PLOS ONE

RESEARCH ARTICLE

Social anxiety in young people: A prevalence

study in seven countries
Philip Jefferies ID*, Michael Ungar
Resilience Research Centre, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada

* [email protected]

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Abstract
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Social anxiety is a fast-growing phenomenon which is thought to disproportionately affect
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a1111111111 young people. In this study, we explore the prevalence of social anxiety around the world
a1111111111 using a self-report survey of 6,825 individuals (male = 3,342, female = 3,428, other = 55),
aged 16–29 years (M = 22.84, SD = 3.97), from seven countries selected for their cultural
and economic diversity: Brazil, China, Indonesia, Russia, Thailand, US, and Vietnam. The
respondents completed the Social Interaction Anxiety Scale (SIAS). The global prevalence
OPEN ACCESS of social anxiety was found to be significantly higher than previously reported, with more
than 1 in 3 (36%) respondents meeting the threshold criteria for having Social Anxiety Disor-
Citation: Jefferies P, Ungar M (2020) Social
anxiety in young people: A prevalence study in der (SAD). Prevalence and severity of social anxiety symptoms did not differ between sexes
seven countries. PLoS ONE 15(9): e0239133. but varied as a function of age, country, work status, level of education, and whether an indi-
https://doi.org/10.1371/journal.pone.0239133 vidual lived in an urban or rural location. Additionally, 1 in 6 (18%) perceived themselves as
Editor: Sarah Hope Lincoln, Harvard University, not having social anxiety, yet still met or exceeded the threshold for SAD. The data indicate
UNITED STATES that social anxiety is a concern for young adults around the world, many of whom do not
Received: March 11, 2020 recognise the difficulties they may experience. A large number of young people may be
Accepted: August 31, 2020 experiencing substantial disruptions in functioning and well-being which may be ameliorable
with appropriate education and intervention.
Published: September 17, 2020

Peer Review History: PLOS recognizes the

benefits of transparency in the peer review
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editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0239133 Social anxiety occurs when individuals fear social situations in which they anticipate negative
evaluations by others or perceive that their presence will make others feel uncomfortable [1].
Copyright: © 2020 Jefferies, Ungar. This is an open
From an evolutionary perspective, at appropriate levels social anxiety is adaptive, prompting
access article distributed under the terms of the
Creative Commons Attribution License, which greater attention to our presentation and reflection on our behaviours. This sensitivity ensures
permits unrestricted use, distribution, and we adjust to those around us to maintain or improve social desirability and avoid ostracism
reproduction in any medium, provided the original [2]. However, when out of proportion to threats posed by a normative social situation (e.g.,
author and source are credited. interactions with a peer group at school or in the workplace) and when impairing functioning
Data Availability Statement: All data files are to a significant degree, it may be classified as a disorder (SAD; formerly ‘social phobia’; [3]).
available from the Open Science Framework The hallmark of social anxiety in western contexts is an extreme and persistent fear of embar-
repository (DOI: 10.17605/OSF.IO/VCNF7). rassment and humiliation [1, 4, 5]. Elsewhere, notably in Asian cultures, social anxiety may
Funding: The author(s) received no specific also manifest as embarrassment of others, such as Taijin kyofusho in Japan and Korea [6].
funding for this work. Common concerns involved in social anxiety include fears of shaking, blushing, sweating,

