Ethiopia, where the majority of its cultural dimensions could be regarded as collectivistic. A total of 126 children with (n = 63) and without (n = 63) dyslexia, aged 8-11 (41 boys and 22 girls, in each group; and age: M = 9.43 years; SD = 1.14 and M = 9.46; SD =1.11), participated. Dyslexia was assessed using an Amharic dyslexia assessment battery, while anxiety level and coping strategy were respectively measured using the Spence Children's Anxiety Scales (SCAS) and the Children's Coping Questionnaire (CCQ), both translated into Amharic. Results indicated that dyslexia was associated with higher levels of anxiety (especially generalized anxiety) and lower levels of support-seeking coping strategies. We discuss these results in the light of the cultural and institutional context in Ethiopia.

Cross-lagged analysis of rumination and social anxiety among Chinese college students

BACKGROUND

Social anxiety, which is widely prevalent among Chinese college students, poses a significant barrier to their holistic psychological and physiological development. Although numerous cross-sectional studies have examined the relationship between rumination and social anxiety, there is still a gap in understanding their interplay over time. This longitudinal study aimed to explore and analyze the intricate interrelations between these two factors, with the ultimate goal of informing the development of effective mental health education interventions for university students.

METHODS

Using the Ruminative Responses Scale (RRS) and the Interaction Anxiousness Scale (IAS), a two-stage longitudinal follow-up study of 392 college students from three universities in Henan Province was conducted over a six-month period (October 2022 to March 2023) using a cross-lagged model to explore the correlation between rumination and social anxiety. The results of the correlation analysis showed that rumination was positively associated with social anxiety at both time points (r = 0.18,0.12, p < 0.01).

RESULTS

Cross-lagged regression analyses revealed that the predictive effect of the first measure (T1) rumination on the second measure (T2) rumination was statistically significant (β = 0.32, p < 0.001). The predictive effect of T1 social anxiety on T2 social anxiety was statistically significant (β = 0.65, p < 0.001), the predictive effect of T1 rumination on T2 social anxiety was statistically significant (β = 0.33, p < 0.001), and the prediction of T1 social anxiety on T2 rumination was statistically significant (β = 0.28, p < 0.001).

CONCLUSION

College students' rumination and social anxiety are mutually predictive of each other, and interventions by educators in either of these areas have the potential to interrupt the vicious cycle between ruminant thinking and social anxiety.

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.

Information Seeking and Avoidance in the COVID-19 Pandemic as a Function of Political Ideology and National Context: A Survey Comparing the US and Germany

The COVID-19 pandemic sparked a globally heightened need for scientific information. At the same time, the abundance of information led to tendencies of media fatigue and information avoidance. Both information seeking and avoidance are embedded in a specific national context, in which conditions of and measures against the pandemic may differ dramatically. In addition, the pandemic quickly became entangled with political ideology. Using the Risk Information Seeking and Processing Model (RISP) as a theoretical background, we investigate the role of national context and political ideology for information seeking and avoidance in a comparative survey in the U.S. and Germany during the early phase of the pandemic. Results show that the factors predicting information behavior are effective in both countries with only few differences: In both countries, perceived hazard characteristics, information norms and perceived information gathering capacity were related to higher information seeking and lower information avoidance. Ideology too is an important influence: Right-leaning ideology was associated with lower levels of information norms in both countries; but only in the US was right-leaning ideology connected to less perceived hazard characteristics and less negative affective responses. Results are discussed regarding their implications for the RISP model.

Whether and how will using social media induce social anxiety? The correlational and causal evidence from Chinese society

Background

Prior literature has well established the relationship between social media use and social anxiety, but little attention has been paid to the underlying mechanisms. Additionally, the causal evidence concerning the effect of social media use on social anxiety is scarce.

Objective

Given that, two studies were conducted to examine the effect of social media use on social anxiety and the underlying mechanisms.

Methods and results

In Study 1, with 470 undergraduates as participants, we applied the questionnaire survey to investigate the relationship between social media use and social anxiety. The results showed that higher social media use intensity was significantly related to higher social anxiety, and social media use was related to social anxiety via two possible mediation paths: (1) social media use → upward social comparison → social anxiety, (2) and social media use → upward social comparison → self-esteem → social anxiety. In Study 2, with 180 undergraduates as participants, we conducted a lab experiment, in which participants were assigned to the experimental (exposed to the content that undergraduates frequently access on social media) or control (exposed to landscape documentaries) condition, and then measured their upward social comparison, self-esteem and social anxiety. The results showed that participants in the experimental condition reported higher social anxiety than those in the control condition, demonstrating the causality between social media exposure and social anxiety. The subsequent mediation analysis basically replicated the findings of Study 1. That is, upward social comparison played the mediating role between social media exposure and social anxiety, and upward social comparison and self-esteem played the chain-mediating role between them.

Conclusion

The current research firstly demonstrated the causality between social media use and social anxiety in Chinese society, and also revealed the mediating mechanisms between them, which would deepen our understanding of how social media use will increase social anxiety.

