The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Protocol and Registration
2.2. Search Strategy and Study Selection
2.3. Search Results
2.4. Data Extraction
2.5. Study Quality Assessment
2.6. Data Synthesis
3. Results and Discussion
3.1. Summary Descriptions
3.2. Methodological Quality
3.3. Social Anxiety in the General Population Due to the COVID-19 Pandemic
3.4. Social Anxiety in Specific Populations due to the COVID-19 Pandemic
3.4.1. Gender Effects
3.4.2. Financial Stress
3.5. The COVID-19 Pandemic’s Effects on Individuals with SAD
3.6. Risk and Protective Factors Influencing Social Anxiety Levels during the COVID-19 Pandemic
3.6.1. Contracting COVID-19
3.6.2. Socio-Emotional Well-Being and Coping Style
3.6.3. Social Networks and Friendships
3.6.4. Student/Work Mode
3.7. Responses to the COVID-19 Pandemic due to Social Anxiety
3.7.1. Educational Environments
3.7.2. COVID-19 Knowledge
3.7.3. Social Media
3.7.4. COVID-Related Anxiety and Worry
3.7.5. Affiliative Responses
3.7.6. Loneliness and Friendship
3.7.7. Depression, Generalized Anxiety, and Stress during Lockdowns
3.7.8. Mental Health Outcomes during Easing of Restrictions
3.7.9. Influence of Pre-Lockdown Social Anxiety on Self Care during Lockdown
4. Limitations of Existing Research and Directions for Future Research
5. Clinical Implications
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Section and Topic | Item # | Checklist Item | Location Where Item is Reported |
---|---|---|---|
TITLE | |||
Title | 1 | Identify the report as a systematic review. | Page 1 |
ABSTRACT | |||
Abstract | 2 | See the PRISMA 2020 for Abstracts checklist. | Page 1 |
INTRODUCTION | |||
Rationale | 3 | Describe the rationale for the review in the context of existing knowledge. | Pages 1–2 |
Objectives | 4 | Provide an explicit statement of the objective(s) or question(s) the review addresses. | Page 2 |
METHODS | |||
Eligibility criteria | 5 | Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses. | Page 3 |
Information sources | 6 | Specify all databases, registers, websites, organisations, reference lists, and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted. | Page 3 |
Search strategy | 7 | Present the full search strategies for all databases, registers and websites, including any filters and limits used. | Page 3 and Appendix A |
Selection process | 8 | Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and, if applicable, details of automation tools used in the process. | Page 3 |
Data collection process | 9 | Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and, if applicable, details of automation tools used in the process. | Page 4 |
Data items | 10 a | List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g., for all measures, time points, analyses), and if not, the methods used to decide which results to collect. | Appendix C |
10 b | List and define all other variables for which data were sought (e.g., participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information. | Appendix C | |
Study risk of bias assessment | 11 | Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and, if applicable, details of automation tools used in the process. | Page 4 |
Effect measures | 12 | Specify for each outcome the effect measure(s) (e.g., risk ratio, mean difference) used in the synthesis or presentation of results. | Page 4 |
Synthesis methods | 13 a | Describe the processes used to decide which studies were eligible for each synthesis (e.g., tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)). | Not Applicable |
13 b | Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics or data conversions. | Not Applicable | |
13 c | Describe any methods used to tabulate or visually display the results of individual studies and syntheses. | Not Applicable | |