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Competing interests: I have read the journal’s appearing anxious, boring, or incompetent [7]. Individuals experiencing social anxiety visibly
policy and the authors of this manuscript have the struggle with social situations. They show fewer facial expressions, avert their gaze more often,
following competing interests: Unilever funds the
and express greater difficulty initiating and maintaining conversations, compared to individu-
lead author’s research fellowship at Dalhousie
University’s Resilience Research Centre, though in als without social anxiety [8]. Recognising difficulties can lead to dread of everyday activities
no way have they directed this research, its such as meeting new people or speaking on the phone. In turn, this can lead to individuals
analysis or the reporting or results. reducing their interactions or shying away from engaging with others altogether.
The impact of social anxiety is widespread, affecting functioning in various domains of life
and lowering general mood and wellbeing [9]. For instance, individuals experiencing social
anxiety are more likely to be victims of bullying [10, 11] and are at greater risk of leaving
school early and with poorer qualifications [11, 12]. They also tend to have fewer friends [13],
are less likely to marry, more likely to divorce, and less likely to have children [14]. In the
workplace, they report more days absent from work and poorer performance [15].
A lifetime prevalence of SAD of up to 12% has been reported in the US [16], and 12-month
prevalence rates of .8% have been reported across Europe [17] and .2% in China [18]. How-
ever, there is an increasing trend to consider a spectrum of social anxiety which takes account
of those experiencing subthreshold or subclinical social anxiety, as those experiencing more
moderate levels of social anxiety also experience significant impairment across different
domains of functioning [19–21]. Therefore, the proportion of individuals significantly affected
by social anxiety, which include a substantial proportion of individuals with undiagnosed SAD
[8], may be higher than current estimates suggest.
Studies also indicate younger individuals are disproportionately affected by social anxiety,
with prevalence rates at around 10% by the end of adolescence [22–24], with 90% of cases
occurring by age 23 [16]. Higher rates of social anxiety have also been observed in females and
are associated with being unemployed [25, 26], having lower educational status [27], and living
in rural areas [28, 29]. Leigh and Clark [30] have explored the higher incidence of social anxi-
ety in younger individuals, suggesting that moving from a reliance on the family unit to peer
interactions and the development of neurocognitive abilities including public self-conscious-
ness may present a period of greater vulnerability to social anxiety. While most going through
this developmentally sensitive period are expected to experience a brief increase in social fears
[31], Leigh and Clark suggest that some who may be more behaviourally inhibited by tempera-
ment are at greater risk of developing and maintaining social anxiety.
Recent accounts suggest that levels of social anxiety may be rising. Studies have indicated
that greater social media usage, increased digital connectivity and visibility, and more options
for non-face-to-face communication are associated with higher levels of social anxiety [32–
35]. The mechanism underpinning these associations remains unclear, though studies have
suggested individuals with social anxiety favour the relative ‘safety’ of online interactions [32,
36]. However, some have suggested that such distanced interactions such as via social media
may displace some face to face relationships, as individuals experience greater control and
enjoyment online, in turn disrupting social cohesion and leading to social isolation [37, 38].
For young people, at a time when the development of social relations is critical, the perceived
safety of social interactions that take place at a distance may lead some to a spiral of with-
drawal, where the prospect of normal social interactions becomes ever more challenging.
Therefore, in this study, we sought to determine the current prevalence of social anxiety in
young people from different countries around the world, in order to clarify whether rates of
social anxiety are increasing. Specifically, we used self-report measures (rather than medical
records) to discover both the frequency of the disorder, severity of symptoms, and to examine
whether differences exist between sexes and other demographic factors associated with differ-
ences in social anxiety.

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Materials and methods

Design
This study is a secondary analysis of a dataset that was created by Edelman Intelligence for a
market research campaign exploring lifestyles and the use of hair care products that was
commissioned by Clear and Unilever. The original project to collect the data took place in
November 2019, where participants were invited to complete a 20-minute online question-
naire containing measures of social anxiety, resilience, social media usage, and questions
related to functioning across various life domains. Participants were randomly recruited
through the market research companies Dynata, Online Market Intelligence (OMI), and
GMO Research, who hold nationally representative research panels. All three companies are
affiliated with market research bodies that set standards for ethical practice. Dynata adheres to
the Market Research Society code of conduct; OMI and GMO adhere to the ESOMAR market
research code of conduct. The secondary analyses of the dataset were approved by Dalhousie
University’s Research Ethics Board.

Participants
There were 6,825 participants involved in the study (male = 3,342, female = 3,428, other = 55),
aged 16–29 years (M = 22.84, SD = 3.97), from seven countries selected for their social and
economic diversity (Brazil, China, Indonesia, Russia, Thailand, US, and Vietnam) (see Table 1
for full sample characteristics). Participant ages were collected in years, but some individuals
aged 16–17 were recruited through their parents and their exact age was not given. They were
assigned an age of 16.5 years in order to derive the mean age and standard deviation for the
full sample.