Emotional and Behavioural Problems among Preschool Children in Northeast Peninsular Malaysia: Parent Report Version

The rising prevalence of mental health disorders among children is a serious concern. Young children who exhibit early warning signs of mental health issues are more likely to develop symptoms in the same or overlapping regions years later. The research aimed to identify emotional and behavioural problems and associated factors in Malaysian preschools. A sample of young children aged 4-6 years from public and private preschools was chosen using a multistage random sampling method. Data were collected from 18 preschools via a parent survey using the Strengths and Difficulties Questionnaire (SDQ). The sample involved 557 children in the SDQ assessment (92%). The overall estimated prevalence of emotional and behavioural problems was 8.4%. Peer problems were the most prevalent attribute, with a percentage of 19.7%. Conduct problems were found in 5.2%, hyperactivity problems in 5.6%, prosocial behaviours in 13.5%, and emotional problems in 6.8%. Girls showed a significant increase in behavioural and emotional problems compared to boys. Having one parent working, having more than two siblings, and having a single-parent family were associated with emotional and behavioural problems. The prevalence of emotional and behavioural problems in Malaysian children was relatively low compared to data from previous studies and other Asian countries but consistent with European studies. Measuring mental health disparities in young children helps stakeholders launch local early intervention programmes.

Status of mental health among college and university students during first and second wave of COVID-19 outbreak in India: A cross-sectional study

Background

India has been badly affected by Covid-19 not only in terms of human lives but also has a long-term effect on mental health of the population. This paper is an attempt to understand the psychological effects of the pandemic on the college and university students in India after the second wave of COVID-19 outbreak and its associated factors.

Method

A web-based survey was conducted to collect information from the students both at individual and household level. The study applied binary and multivariate logistic regression to estimate the adjusted and unadjusted marginal effects of the predictor variables.

Result

Results show a significant increase in mental health concerns during the second wave of the pandemic, as compared to the first year. The key factors contributing to the higher prevalence of depression, anxiety, and stress are the difficulties faced in the adaptation to the new way of learning, fear of discontinuation of education due to financial constraints faced by household, limited physical interaction, and prolonged screen-time during the pandemic.

Limitation

The study has some limitations regarding selection of the sample as the survey was web-based. Also, the mental health situation of the students is self-reported and the study does not consider the prevailing mental health issues before the pandemic.

Conclusion

The study recommends initiatives like offering counselling classes and strategies to cope up with mental health disorders. Further, there is a need to conduct follow-up studies to assess the long-term impacts of prolonged home quarantine on the mental health of the students.

Annual Research Review: Developmental pathways linking early behavioral inhibition to later anxiety

Behavioral Inhibition is a temperament identified in the first years of life that enhances the risk for development of anxiety during late childhood and adolescence. Amongst children characterized with this temperament, only around 40 percent go on to develop anxiety disorders, meaning that more than half of these children do not. Over the past 20 years, research has documented within-child and socio-contextual factors that support differing developmental pathways. This review provides a historical perspective on the research documenting the origins of this temperament, its biological correlates, and the factors that enhance or mitigate risk for development of anxiety. We review as well, research findings from two longitudinal cohorts that have identified moderators of behavioral inhibition in understanding pathways to anxiety. Research on these moderators has led us to develop the Detection and Dual Control (DDC) framework to understand differing developmental trajectories among behaviorally inhibited children. In this review, we use this framework to explain why and how specific cognitive and socio-contextual factors influence differential pathways to anxiety versus resilience.

Elderly Users’ Emotional and Behavioral Responses to Self-Service Technology in Fast-Food Restaurants

While COVID-19 has accelerated digital transformation, increasing labor costs and 52-h workweek rules are replacing human labor with self-service technologies (SSTs). Self-service technology is increasingly being implemented in restaurant settings. However, the elderly, who have relatively lower levels of digital literacy, are being excluded from services that can alleviate the economic and social difficulties of their daily lives. This study thus aims to explain how elderly users feel about and respond to SST in fast-food restaurants. An off-site survey was conducted with individuals who had experience using SST. We analyzed the data using the partial least squares structural equation modeling method by SmartPLS 3.0. The results showed that SST’s reduction, perceived ease of use of SST, and perceived time pressure significantly influenced users’ negative emotions toward the SST. However, perceived physical condition and perceived crowding did not have significant influences on users’ emotions. In empirically investigating individuals’ negative emotions toward and coping strategies for challenges posed by SST, this study emphasizes the development of a nationwide digital inclusion policy that can help bridge the digital divide.

Social Withdrawal in Adolescence: Developmental and Humanistic Perspectives

In both the West and East, social withdrawal, manifested as solitude and shyness, has distinct developmental implications for adolescent mental health. Representative countries in the West (e.g., North America and Europe) and East (e.g., China) were selected to compare cultural differences. This literature review aims to discuss how adolescents experience solitude and shyness differently in North America, Europe, and China from a developmental perspective, and adopts a cross-cultural perspective to explain the distinct outcomes of adolescent social withdrawal. Furthermore, humanistic perspectives are discussed to link adolescent development and humanism in terms of previous empirical evidence and counseling practices. In North America and Europe, solitude has both adaptive and harmful effects on adolescents’ mental health. However, solitude in China and shyness in both cultural settings tend to adversely affect adolescent mental health. These findings from previous studies correspond to developmental perspectives in terms of mental health, personal adaptation, and self-development during adolescence. The strengths, weaknesses, and implications of this literature review are also discussed.

The psychological and financial impacts of an emotional culture of anxiety and its antidote, an emotional culture of companionate love

RATIONALE

Anxiety is an increasingly common problem in society, including at work, yet the effects of an emotional culture of anxiety remain unexplored. We offer a new lens on anxiety in the workplace, examining its collective enactment in the form of an emotional culture of anxiety.