13 d | Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used. | Not Applicable | |
13 e | Describe any methods used to explore possible causes of heterogeneity among study results (e.g., subgroup analysis, meta-regression). | Not Applicable | |
13 f | Describe any sensitivity analyses conducted to assess the robustness of the synthesized results. | Not Applicable | |
Reporting bias assessment | 14 | Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases). | Page 4 |
Certainty assessment | 15 | Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome. | Page 5–19 |
RESULTS | |||
Study selection | 16 a | Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram. | Page 3 |
16 b | Cite studies that might appear to meet the inclusion criteria but which were excluded, and explain why they were excluded. | Not Applicable | |
Study characteristics | 17 | Cite each included study and present its characteristics. | Table 1 |
Risk of bias in studies | 18 | Present assessments of the risk of bias for each included study. | Table 1 |
Results of individual studies | 19 | For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g., confidence/credible interval), ideally using structured tables or plots. | Page 5–19 |
Results of syntheses | 20 a | For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies. | Not Applicable |
20 b | Present results of all statistical syntheses conducted. If meta-analysis was conducted, present for each the summary estimate and its precision (e.g., confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect. | Not Applicable | |
20 c | Present results of all investigations of possible causes of heterogeneity among study results. | Not Applicable | |
20 d | Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results. | Not Applicable | |
Reporting biases | 21 | Present assessments of the risk of bias due to missing results (arising from reporting biases) for each synthesis assessed. | Page 4 |
Certainty of evidence | 22 | Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed. | Page 5–19 |
DISCUSSION | |||
Discussion | 23 a | Provide a general interpretation of the results in the context of other evidence. | Page 5–19 |
23 b | Discuss any limitations of the evidence included in the review. | Page 19–20 | |
23 c | Discuss any limitations of the review processes used. | Page 19–20 | |
23 d | Discuss the implications of the results for practice, policy, and future research. | Page 19–20 | |
OTHER INFORMATION | |||
Registration and protocol | 24 a | Provide registration information for the review, including register name and registration number, or state that the review was not registered. | Page 3 |
24 b | Indicate where the review protocol can be accessed or state that a protocol was not prepared. | Page 3 | |
24 c | Describe and explain any amendments to the information provided at registration or in the protocol. | Not Applicable | |
Support | 25 | Describe sources of financial or non-financial support for the review and the role of the funders or sponsors in the review. | Page 24 |
Competing interests | 26 | Declare any competing interests of review authors. | Page 24 |
Availability of data, code and other materials | 27 | Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review. | Appendix A, Appendix B and Appendix C |
Appendix B
Database | Search String | Hits | Search Date (dd/mm/yyyy) |
---|---|---|---|
EBSCOhost | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (All fields) | 69 | 1 September 2021 |
56 | 1 March 2022 | ||
41 | 1 August 2022 | ||
11 | 1 October 2022 | ||
EMBASE | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (Title/Abstract) | 74 | 1 September 2021 |
27 | 1 March 2022 | ||
49 | 1 August 2022 | ||