Procedure
Email invitations to participate were sent to 23,346 young people aged 16–29, of whom 76%
(n = 17,817) were recruited to take the survey. These were panel members who had previously
registered and given their consent to participate in surveys. Sixty-five percent of respondents
were ineligible, with 10,816 excluded because they or their close friends worked in advertising,
market research, public relations, journalism or the media, or for a manufacturer or retailer of
haircare products. A further 176 respondents were excluded for straight-lining (selecting the
same response to every item of the social anxiety measure, indicating they were not properly
engaged with the survey; [39]). The final sample comprised 6,825 participants and matched

Table 1. Sample characteristics.

Male Female Other a Total
Brazil 479 491 7 977
China 486 500 6 992
Indonesia 494 457 8 959
Russia 475 500 8 983
Thailand 469 487 12 968
US 452 500 10 962
Vietnam 487 493 4 984
Total 3,342 3,428 55 6,825
a
“Other” includes individuals who selected non-binary (n = 17), prefer to self-describe (n = 7), and prefer not to say
(n = 31).

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

quotas for sex, region, and age, to achieve a sample with demographics representative of each
country.
Participants were compensated for their time using a points-based incentive system, where
points earned at the end of the survey could be redeemed for gift cards, vouchers, donations to
charities, and other products or services.

Measures
The survey included the 20-item self-report Social Interaction Anxiety Scale (SIAS; [40]).
Based on the DSM, the SIAS was originally developed in conjunction with the Social Phobia
Scale to determine individuals’ levels of social anxiety and how those with SAD respond to
treatment. Both the SIAS and Social Phobia Scale correlate strongly with each other [40–43],
but while the latter was developed to assess fears of being observed or scrutinised by others,
the SIAS was developed more specifically to assess fears and anxiety related to social interac-
tions with others (e.g., meeting with others, initiating and maintaining conversations). The
SIAS discriminates between clinical and non-clinical populations [40, 44, 45] and has also
been found to differentiate between those with social anxiety and those with general anxiety
[46], making it a useful clinical screening tool. Although originally developed in Australia, it
has been tested and found to work well in diverse cultures worldwide [47–50], and has strong
psychometric properties in clinical and non-clinical samples [40, 42, 43, 45–47].
For the current study, all 20 items of the SIAS were included in the survey, though we omit-
ted the three positively-worded items from analyses, as studies have demonstrated that includ-
ing them results in weaker than expected relationships between the SIAS and other measures,
that they hamper the psychometric properties of the measure, and that the SIAS performs bet-
ter without them [e.g., 51–53] (the omitted items were ‘I find it easy to make friends my own
age’, ‘I am at ease meeting people at parties, etc’, and ‘I find it easy to think of things to talk
about’.). One item of the SIAS was also modified prior to use: ‘I have difficulty talking to attrac-
tive persons of the opposite sex’ was altered to ‘I have difficulty talking to people I am attracted
to’, to make it more applicable to individuals who do not identify as heterosexual, given that
the original item was meant to measure difficulty talking to an attractive potential partner
[54].
The questionnaire also included measures of resilience, in addition to other questions con-
cerning functioning in daily life. These were included as part of a corporate social responsibil-
ity strategy to investigate the rates of social anxiety and resilience in each target market. A
translation agency (Language Connect) translated the full survey into the national languages of
the participants.

Analyses
We analysed social anxiety scores for the overall sample, as well as by country, sex, and age (for
sex, given the limited number and heterogeneity of individuals grouped into the ‘other’ cate-
gory, we only compared males and females). As social anxiety is linked to work status [25], we
also examined differences in SIAS scores between those working and those who were unem-
ployed. Urban/rural differences were also investigated as previous research has suggested anxi-
ety disorders may differ depending on where an individual lives [28]. Education level [27], too,
was included using completion of secondary education (ISCED level 3) in a subgroup of par-
ticipants aged 20 years and above to ensure all were above mandatory ages for completing high
school. Descriptive statistics are reported for each group with significant differences explored
using ANOVA (with Tukey post-hoc tests) or t-tests.