OBJECTIVE

This study examines the implications of an emotional culture of anxiety for psychological and financial outcomes within a poorly performing healthcare organization. We also examine whether an emotional culture of companionate love, which helps people "calm and connect", can counteract the negative effects of an emotional culture of anxiety.

METHODS

Drawing on survey data of 822 employees from 85 departments in a large US medical center and a time-lagged archival measure of financial performance across those departments, we used ordinary least squares regression and random coefficient regression modeling to examine the main effects of these two emotional cultures and the buffering effect of an emotional culture of companionate love on an emotional culture of anxiety for department costs, department psychological safety, and individual employee burnout and satisfaction.

RESULTS

We find significant direct relationships between an emotional culture of anxiety and an emotional culture of companionate love on employee burnout and satisfaction in the predicted directions. We also find a significant interaction between the two emotional cultures, with a culture of companionate love attenuating the relationship of a culture of anxiety on job satisfaction, burnout, and financial performance in the form of time-lagged department costs.

CONCLUSIONS

Our results indicate that a culture of companionate love can be a protective force against the negative outcomes of an emotional culture of anxiety. Examining these two emotional cultures concurrently offers a better understanding of how to address the pernicious effects of anxiety in organizations.

The relationship between interdependent and independent self-construals and social anxiety symptom severity in a clinical sample of treatment-seeking patients

Differences in cultural orientations, such as interdependent and independent self-construals, may influence social anxiety disorder (SAD) symptom presentations. However, prior research on the association between interdependent/independent self-construals and SAD was limited to non-clinical samples. Using a treatment-seeking population with clinical levels of anxiety, the current study extends prior research by examining whether the relationship between interdependent/independent self-construals and SAD is specific to SAD or indicative of a broader relationship with anxiety or depression more generally. We also expand upon prior work by examining the effect of self-construals on treatment outcomes and whether self-construals change over time. The results showed that endorsing a less independent self-construal was associated with greater SAD symptoms specifically, and was not associated with other anxiety or depression symptom measures. Additionally, while interdependent and independent self-construals did not moderate SAD treatment outcomes, there was a decrease in interdependent self-construal and increase in independent self-construal over a course of cognitive behavioral therapy. Notably, this change over time was tied to specific items that correlated strongly with SAD symptoms. Together, these results increase our understanding of the relationship between interdependent/independent self-construals and SAD symptoms in treatment-seeking anxiety patients.

Men’s anxiety, why it matters, and what is needed to limit its risk for male suicide

Anxiety disorders are the most prevalent mental health disorder experienced by men. If left untreated, anxiety is predictive of psychiatric disorders including depression and associated suicide risk. Despite the prevalence and impact of men’s anxiety, it remains largely overlooked in the field of men’s mental health. Globally, men are reported to have lower rates of anxiety disorders compared to women; however, these sex-differences do not reflect the complexity and nuance of men’s experiences. There is early evidence to suggest a male-type anxiety phenotype which may go undetected with generic diagnostic classifications. Masculine norms (i.e., stoicism, toughness, invulnerability) appear to be central to men’s experiences and expressions of anxiety as well as men’s help-seeking and coping behaviours. This is particularly concerning given anxiety increases men’s risk of physical and psychological comorbidities and suicide risk. The effective assessment, detection and treatment of men’s anxiety is therefore critical to improve mental health outcomes across the male lifespan. We propose three key recommendations for the field of men’s anxiety: (i) to develop a theoretical model surrounding men’s experiences of anxiety, (ii) broaden mental health resources, interventions and suicide prevention strategies to encompass men’s gendered experiences of anxiety (e.g., sentiments of shame, physical symptom manifestation), and (iii) utilise informal supports (i.e., friends and family) as an avenue of intervention to improve men’s anxiety outcomes. Without a substantial research agenda in men’s anxiety, we will fail to recognise and respond to men’s gendered experiences of anxiety and ultimately fail to reduce male suicides.

Validity and reliability of safety behaviors questionnaire for Persian adults who stutter: A cultural perspective

INTRODUCTION

Adults who stutter (AWS) are reported to have higher social anxiety compared to those who do not stutter. Previous studies have suggested that safety behaviors, which are cognitive or behavioral strategies used by people with anxiety to prevent negative consequences, are important factors in maintaining anxiety. However, the frequency and types of such behaviors might vary in different cultures. Therefore, the aim of the present study was to develop a transcultural adaptation of Safety Behaviors Questionnaire (Helgadottir et al., 2014) for Persian-speaking AWS and assess its validity and reliability.

METHODS

In the first step, the original English questionnaire was translated into Persian using the International Quality of Life Assessment (IQOLA) method. Then, 17 speech and language pathologists (SLPs) and 5 AWS evaluated all questionnaire items using Likert scales to determine face validity. Finally, 167 Persian-speaking AWS completed the questionnaire to assess its construct validity and reliability. Their responses were analyzed using factor analysis and Cronbach's Alpha.

RESULTS

Some items of the original questionnaire were modified or combined with other similar items after assessing the face validity of the Persian-translated questionnaire. Construct validity analysis categorized the remaining 29 questionnaire items into four factors: general avoidance, practice and control, rehearsal, and choosing safe and easy people. The high Cronbach's Alpha of 0.89 for all items confirmed the internal reliability of the Persian-translated questionnaire.