23 | 1 October 2022 | ||
Cochrane | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (Title or Abstract or Keyword) | 4 | 1 September 2021 |
63 | 1 March 2022 | ||
0 | 1 August 2022 | ||
2 | 1 October 2022 | ||
Proquest Dissertations and Theses | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (Document title or Abstract) | 8 | 1 September 2021 |
0 | 1 March 2022 | ||
3 | 1 August 2022 | ||
12 | 1 October 2022 | ||
PsycNET | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (Any Field) | 19 | 1 September 2021 |
9 | 1 March 2022 | ||
11 | 1 August 2022 | ||
20 | 1 October 2022 | ||
Scopus | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (Title/Abstract/Keywords) | 96 | 1 September 2021 |
33 | 1 March 2022 | ||
68 | 1 August 2022 | ||
19 | 1 October 2022 | ||
Web of Science | (“Social Anxiety” OR “Social phob*”) AND (“COVID*” OR “Coronavirus” OR “Pandemic” OR “Lockdown”) (Topic) | 53 | 1 September 2021 |
46 | 1 March 2022 | ||
31 | 1 August 2022 | ||
13 | 1 October 2022 |
Appendix C
PICO Elements | Description |
---|---|
Aim 1: The incidence of social anxiety within the general population because of the COVID-19 pandemic. | |
Population/Condition | All individuals affected by the COVID-19 pandemic |
Interventions | Onset of the COVID-19 pandemic |
Comparator | Not applicable to the general population.Subpopulations include adults vs. children/adolescents, Socio-Economic Status, men vs. women, gender diverse vs. gender conforming) |
Outcomes of interest | Social anxiety measures |
Type of studies | Longitudinal studies, naturalistic observation studies, retrospective studies, prognostic studies, prevalence studies, repeated cross-sectional studies |
Aim 2: How COVID-19 has affected individuals with a clinical diagnosis of Social Anxiety Disorder | |
Population/Condition | Individuals with a diagnosis of Social Anxiety Disorder or who self-identify as having Social Anxiety Disorder |
Interventions | Onset of the COVID-19 pandemic |
Comparator | Comparators may include Individuals with no diagnosis of Social Anxiety Disorder |
Outcomes of interest | All patient-oriented mental health outcomes |
Type of studies | Comparative studies, longitudinal studies, naturalistic observation studies, retrospective studies, repeated cross-sectional studies, prognostic studies |
Aim 3: Risk and protective factors that may have influenced levels of social anxiety in the context of the COVID-19 pandemic | |
Population/Condition | All individuals affected by the COVID-19 pandemic |
Interventions | Onset of the COVID-19 pandemic |
Comparator | Individuals with differential scores on outcomes related to risk and protective factors |
Outcomes of interest | Social anxiety measures |
Type of studies | All study designs |
Aim 4: How social anxiety has influenced affective, behavioural, and cognitive responses to the COVID-19 environment. | |
Population/Condition | Individuals experiencing social anxiety during the pandemic |
Interventions | Not Applicable |
Comparator | Individuals with differential scores on social anxiety |
Outcomes of interest | All patient-oriented mental health outcomes |
Type of studies | All study designs |
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Study | Country | Sample Size | Sample Characteristics (SD in Parentheses) | Population Type | Design and Date of Data Collection (dd/mm/yyyy) | Relevant Measures | Qualsyst Score |
---|---|---|---|---|---|---|---|
Arad et al. [44] | Israel | n = 99 | Mean age (treatment): 22.62 (2.36) Mean age (control): 21.57 (1.90) Gender: 85% female | University students (>50 LSAS) | Natural experiment T1: September 2019 to December 2019 T2: January 2020 to April 2020 | LSAS-SR, PHQ-9 | 0.95 (strong) |