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

The SIAS is said to be unidimensional when using just the 17 straightforwardly-worded

items [52], with item scores summed to give general social anxiety scores. Higher scores indi-
cate greater levels of social anxiety. Heimberg and colleagues [42] have suggested a cut-off of
34 on the 20-item SIAS to denote a clinical level of social anxiety (SAD). This level has been
adopted in other studies [e.g., 45] and found to accurately discriminate between clinical and
non-clinical participants [53]. This threshold for SAD scales to 28.9 when just the 17 items are
used, and this is slightly more conservative than others who have used 28 as an adjusted
17-item threshold [53, 55]. Therefore, in addition to analyses of raw scores to gauge the sever-
ity of social anxiety (and reflect consideration of social anxiety as a spectrum), we also report
the proportion of individuals meeting or exceeding this threshold for SAD (�29) and analyse
differences between groups using chi-square tests.
Additionally, despite the unidimensionality of the SIAS, the individual items can be inter-
preted as examples of contexts where social anxiety may be more or less acutely experienced
(e.g., social situations with authority: ‘I get nervous if I have to speak with someone in authority’,
social situations with strangers: ‘I am nervous mixing with people I don’t know well’). Therefore,
as social anxiety may be experienced differently depending on culture [6], we also sorted the
items in the measure to understand the top and least concerning contexts for each country.
Finally, we also sought to understand whether individuals perceived themselves as having
social anxiety. After completing the SIAS, participants were presented with a definition of
social anxiety and asked to reflect on whether they thought this was what they experienced.
We contrasted responses with a SIAS threshold analysis to determine discrepancies, including
assessment of the proportion of false positives (those who thought they had social anxiety but
did not exceed the threshold) and false negatives (those who thought they did not have social
anxiety but exceeded the threshold).
All analyses were conducted using SPSS v25 [56].

Results
As the survey required a response for each item, there were no missing data. The internal reli-
ability of the SIAS was found to be strong (α = .94), with the removal of any item resulting in a
reduction in consistency.

Social anxiety by sex, age, and country

In the overall sample, the distribution of social anxiety scores formed an approximately normal
distribution with a slightly positive skew, indicating that most respondents scored lower than
the midpoint on the measure (Fig 1). However, more than one in three (36%) were found to
score above the threshold for SAD. There were no significant differences in social anxiety
scores between male and female participants (t(6768) = -1.37, n.s.) and the proportion of
males and females scoring above the SAD threshold did not significantly differ either
(χ2(1,6770) = .54, n.s.).
Social anxiety scores significantly differed between countries (F(6,6818) = 74.85, p < .001,
ηp2 = .062). Indonesia had the lowest average scores (M = 18.94, SD = 13.21) and the US had
the highest (M = 30.35, SD = 15.44). Post-hoc tests revealed significant differences (ps�.001)
between each of the countries, except between Brazil and Thailand, between China and Viet-
nam, between Russia and China, and between Russia and Indonesia (see Table 2). The propor-
tion of individuals exceeding the threshold for SAD was also found to significantly differ
between the seven countries (χ2(6,6825) = 347.57, p < .001). Like symptom severity, the US
had the highest prevalence with more than half of participants surveyed exceeding the thresh-
old (57.6%), while Indonesia had the lowest, with fewer than one in four (22.9%).

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Fig 1. Frequency of social anxiety scores (full sample).