DISCUSSION/CONCLUSIONS

The results confirmed the psychometric characteristics of the Persian- translated version of the Safety Behaviors Questionnaire (Helgadottir et al., 2014); therefore, speech pathologists can apply it in future clinical and research settings. Similar to Australian AWS, Persian participants of this study self-reported use of various types of safety behaviors frequently.

Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative

Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.

Prevalence of social anxiety disorder and symptoms among Chinese children, adolescents and young adults: A systematic review and meta-analysis

The objective of the study is to provide a reliable estimate of the pooled prevalence of social anxiety disorder (SAD) and social anxiety symptoms (SAS) among children, adolescents, and young adults (CAYA) in China. Meta-analysis is used to provide pooled-prevalence rate of SAD and SAS. Literature searches were conducted in both English and Chinese databases from the database's inception to April 2019. Eleven studies were identified for SAD, and 17 were included for SAS. The results revealed a pooled prevalence of SAD of 2.1% (95% CI: 1.2-3.8%) with high between-studies heterogeneity (Q = 1,055.2, I 2 = 99.1%, p < 0.001). The pooled prevalence estimate of SAS was 23.5% (95% CI: 18.6-29.3%), also with significant heterogeneity (Q = 1,019.3, I 2 = 98.4%, p < 0.001). Different diagnostic tools or self-report scales reported significant different prevalence of SAD or SAS. Further analysis stratified by gender, age, sampling methods, economic status, and risk of bias were performed. Limitations include the high level of heterogeneity between studies, inadequate number of the studies, and significant differences in prevalence caused by measurements.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020149591, identifier: PROSPERO CRD42020149591.

Social Motivation to Comply with COVID-19 Guidelines in Daily Life in South Korea and the United States

Collectivism assessed at the national level has been suggested as a psychological factor that affects compliance with COVID-19 guidelines in daily life. The level of assessment and conceptual construct of collectivism, however, vary across studies, which calls for the need to clarify the power of collectivism in explaining individuals’ compliance behaviour. With this aim, we investigated individual-level collectivism, the unique variance and other relevant factors, such as altruism (e.g., for the family, community, and humanity) and impression management (e.g., what others would think of me) in explaining compliance with COVID-19 guidelines in US and South Korean participants. The results of hierarchical regression analysis showed that collectivism was a significant factor that explained compliance only in the US participants, whereas impression management was significant and explained the additional variance over collectivism in compliance in both the US and South Korean participants. The findings suggest the importance of elucidating the overlap between collectivism and impression management in studies exploring COVID-19 guideline adherence in daily life.

Design for Pandemic Information: Examining the Effect of Graphs on Anxiety and Social Distancing Intentions in the COVID-19

To increase public awareness and disseminate health information, the WHO and health departments worldwide have been visualizing the latest statistics on the spread of COVID-19 to increase awareness and thus reduce its spread. Within various sources, graphs are frequently used to illustrate COVID-19 datasets. Limited research has provided insights into the effect of different graphs on emotional stress and ineffective behavioral strategies from a cross-cultural perspective. The result of current research suggests a graph with a high proportion size of the colored area (e.g., stacked area graph) might increase people's anxiety and social distancing intentions; people in collectivist culture might have a high level of anxiety and social distancing intentions; the effect of different graphs on social distancing intentions is mediated by anxiety experienced. Theoretical contribution and practical implications on health communication were also discussed in this study.

Courage: A Potential Mediator of the Relationship Between Personality and Social Anxiety

Social anxiety is one of the most prevalent and chronic mental-health conditions in young adults. To date, no studies have been conducted about the relationships between the Big Five personality dimensions, courage, and social anxiety among Malaysian undergraduate students. Therefore, this study was designed to examine courage as a potential mediator of the association between the Big Five personality dimensions and social anxiety among Malaysian Undergraduates. In this study, 500 Malaysian undergraduate students (205 males and 295 females) completed a series of questionnaires. Structural equation modelling (AMOS-SEM) revealed that, of the Big Five, neuroticism and social anxiety were positively correlated. Extraversion, conscientiousness, openness to experience, and agreeableness, as well as courage, were negatively correlated with social anxiety. Courage mediated the relationship between the Big Five personality dimensions and social anxiety. The main contribution of the present research is to show how the Big Five personality dimensions may contribute to social anxiety. The findings of this study also could be implicated for counselling practice for undergraduate students in Malaysia as a collectivist setting and other collectivist settings around the world.

Socio-Demographic and Attitudinal Correlates of Problematic Social Media Use: Analysis of Ithra's 30-Nation Digital Wellbeing Survey

Time spent on social media continues to rise globally. For some individuals, social media use can become maladaptive and associated with clinically significant social and occupational impairments. This problematic social media use (PSMU) is also linked with poorer health and wellbeing. Much of our existing PSMU knowledge comes from single nation studies, heavily focused on adolescent and college-age samples. This study uses data from Ithra's 2021 global digital wellbeing survey to explore rates of PSMU and identify socio-demographic and attitudinal correlates. Participants (N = 15,000) were representative adult samples (N = 500) drawn from 30 nations. All participants provided socio-demographic data and completed a measure of PSMU, along with questions assessing attitudes toward social media and general usage patterns. PSMU prevalence was 6.82%, varying from 1.7 to 18.4% between nations. Multivariate logistical regression identified several correlates, including national culture, age, parenthood and frequency of use. These findings can help inform public policy and public health initiatives to reduce PSMU prevalence.