Bendau et al. [45] | Germany | n = 307 | Mean age: 39.64 (11.7) Gender: 71.2% female | Clinical (self-diagnosed) | Longitudinal T1: 27 March 2020 to 6 April 2020 T2: 24 April 2020 to 4 May 2020 T3: 15 May 2020 to 25 May 2020 T4: 5 June 2020 to 15 June 2020 | C-19-A, PHQ-4 | 0.95 (strong) |
Blasco-Belled et al. [46] | Spain | n = 541 | Mean age: 38.82 (15.97) Gender: 65.8% female | Community | Cross-sectional Data collected from 12 March 2020 to 15 March 2020 | LSAS-SR, PWI, SPANE | 0.91 (strong) |
Buckner et al. [47] | USA | n = 120 | Mean age: 19.8 (1.6) Gender: unspecified | Community | Longitudinal T1: 16 February 2020 to 13 March 2020 T2: 13 April 2020 to 15 May 2020 | DASS-21, SIAS, Worry Index | 0.91 (strong) |
Carlton et al. [48] | USA | n = 84 | Mean age: 19.5 (1.47) Gender: 73.8% female | Clinical | Repeated cross-sectional T1: January 2021 to March 2021 T2: 1 month after T1 | ADIS-5, DASS-21, FIVE, RSQ, SAFE | 0.82 (strong) |
Charmaraman et al. [49] | USA | n = 586 | Mean age: 12.53 (1.18) Gender: 53% female | Community | Longitudinal T1: September 2019 to November 2019 T2: October 2020 to December 2020 | CESDR-10, COVID-19-Related Grief Scale, PRIUSS, SAS-A | 0.95 (strong) |
Czorniej et al. [50] | Poland | n = 255 | Mean age: 24.30 (1.69) Gender: 53.7% female | Healthcare Students | Cross-sectional Data collected from May 2021 to May 2022 | LSAS, STAI | 0.85 (strong) |
Eskiyurt & Akaca [51] | Turkey | n = 670 | Mean age: 20.77 (2.77) Gender: 82% female | Community | Cross-sectional Data collected from February 2020 to February 2021 | B-FNE, LSAS | 0.91 (strong) |
Falco et al. [52] | Spain | n = 439 | Mean age: 36.64 (13.37) Gender: 73.1% female | University Community | Cross-sectional Data collected from March 2020 to May 2020 | ESTAD Anxiety and depression disorders symptoms scale, F-COVID-19, Impact of event scale-revised | 0.86 (strong) |
Fawwaz et al. [53] | Malaysia | n = 158 | Mean age: 21.77 (1.54) Gender: 56.3% female | Community | Cross-sectional Data collected from January 2021 to February 2021 | MTOQ, UMS, SPIN | 0.73 (good) |
Hawes et al. [54] | USA | n = 451 | Mean age: 17.49 (1.42) Gender: 65.4% female | Community | Longitudinal T1: Pre-pandemic (unspecified) T2: 27 March 2020 to 15 May 2020 | CDI, SCARED | 0.91 (strong) |
Ho & Moscovitch [55] | USA | n = 488 | Median age: 25–39 (N/A) Gender: 48% female | Community | Cross-sectional Data collected from May 2020 | BFNE, CAS, CSS, SDSa, SIAS, TILS | 0.86 (strong) |
Huang et al. [56] | China | n = 501 | Mean age: 24.31 (7.83) Gender: 63.9% female | Community | Cross-sectional Data collected from March 2020 | IPCS, LSAS-SR | 0.91 (strong) |
Itani et al. [57] | Lebanon | n = 178 | Median age: 16 years old Gender: 59.0% female | Community | Cross-sectional Data collected from August 2020 to September 2020 | LSAS-CA | 0.73 (good) |
Ju et al. [58] | China | n = 199 | Mean age: 42.72 (17.53) Gender: 53.3% female | Discharged COVID-19 patients | Cross-sectional Data collected from July 2020 to September 2020 | Self-Stigma Scale, Self- consciousness Scale | 0.77 (good) |
Juvonen et al. [59] | USA | n = 1557 | Mean age: 22.5 (0.75) Gender: 62% female | Community | Longitudinal T1: Pre-pandemic (2017–2019) T2: March 2021 to June 2021 | CES-D, GAD-7, SAS-A | 0.95 (strong) |
Krämer et al. [60] | Germany | n = 190 | Mean age: 44.2 (14.18) Gender: 47% female | Community | Longitudinal T1: 6 April 2020 T2: 29 April 2020 T3: 20 May 2020 T4: 10 June 2020 | BFI-2, PHQ-4, SIAS-6, SOEP, Unified Motive Scale | 0.91 (strong) |
Langhammer et al. [61] | Germany | n = 47 | Mean age: 37.3 (10.78) Gender: 60% female | Clinical outpatient | Cross-sectional Data collected from July 2020 | BDI-II, HAMA-A, PAS, PHQ-9, SMSP | 0.82 (strong) |