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A significant age difference was also observed (F(2,6822) = 39.74, p < .001, ηp2 = .012),
where 18-24-year-olds scored significantly higher (M = 25.33, SD = 13.98) than both 16-
17-year-olds (M = 21.92, SD = 14.24) and 25-29-year-olds (M = 22.44, SD = 14.22). Also, 25-
29-year-olds scored significantly higher than 18-24-year-olds (ps < .001). The proportion of
individuals scoring above the threshold for SAD also significantly differed between age groups
(χ2(2,6825) = 48.62, p < .001) (Fig 2).
A three-way ANOVA confirmed significant main effect differences in social anxiety scores
between age groups (F(2,6728) = 38.93, p < .001, ηp2 = .011) and countries (F(6,6728) = 45.37,
p < .001, ηp2 = .039), as well as the non-significant difference between males and females
(F(1,6728) = .493, n.s.). However, of the interactions between sex, age, and country, the two-
way country� age interaction was significant (F(12,6728) = 1.89, p = .031, ηp2 = .003), where 16-
17-year-olds in Indonesia were found to have the lowest scores (M = 15.70, SD = 13.46) and
25-29-year-olds in the US had the highest (M = 30.47, SD = 16.17) (Fig 3). There was also a sig-
nificant country� sex interaction (F(6,6728) = 2.25, p = .036, ηp2 = .002), where female partici-
pants in Indonesia had the lowest scores (M = 18.07, SD = 13.18) and female participants in
the US had the highest (M = 30.37, SD = 15.11) (Fig 4).

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Table 2. Social anxiety scores.

SCORES SCORE DIFFERENCE BETWEEN PROPORTION WITH SAD PROPORTION DIFFERENCE BETWEEN
M SD GROUPS (T / F, P) (SIAS�29) (%) GROUPS (Χ2, P)
Overall sample 23.82 14.18 36.2
Sex -1.37, n.s. .54, n.s.
Male 23.53 14.12 35.6
Female 24.00 14.18 36.5
Country 74.85, < .001 347.57, < .001
Brazil 26.18 15.23 42.4
China 22.30 13.52 32.1
Indonesia 18.94 13.21 22.9
Russia 20.78 12.79 27.0
Thailand 25.57 13.92 41.4
US 30.35 15.44 57.6
Vietnam 22.68 11.77 30.7
Age 39.74, < .001 48.62, < .001
16–17 21.92 14.24 30.8
18–24 25.33 13.98 40.3
25–29 22.44 14.22 32.8
Work 9.48, < .001 7.55, .023
Employed 23.28 14.32 35.3
Studying 23.96 13.50 36.5
Unemployed 26.27 14.54 41.7
Urban/rural 9.95, < .001 35.84, < .001
Central urban 22.70 14.67 33.0
Urban area 23.62 13.77 35.3
Suburban 25.64 14.08 42.4
Semi-rural 24.53 13.74 37.9
Rural 25.37 13.91 41.9
Education 5.51, < .001 38.75, < .001
L3 unfinished 27.94 15.07 52.0
L3 finished 23.40 14.15 34.8

M = mean, SD = standard deviation, t = t-test, F = ANOVA, χ2 = chi-square, p = significance, L3 = ISCED level 3 (secondary education), SAD = Social Anxiety
Disorder.

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Work status
Social anxiety scores were also found to significantly differ in terms of work status (employed/
studying/unemployed; F(2,6030) = 9.48, p < .001, ηp2 = .003), with those in employment hav-
ing the lowest scores (M = 23.28, SD = 14.32), followed by individuals who were studying
(M = 23.96, SD = 13.50). Those who were unemployed had the highest scores (M = 26.27,
SD = 14.54). Post-hoc tests indicated there were significant differences between those who
were employed and unemployed (p < .001), between those studying and unemployed (p =
.006), but not between those employed and those who were studying. The difference between
those exceeding the SAD threshold between groups was also significant (χ2(2,6033) = 7.55, p =
.023).

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Fig 2. Proportion of individuals meeting the threshold for Social Anxiety Disorder by age group and country.
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Urban/Rural
Social anxiety scores also significantly varied depending on an individual’s place of residence
(F(4,6820) = 9.95, p < .001, ηp2 = .006). However, this was not a linear relationship from urban

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Fig 3. Levels of social anxiety by country and age.

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to rural extremes (Fig 5); instead, those living in suburban areas had the highest scores
(M = 25.64, SD = 14.08) and those in central urban areas had the lowest (M = 22.70,
SD = 14.67). This pattern was reflected in the proportions of individuals exceeding the SAD
threshold (χ2(4,6825) = 35.84, p < .001).