Preliminary examination of reliability and validity of the Japanese child anxiety impact scale-parent version in Japanese community sample

The child anxiety impact scale-parent version (CAIS-P) is a useful measure to assess the impact of anxiety on a child's daily life; however, a Japanese version of the CAIS-P has not been developed, and whether the CAIS-P can be utilized in Eastern countries remains unascertained. The purpose of this study was to develop a Japanese version of the CAIS-P and examine its reliability and validity. Parents of 400 children (aged 7 to 15 years) from the Japanese community completed the CAIS-P. A confirmatory factor analysis indicated that the factor structure of the original CAIS-P, consisting of school activity, social activity, and home/family activity factors, provided a good fit for the Japanese version of the CAIS-P. Estimated Spearman's correlation coefficients showed moderate correlations between the total and factor scores of the CAIS-P, anxiety symptoms (Spence Child Anxiety Scale-parent version), and depressive symptoms (Child Depression Inventory). Furthermore, the item response theory model revealed that each factor of the CAIS-P is a high information reliable measure for children with high trait anxiety. These results provide support for the Japanese version of the CAIS-P's factorial validity, convergent validity, and reliability and its potential for application in child anxiety research in Japan.

Predicting High-Risk Groups for COVID-19 Anxiety Using AdaBoost and Nomogram: Findings from Nationwide Survey in South Korea

People living in local communities have become more worried about infection due to the extended pandemic situation and the global resurgence of COVID-19. In this study, the author (1) selected features to be included in the nomogram using AdaBoost, which had an advantage in increasing the classification accuracy of single learners and (2) developed a nomogram for predicting high-risk groups of coronavirus anxiety while considering both prediction performance and interpretability based on this. Among 210,606 adults (95,287 males and 115,319 females) in South Korea, 39,768 people (18.9%) experienced anxiety due to COVID-19. The AdaBoost model confirmed that education level, awareness of neighbors/colleagues’ COVID-19 response, age, gender, and subjective stress were five key variables with high weight in predicting anxiety induced by COVID-19 for adults living in South Korean communities. The developed logistic regression nomogram predicted that the risk of anxiety due to COVID-19 would be 63% for a female older adult who felt a lot of subjective stress, did not attend a middle school, was 70.6 years old, and thought that neighbors and colleagues responded to COVID-19 appropriately (classification accuracy = 0.812, precision = 0.761, recall = 0.812, AUC = 0.688, and F-1 score = 0.740). Prospective or retrospective cohort studies are required to causally identify the characteristics of anxiety disorders targeting high-risk COVID-19 anxiety groups identified in this study.

MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder

Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.

Mask-Wearing Behavior During the COVID-19 Pandemic: A Cross-Cultural Comparison Between the United States and South Korea

This study identified and compared factors that directly and indirectly influenced face mask-wearing in the United States and South Korea during the COVID-19 pandemic by applying the theory of reasoned action. The overall levels of attitudes and future mask-wearing behavioral intention were lower for United States than Korean participants (N _US = 150 and N _{South Korea} = 150). Differences between the groups were noted in the impact of norms and background characteristics on attitudes and behavioral intention. Messages communicating the importance of wearing masks should be tailored to different cultures. Americans should be encouraged to try wearing masks on their own while Koreans should hear about the social benefits of mask-wearing.

Levels of Trust in Information Sources as a Predictor of Protective Health Behaviors During COVID-19 Pandemic: A UAE Cross-Sectional Study

Health information sources and the level of trust in a particular source may influence the subsequent adoption of advocated health behaviors. Information source preference and levels of trust are also likely to be influenced by sociodemographic (culture, age, gender) variables. Understanding these source-trust-behavior relationships across various national and cultural contexts is integral to improved health messaging. The present study identified the sources most frequently consulted to obtain information about COVID-19 during the pandemic's early stages in the United Arab Emirates (UAE). The study quantified levels of trust across an array of information sources, factoring in sociodemographic variables. Finally, the study explored the relationship between sociodemographic variables, levels of trust in information sources, and the adoption of COVID-19 related protective behaviors. Participants (n = 1585) were recruited during the first 2 weeks of April 2020 via announcements in the UAE media and through email networks. All participants completed a web-based survey presented in English or Arabic, as preferred. The most frequently consulted information sources were websites (health information websites), social media, government communications, and family and friends. The sources rated most trustworthy were: personal physicians, health care professionals, and government communications. There were differences in the use of sources and levels of trust according to age, gender, and education. The levels of trust in sources of information were associated with the adoption of protective behaviors, significantly so for citizens of the UAE. These findings may help inform the improvement of pandemic-related health messaging in multicultural contexts.

Reading the Mind in the Eyes: A Population-Based Study of Social Cognition in Older Adults

BACKGROUND

Social cognition indicates the cognitive processes involved in perceiving, interpreting, and processing social information. Although it is one of the six core DSM-5 cognitive domains for diagnosing neurocognitive disorders, it is not routinely assessed in older adults. The Reading the Mind in the Eyes Test assesses Theory of Mind, the social cognition mechanism which forms the root of empathy.

OBJECTIVES

To describe the distribution of, and factors associated with, scores on a 10-item version of Reading the Mind in the Eyes Test (RMET-10) in older adults.

DESIGN

Population-based cross-sectional study.

SETTING

Small-town communities in Pennsylvania.