Li [62] | China | n = 600 | Median age: 20 (N/A) Gender: 46% female | Community | Cross-sectional Data collected from March 2020 | SIAS | 0.68 (adequate) |
Liang et al. [63] | China | n = 3137 | Mean age: N/A Gender: 78.58% female | University students | Cross-sectional Data collected from February 2020 | SAD, SAS, SDSb | 0.82 (strong) |
Lim et al. [64] | Australia | n = 1562 | Mean age = 48.8 Gender: 84.2% female | Community | Longitudinal T1: March 2020 T2: 6–8 weeks after T1 T3: 6–8 weeks after T2 | Mini-SPIN, PHQ-8, UCLA Loneliness Scale | 1.0 (strong) |
Ma [65] | USA | n = 23 | Mean age: 21.3 (N/A) Gender: 78.3% female | Community | Cross-sectional Data collected from September 2020 to December 2020 | CD-RISC-10, GAD-7, SM-SAD | 0.41 (limited) |
McLeish et al. [66] | USA | n = 934 | Mean age: 20.4 (3.59) Gender: 72.4% female | University students | Repeated cross-sectional T1: March 2020 to May 2020 T2: September 2020 to December 2020 T3: January 2021 to April 20201 | OASIS, ODSIS, PSWQ-3, SIAS-6, SPS-6, SSASI | 0.73 (good) |
Morales et al. [67] | USA | n = 164 | Mean age: 16.16 (0.61) Gender: N/A | Community | Longitudinal T1: March 2017 to August 2019 T2: April 2020 to May 2020 T3: June 2020 to July 2020 T4: August 2020 to September 2020 | SCARED, CASPE, GAD-7, K-SADS, PSS-10 | 0.95 (strong) |
Moran et al. [68] | USA | n = 32 | Mean age: 27.9 (4.52) Gender: 90.6% female | Domestic Violence Survivors | Cross-sectional Data collected from January 2021 to March 2021 | ABI, IDAS, MAC-RF, MSPSS | 0.65 (adequate) |
Pang [69] | China | n = 566 | Median age: 21–23 (N/A) Gender: 58.8% female | Community | Cross-sectional Data collected from April 2020 | 0.82 (strong) | |
Quittkat et al. [70] | Germany | n = 86 | Mean age: 33.41 (11.45) Gender: 73% female | Clinical (self-diagnosed) | Cross-sectional Data collected from 2 April 2020 to 6 May 2020 | PHQ-9, SIAS, SPS | 0.95 (strong) |
Samantaray et al. [71] | India | n = 65 | Mean age: 21.77 (2.67) Gender 53.8% female | Clinical | Cross-sectional Data collection unspecified. | F-COVID-19, SPIN | 0.83 (strong) |
Tekin [72] | Turkey | n = 118 | Mean age: 13.2 (2.1) Gender 65% female | Community | Cross-sectional Data collected from March 2021 to April 2021 | ARI-P, RCADS-P, PedsQL, Turgay-DSM-IV-S | 0.77 (good) |
Terin et al. [73] | Turkey | n = 199 | Mean age: 14.48 (2.15) Gender: 74.6% female | Hospital patients | Cross-sectional Data collected from October 2021 to January 2022 | CAS, CASI, RCADS-CV | 0.91 (strong) |
Thompson et al. [42] | USA | n = 204 | Mean age: 30.4 (11.2) Gender: 83.2% female | Community | Cross-sectional Data collected from September 2020 | LSNS-6, SPS, UCLA Loneliness scale | 0.55 (adequate) |
Yurteri & Sarigedik [74] | Turkey | n = 60 | Mean age: 10.22 (N/A) Gender: 46.7% female | Community | Longitudinal T1: Pre-pandemic (unspecified) T2: Post-Pandemic (unspecified) | CDI, SCARED | 0.86 (strong) |
Zhu et al. [43] | China | n = 1393 | Mean age: 13.04 (0.86) Gender 53.1% female | Community | Longitudinal T1: September 2019 T2: June 2020 | GAD-7, PHQ-9, MSPSS, MDASS, SAS, SCS, STAI, SWLS | 0.95 (strong) |
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Kindred, R.; Bates, G.W. The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review. Int. J. Environ. Res. Public Health 2023, 20, 2362. https://doi.org/10.3390/ijerph20032362
Kindred R, Bates GW. The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review. International Journal of Environmental Research and Public Health. 2023; 20(3):2362. https://doi.org/10.3390/ijerph20032362
Chicago/Turabian StyleKindred, Reuben, and Glen W. Bates. 2023. "The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review" International Journal of Environmental Research and Public Health 20, no. 3: 2362. https://doi.org/10.3390/ijerph20032362