Education level
In the subsample of individuals aged 20 or above, level of education also resulted in a signifi-
cant differences in social anxiety scores (t(5071) = 5.51, p < .001), with individuals who com-
pleted secondary education presenting lower scores (M = 23.40, SD = 14.15) than those who
had not completed secondary education (M = 27.94, SD = 15.07). Those exceeding the thresh-
old for SAD also significantly differed (χ2(1,5073) = 38.75, p < .001), with half of those who
had not finished secondary education exceeding the cut-off (52%), compared to just over a
third of those who had (35%).

Concerns by context
Table 3 illustrates the items of the SIAS sorted by severity for each country. For East-Asian
countries, speaking with someone in authority was a top concern, but less so for Brazil, Russia,
and the US. Patterns became less discernible between countries beyond this top concern, indi-
cating heterogeneity in the specific situations related to social anxiety, although individuals in
most countries appeared to be least challenged by mixing with co-workers and chance encoun-
ters with acquaintances.

Self-perceptions of social anxiety

Just over a third of the sample perceived themselves to experience social anxiety (34%).
Although this was similar to the proportion of individuals who exceeded the threshold for

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Fig 4. Levels of social anxiety by country and sex.

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SAD (36%), perceptions significantly differed from threshold results (χ2(1,6825) = 468.80, p <
.001). Just fewer than half of the sample (48%) perceived themselves as not being socially anx-
ious and were also below the threshold, and a fifth (18%) perceived themselves as being socially
anxious and exceeded the threshold (Fig 6). However, 16% perceived themselves to be socially
anxious yet did not exceed the threshold (false positives) and 18% perceived themselves not to
be socially anxious yet exceeded the threshold (false negatives). This suggests a large propor-
tion of individuals do not properly recognise their level of social anxiety (over a third of the
sample), and perhaps most importantly, that more than 1 in 6 may experience SAD yet not
recognise it (Table 4).

Discussion
This study provides an estimate of the prevalence of social anxiety among young people from
seven countries around the world. We found that levels of social anxiety were significantly
higher than those previously reported, including studies using the 17-item version of the SIAS
[e.g., 55, 57, 58]. Furthermore, our findings show that over a third of participants met the
threshold for SAD (23–58% across the different countries). This far exceeds the highest of fig-
ures previously reported, such as Kessler and colleague’s [16] lifetime prevalence rate of 12%
in the US.
As this study specifically focuses on social anxiety in young people, it may be that the inclu-
sion of older participants in other studies leads to lower average levels of social anxiety [27,
59]. In contrast, our findings show significantly higher rates of SAD than anticipated, and

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Fig 5. Level of social anxiety by place of living.

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Table 3. Concerns by country.

Item BR CN ID RU TH US VN Overall
1 I get nervous if I have to speak with someone in authority (teacher, boss, etc.) 5 1 1 4 1 5 3 1
2 I have difficulty making eye contact with others 11 11 10 9 14 12 12 12
3 I become tense if I have to talk about myself or my feelings 1 8 5 1 8 2 5 4
4 I find it difficult to mix comfortably with the people I work with 16 17 15 17 13 16 16 16
5 I tense up if I meet an acquaintance in the street 17 15 13 16 17 15 17 17
6 When mixing socially, I am uncomfortable 13 10 16 12 10 8 15 14
7 I feel tense if I am alone with just one other person 12 9 9 15 5 14 9 11
8 I have difficulty talking with other people 14 16 17 14 16 13 14 15
9 I worry about expressing myself in case I appear awkward 6 4 2 2 6 3 1 3
10 I find it difficult to disagree with another’s point of view 15 12 11 13 7 17 6 13
11 I have difficulty talking to people I am attracted to 3 13 4 8 4 6 8 7
12 I find myself worrying that I won’t know what to say in social situations 4 3 8 7 3 4 4 5
13 I am nervous mixing with people I don’t know well 2 5 3 6 2 1 2 2
14 I feel I’ll say something embarrassing when talking 7 14 14 3 15 7 7 10
15 When mixing in a group, I find myself worrying I will be ignored 8 7 7 10 11 11 11 8
16 I am tense mixing in a group 10 6 12 11 12 9 13 9
17 I am unsure whether to greet someone I know only slightly 9 2 6 5 9 10 10 6

Dark shaded cells indicate the top three concerns (1–3); lightly shaded cells indicate the least three concerns (15–17); BR = Brazil; CN = China; ID = Indonesia;
RU = Russia; TH = Thailand; US = United States; VN = Vietnam.