PARTICIPANTS

Adults aged 66-105 years (N = 902, mean age = 76.6).

MEASUREMENTS

The assessment included RMET-10, demographics, cognitive screening, literacy, depression symptoms, anxiety symptoms, cognitive composites derived from a neuropsychological test battery, Social Norms Questionnaire, and Clinical Dementia Rating (CDR).

RESULTS

RMET-10 score was normally distributed in our overall study sample. Normative RMET-10 scores among those rated as CDR = 0 were calculated by age, sex, and education. RMET-10 score was significantly higher with younger age, higher education, white race, higher cognitive screening scores, literacy, social norms scores, higher scores in all five domains in cognitive composites, and lower CDR. RMET-10 score was also significantly higher with fewer depression and anxiety symptoms after adjusting for demographics.

CONCLUSIONS

The RMET is a potentially useful measure of social cognition for use in the research assessment of older adults. With appropriate calibration it should also have utility in the clinical setting.

Effects of mask-wearing on social anxiety: an exploratory review

BACKGROUND

A unique feature of the global coronavirus pandemic has been the widespread adoption of mask-wearing as a public health measure to minimize the risk of contagion. Little is known about the effects of increased mask-wearing on social interactions, social anxiety, or overall mental health.

OBJECTIVES

Explore the potential effects of mask-wearing on social anxiety.

DESIGN

We review existing literatures to highlight three preselected sets of factors that may be important in shaping the effects of mask-wearing on social anxiety. These are: (a) people's perceptions of the social norms associated with wearing masks; (b) people's experiences of the degree to which masks prevent accurate interpretation of social and emotional cues; and (c) people's use of masks as a type of safety behavior that enables self-concealment.

METHODS

APA PsycNet and PubMed were searched principally between September and November 2020 for articles describing the relationship between social anxiety, intolerance of uncertainty, ambiguous feedback, and safety behavior use and for research on the relationship between mask-wearing and social norms and social interactions. Information identified as relevant from articles of interest was extracted and included in our review.

RESULTS & CONCLUSIONS

The effects of mask-wearing on social anxiety are likely to be substantial and clinically relevant.

The Japanese self-focused attention scale: Factor structure, internal consistency, convergent, and discriminant validity

OBJECTIVE

Self-focused attention is a maintaining factor for social anxiety disorder. It was shown that self-focused attention correlates with trait mindfulness, but not with attention control. This study examined the reliability and validity of the Japanese version of the self-focused attention (J-SFA) scale.

METHOD

Students (N = 502) completed a set of questionnaires, measuring self-focused attention, social anxiety symptoms, trait mindfulness, and attention control.

RESULTS

A confirmatory factor analysis indicated that the J-SFA scale has a bi-factor structure. The Cronbach's α coefficient was high. Correlation analysis showed that each factor of the J-SFA scale was significantly weakly to moderately correlated with social anxiety symptoms and trait mindfulness, and the J-SFA scale's factors were significantly or non-significantly very weakly correlated with attentional control functions.

CONCLUSION

The findings indicate that the J-SFA demonstrated satisfactory reliability and validity for our sample and provide impetus for future research into the measure for clinical and nonclinical samples in Japan.

Psychometric properties of the social interaction anxiety scale and the social phobia scale in Hungarian adults and adolescents

BACKGROUND

Although social anxiety disorder is one of the most frequent disorders, it often remained unrecognized. Utilizing brief, yet reliable screening tools, such as the Social Interaction Anxiety Scale (SIAS-6) and the Social Phobia Scale (SPS-6) are helping to solve this problem in parts of Western Europe and the US. Still some countries, like Hungary, lag behind. For this purpose, previous studies call for further evidence on the applicability of the scales in various populations and cultures, as well as the elaborative validity of the short forms. Here, we aimed to provide a thorough analysis of the scales in five studies. We employed item response theory (IRT) to explore the psychometric properties of the SIAS-6 and the SPS-6 in Hungarian adults (n = 3213, age range:19-80) and adolescents (n = 292, age range:14-18).

RESULTS

In both samples, IRT analyses demonstrated that the items of SIAS-6 and SPS-6 had high discriminative power and cover a wide range of the latent trait. Using various subsamples, we showed that (1) the scales had excellent convergent and divergent validity in relation to domains of anxiety, depression, and cognitive emotion regulation in both samples. Further, that (2) the scales discriminated those with a history of fainting or avoidance from those without such history. Lastly, (3) the questionnaires can discriminate people diagnosed with social anxiety disorder (n = 30, age range:13-71) and controls.

CONCLUSIONS

These findings suggest that the questionnaires are suitable for screening for SAD in adults and adolescents. Although the confirmation of the two-factor structure may be indicative of the validity of the "performance only" specifier of SAD in DSM-V, the high correlation between the factors and the similar patter of convergent validity might indicate that it is not a discrete entity but rather a part of SAD; and that SAD is latently continuous.

The Three Teachings of East Asia (TTEA) Inventory: Developing and Validating a Measure of the Interrelated Ideologies of Confucianism, Buddhism, and Taoism

Objectives: Buddhism, Taoism, and Confucianism have influenced societies and shaped cultures as they have spread across the span of history and ultimately across the world. However, to date, the interrelated nature of their impacts has yet to be examined largely due to the lack of a measure that comprehensively assesses their various tenets. Building on a conceptual integration of foundational texts on each ideology as well as on recent measure development work (much of which is unpublished), the current studies developed a comprehensive measure of these ideologies (the Three Teachings of East Asia Inventory; TTEA) and validated it across four languages.

Methods: A combined sample of 2,091 online respondents (Study 1: 322 Chinese respondents, Study 2: 400 Japanese respondents, Study 3: 362 Taiwanese respondents, Study 4: 688 White Americans and 319 Asian Americans) completed 25–35 min online survey in their preferred language: English, Traditional Mandarin, Simplified Mandarin, or Japanese.

Results: Exploratory Factor Analyses within a 122-item pool identified 18 stable dimensions across all samples. Measurement invariance analyses identified the final 61-items of the TTEA inventory (demonstrating reasonable invariance across all languages), confirming 18 individual tenet subscales that organize into four higher-order composites: Buddhism, Taoism, Restrictive Confucianism, and Empowering Confucianism. A shorter 36-item version of the TTEA inventory was also developed. The TTEA scales demonstrated (1) acceptable internal consistency, (2) discriminant validity, and (3) incremental predictive validity for current life satisfaction and vitality.

Conclusions: The TTEA inventory offers one of the first comprehensive, multilingual measures that will allow cross-cultural researchers to examine the influence of three related Eastern ideologies on societies across the world.

A Longitudinal Study on Generalized Anxiety Among University Students During the First Wave of the COVID-19 Pandemic in Switzerland

OBJECTIVE

The COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic.

METHODS

676 students (76% females) at Zurich University of Applied Sciences participated in the first (T0) and second (T1) survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7 (GAD-7). Risk and protective factors (e.g., COVID-19-related variables) were examined.

RESULTS

GAD-7 scores decreased significantly from T0 to T1 (mean change: -0.446, SE = 0.132, 95% CI: -0.706, -0.186, t = -3.371, df = 659, p = 0.001). Participants with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants' concern about their own health, and interaction between time and participants' concern about their own health. Resilience and social support negatively predicted anxiety.

CONCLUSIONS

Our findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency.

Perceptions of the appropriate response to norm violation in 57 societies

Norm enforcement may be important for resolving conflicts and promoting cooperation. However, little is known about how preferred responses to norm violations vary across cultures and across domains. In a preregistered study of 57 countries (using convenience samples of 22,863 students and non-students), we measured perceptions of the appropriateness of various responses to a violation of a cooperative norm and to atypical social behaviors. Our findings highlight both cultural universals and cultural variation. We find a universal negative relation between appropriateness ratings of norm violations and appropriateness ratings of responses in the form of confrontation, social ostracism and gossip. Moreover, we find the country variation in the appropriateness of sanctions to be consistent across different norm violations but not across different sanctions. Specifically, in those countries where use of physical confrontation and social ostracism is rated as less appropriate, gossip is rated as more appropriate.

Little is known about people’s preferred responses to norm violations across countries. Here, in a study of 57 countries, the authors highlight cultural similarities and differences in people’s perception of the appropriateness of norm violations.

Cultural Values Influence Relations Between Parent Emotion Socialization and Adolescents' Neural Responses to Peer Rejection

Adolescents' responses to negative social experiences can be influenced by parenting behaviors. This includes how parents react to their child's expression of emotions, an aspect of parenting referred to as emotion socialization. Emotion socialization may intersect with cultural values, particularly collectivism, a socially-relevant attitude that emphasizes the importance of interpersonal relationships. Examination of a neural measure called the feedback-related negativity (FRN), thought to reflect the degree to which feedback is experienced as aversive, could help elucidate neural contributions to and consequences of the role of collectivism in such family dynamics. Thus, this study examined whether adolescents' endorsement of collectivism moderated the association of parents' dismissive emotion socialization responses (called override responses) and FRN following peer rejection. A community sample of 83 Latinx (n = 32), Asian American (n = 20), and non-Latinx White (n = 31) adolescents ages 13-17 completed a computerized peer feedback task while continuous electroencephalogram was recorded. Their parents completed a battery of self-report questionnaires. Regression analyses demonstrated that adolescents' endorsement of collectivism moderated the association of override responses and FRN following peer rejection, such that FRN was enhanced as override responses increased for adolescents endorsing low and moderate levels of collectivism. Results suggest that there is cultural variation in the association of the emotion socialization strategy of override and adolescents' neural responses to socially-salient events. Findings have implications for parenting interventions designed to enhance adolescents' emotion regulation abilities.

A cross-cultural exploratory analysis of pandemic growth: The case of COVID-19

Although the novel coronavirus that has resulted in more than 3 million deaths and 140 million cases of infection worldwide has wreaked havoc globally, some nations were more successful than others in curbing growth in their number of cases, thereby saving lives. In this research note, we integrate insights from cross-cultural research with inquiry in social psychology and public health literatures to advance a theoretically grounded and culturally derived explanation of cross-national variance in the growth rate of COVID-19. Our multi-level analyses, based on longitudinal time series data from 107 nations, and focused on the first 91 days of this pandemic in different nations, illustrate the direct and interactive effects of culture. Specifically, we find that individualism and uncertainty avoidance have a positive impact, while power distance and masculinity have a negative impact, on the growth rate of COVID-19 cases. Three-way interaction analyses between time, government stringency, and culture indicate that early government stringency attenuated pandemic growth, and this attenuation effect was more significant in collectivistic than in individualistic nations, and in high rather than low power distance nations. Our findings provide evidence that can enable policymakers and organizations to develop strategies that not only conform to science but that also consider the cultural orientation of nations.