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

Fig 6. Perceptions of social anxiety vs. classification.

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particularly so for individuals aged 18–24. It also extends the argument of authors such as
Lecrubier and colleagues [60] and Leigh and Clark [30] that developmental challenges during
adolescence may provoke social anxiety, especially the crucial later period when leaving school
and becoming more independent.

Table 4. Classification of social anxiety scores.

Self-perceived as non-SA Self-perceived as SA
SIAS <28a SAD: SIAS �28 b SIAS <28 b SAD: SIAS �28 a
M SD % of group M SD % of group M SD % of group M SD % of group
Overall sample 13.92 7.80 47.8 38.53 8.38 17.8 18.34 6.79 15.9 40.02 8.60 18.4
Sex
Male 13.96 7.82 50.1 37.56 8.42 20.5 18.26 7.02 14.3 39.87 8.39 15.1
Female 13.92 7.77 46.0 38.42 8.29 15.1 18.42 6.60 17.6 40.09 8.73 21.4
Country
Brazil 14.10 8.15 39.4 39.36 8.37 16.2 17.88 6.99 18.2 41.96 9.19 26.2
China 13.18 7.60 46.4 38.73 8.08 15.4 17.78 6.40 21.6 38.36 7.56 16.6
Indonesia 12.49 8.03 65.0 37.42 8.45 15.3 17.62 7.32 12.1 38.89 8.47 7.6
Russia 13.51 7.61 57.1 36.09 6.28 13.9 18.24 6.49 16.0 39.37 7.64 13.0
Thailand 15.15 7.60 46.7 38.76 8.79 21.8 19.48 6.26 11.9 39.38 8.64 19.6
US 13.79 8.70 27.4 40.95 9.32 25.7 19.09 6.70 14.8 41.35 9.15 31.5
Vietnam 15.58 6.82 52.7 36.55 6.88 16.4 18.74 6.49 16.6 37.57 7.01 14.3

M = Mean, SD = Standard Deviation.

a
Congruence: self-perceptions align with measure.
b
Conflict in classification (false positive or negative).