Measuring perfectionism, impulsivity, self-esteem and social anxiety: Cross-national study in emerging adults from eight countries

This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed the Multidimensional Perfectionism Scale (MPS), the UPPS-P Impulsive Behavior Scale, the 5-item Rosenberg Self-Esteem Scale (5-item RSES) and the Social Interaction Anxiety Scale (SIAS-6). Multigroup confirmatory factor analysis was run to examine cross-measure equivalence. Evidence for structural invariance was found for all questionnaires, while weak invariance was supported only for the 5-item RSES and the SIAS-6, and a partial weak invariance was found for the MPS and the UPPS-P. No measure achieved strong invariance. Strict invariance was achieved for the 5-item RSES, whereas only a partial strict invariance was supported for the MPS, UPPS-P and SIAS-6. These results suggest that perfectionism, impulsivity, self-esteem, and social anxiety are subjected to linguistic/cultural influence as well as to the effects of socio-demographic variables and can be evaluated by using the selected measures in eight different countries worldwide - but results should be interpreted with caution.

Developmental Trajectories of Shyness-Sensitivity from Middle Childhood to Early Adolescence in China: Contributions of Peer Preference and Mutual Friendship

This study examined trajectories of shyness-sensitivity and the contributions of peer relationships to these trajectories in Chinese children. Participants were 1061 school-age children (537 boys), initially in fifth grade (M_age = 11 years), in China. Longitudinal data on shyness-sensitivity were collected from peer assessments once a year for four years. In addition, peer nomination data on peer acceptance-rejection and mutual friendship were collected in the initial study. Four distinct shyness-sensitivity trajectories were identified: Low-Stable, Low-Increasing, Moderate-Decreasing, and High-Stable. Children with high peer acceptance scores were more likely to be in the High-Stable and Moderate-Decreasing trajectories than in the Low-Stable and Low-Increasing trajectories. The analysis of predictors of the within-trajectory growth rate indicated that children who were more liked by peers increased their shyness-sensitivity more slowly within the Low-Increasing trajectory and that children with mutual friendship involvement decreased their shyness-sensitivity more slowly within the Moderate-Decreasing trajectory. The results suggested that positive relationships might serve to attenuate developmental changes of shyness-sensitivity within these trajectories. The results were discussed in the Chinese context.

The polysemy of psychotropic drugs: continuity and overlap between neuroenhancement, treatment, prevention, pain relief, and pleasure-seeking in a clinical setting

BACKGROUND

Enhancement involves the use of biomedical technologies to improve human capacities beyond therapeutic purposes. It has been well documented that enhancement is sometimes difficult to distinguish from treatment. As a subtype of enhancement, neuroenhancement aims to improve one's cognitive or emotional capacities.

MAIN BODY

This article proposes that the notion of neuroenhancement deserves special attention among enhancements in general, because apart from the notion of treatment, it also overlaps with other concepts such as prevention, pain relief, and pleasure seeking. Regarding prevention, patients' mental endurance can be enhanced when a patient is prescribed a selective serotonin reuptake inhibitor for the purpose of preventing the relapse of depression following a stressful situation. As for pain relief, psychiatrists use medication to alleviate distress in patients who experience various types of anxiety; the alleviation of distress is equal to psychological pain relief, but is also an enhancement of the patient's temperamental traits. Regarding pleasure seeking, insidious transition exists between neuroenhancement and pleasure seeking when using psychotropic drugs. It is well known that people use psychostimulants for recreational purposes and to induce overconfidence in one's performance. The polysemy of psychotropics derives from their effects on human sensibility. Therefore, when using psychotropic agents, psychiatrists should pay close attention to what the agent is used for on each patient in each situation, and explicitly share the continuity and overlap in the purpose of prescribing a medication with the patients to make a better clinical decision.

CONCLUSIONS

The notion of neuroenhancement overlaps not only with the notion of treatment, but also with other concepts of prevention, pain relief, and pleasure seeking. The continuity between those concepts makes the issues concerning the prescription of psychotropic drugs subtler. Psychiatrists should explicitly share the continuity with the patients to make a better clinical decision.

Comorbid Anxiety Increases Suicidal Risk in Bipolar Depression: Analysis of 9720 Adolescent Inpatients

Objective: To evaluate the risk of association between suicidal behaviors and comorbid anxiety disorders in adolescents with bipolar depression. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS) from the United States. This study included 9720 adolescent inpatients with bipolar depression and further grouped by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety after controlling demographic confounders and psychiatric comorbidities. Results: Out of total inpatients, 34.8% (n = 3385) had comorbid anxiety disorders with a predominance in females (70.3%) and White patients (67.7%). About 54.1% of inpatients with comorbid anxiety had suicidal behaviors versus 44.6% in the non-anxiety cohort (p < 0.001). Comorbid anxiety disorders were associated with 1.35 times higher odds (95% CI 1.23–1.47, p < 0.001) for suicidal behaviors. Conclusion: Suicidal behaviors are significantly prevalent in bipolar depression adolescents with comorbid anxiety disorders. Anxiety disorders are an independent risk factor in bipolar depression that increase the risk of suicidal behaviors by 35%. This necessitates careful assessment and management of comorbid anxiety disorders in bipolar youth to mitigate suicidality.