https://doi.org/10.1371/journal.pone.0239133.t004

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

We also found strong variations in levels of social anxiety between countries. Previous
explorations of national prevalence rates have been less equivocal, with some reporting differ-
ences [6] while others have not [61]. Our findings concur with those of Hofmann and col-
leagues’ [6] who note that the US has typically high rates of social anxiety, which we also found
(in contrast to other countries). However, the authors suggest Russia also has a high prevalence
and that Asian cultures typically show lower rates. In contrast, we found samples from Asian
countries such as Thailand and Vietnam had higher rates than in the sample from Russia, and
that there were significant differences between Asian countries themselves (Table 2). As our
study used the SIAS, which determines how socially anxious an individual is based on their
ratings of difficulty in specific social situation, one way of accounting for differences may be to
consider the kinds of feared social situations that are covered in the measure. For instance, our
breakdown of concerns by country (Table 3) indicates that in Asian countries, speaking with
individuals in authority is a strongly feared situation, but this is less challenging in other cul-
tures. For non-Asian countries, one of the strongest concerns was talking about oneself or
one’s feelings. In Asian countries, where there is typically less of an emphasis on individualism,
talking about oneself may be less stressful if there is less perceived pressure to demonstrate
one’s uniqueness or importance. Future investigations could further explore cultural differ-
ences in social anxiety across different types of social situations or could confirm cross-cultural
social anxiety heterogeneity by using approaches that are less heavily tied to determining social
anxiety within given contexts (e.g., a diagnostic interview), as many of the commonly used
measures appear to be [62, 63].
Our findings also provide mixed support for investigations of other demographic differ-
ences in social anxiety. First, previous studies have tended to indicate that female participants
score higher than males on measures of social anxiety [27, 64]. Although the samples from Bra-
zil and China reflected this, we found no difference between males and females in the overall
sample, nor in samples from Indonesia, Russia, Thailand, US, or Vietnam. Sex-related differ-
ences in social anxiety have been attributed to gender differences, such as suggestions that girls
ruminate more, particularly about relationships with others [65, 66]. It is possible that as gen-
der roles and norms vary between countries, and in some instances start to decline, so may dif-
ferences in social anxiety, which younger generations are likely to reflect first. However, given
the unexpected finding that males in Vietnam scored significantly higher than their female
counterparts, further investigation is needed to account for the potentially culturally nuanced
relationship between sex and social anxiety.
We also confirmed previous findings that higher levels of social anxiety are associated with
lower levels of education and being unemployed. Although these findings are in-line with pre-
vious research [27, 64], our study cannot shed light on causal mechanisms; longitudinal
research is required to establish whether social anxiety leads individuals to struggle with school
and work, whether struggling in these areas provokes social anxiety, or whether there is a
more dynamic relationship.
Finally, we found that 18% of the sample could be classified as “false negatives”. This size-
able group felt they did not have social anxiety, yet their scores on the SIAS considerably
exceeded the threshold for SAD. It has been said that SAD often remains undiagnosed [67],
that individuals who seek treatment only do so after 15–20 years of symptoms [68], and that
SAD is often identified when a related condition warrants attention (e.g., depression or alcohol
abuse; Schneier [5]). It has also been reported that many individuals do not recognise social
anxiety as a disorder and believe it is just part of their personality and cannot be changed [3].
Living with an undiagnosed or untreated condition can result in substantial economic conse-
quences for both individuals and society, including a reduced ability to work and a loss of pro-
ductivity [69], which may have a greater impact over time compared to those who receive

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PLOS ONE Social anxiety in young people: A prevalence study in seven countries

successful treatment. Furthermore, the variety of avoidant (or “safety”) behaviours commonly
associated with social anxiety [70, 71] mean that affected individuals may struggle or be less
able to function socially, and for young people at a time in their lives when relationships with
others are particularly crucial [72, 73], the consequences may be significant and lasting.
Greater awareness of social anxiety and its impact across different domains of functioning
may help more young people to recognise the difficulties they experience. This should be
accompanied by developing and raising awareness of appropriate services and supports that
young people feel comfortable using during these important developmental stages [see 30, 74].

Study limitations
Our ability to infer reasons for the prevalence of SAD is hindered by the present data being
cross-sectional, and therefore only allowing for associations to be drawn. We are also unable
to confirm the number of clinical cases in the sample, as we did not screen for those who may
have received a professional diagnosis of SAD, nor those who are receiving treatment for SAD.
Additionally, the use of an online survey incorporating self-report measures incurs the risk of
inaccurate responses. Further research could build on this investigation by surveying those in
middle and older age to discover whether rates of social anxiety have also risen across other
ages, or whether this increase is a youth-related phenomenon. Future investigations could also
use diagnostic interviews and track individuals over time to determine the onset and progres-
sion of symptoms, including whether those who are subclinical later reach clinical levels, or
vice versa, and what might account for such change.

Conclusion
On a global level, we report higher rates of social anxiety symptoms and the prevalence of
those meeting the threshold for SAD than have been reported previously. Our findings suggest
that levels of social anxiety may be rising among young people, and that those aged 18–24 may
be most at risk. Public health initiatives are needed to raise awareness of social anxiety, the
challenges associated with it, and the means to combat it.

Acknowledgments
The authors would like to acknowledge the role of Edelman Intelligence for collecting the orig-
inal data on behalf of Unilever and CLEAR as part of their mission to support the resilience of
young people.

Author Contributions
Conceptualization: Philip Jefferies, Michael Ungar.
Formal analysis: Philip Jefferies.
Methodology: Philip Jefferies, Michael Ungar.
Writing – original draft: Philip Jefferies.
Writing – review & editing: Philip Jefferies, Michael Ungar.

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