Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
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Association of Social Anxiety Disorder Symptoms with Self-Esteem, Ego-Resiliency and Social Support in Medical Students

의과대학생의 사회불안장애 증상과 자기존중감, 자아탄력성 및 사회적 지지 사이의 연관성

  • Lee, Sung-Eun (Department of Psychiatry, Chosun University Hospital) ;
  • Kim, Seung-Gon (Department of Psychiatry, Chosun University Hospital) ;
  • Kim, Sang Hoon (Department of Psychiatry, Chosun University Hospital) ;
  • Park, Sang Hag (Department of Psychiatry, Chosun University Hospital) ;
  • Seo, Eun Hyun (Premedical Science, Chosun University College of Medicine) ;
  • Yoon, Hyung-Jun (Department of Psychiatry, Chosun University Hospital)
  • 이성은 (조선대학교병원 정신건강의학과) ;
  • 김승곤 (조선대학교병원 정신건강의학과) ;
  • 김상훈 (조선대학교병원 정신건강의학과) ;
  • 박상학 (조선대학교병원 정신건강의학과) ;
  • 서은현 (조선대학교 의과대학 의예과) ;
  • 윤형준 (조선대학교병원 정신건강의학과)
  • Received : 2020.06.26
  • Accepted : 2020.08.04
  • Published : 2020.10.30
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Abstract

Objective : The purpose of this study was to investigate the prevalence of social anxiety disorder (SAD) and its association with psychosocial factors including self-esteem, ego-resiliency, and social support in a sample of medical students. Methods : A total of 405 medical students were included in this study. Subjects were asked to complete a self-reported questionnaire, measures of the Social Phobia Inventory (SPIN), the Rosenberg's Self-Esteem Scale (RSES), the Ego-Resiliency Scale (ERS), and the Duke-UNC Functional Social Support Questionnaire (DUFSS). The SAD and non-SAD group were defined using the SPIN score of 25 as a cut-off. The multiple regression analyses were performed to examine the association of self-esteem, ego-resiliency, and social support with SAD symptoms. Results : A total of 79 subjects (19.5%) were identified with SAD. The total RSES score, ERS score, and DUFSS score were significantly lower in the SAD group than the non-SAD group. The total SPIN score negatively correlated with the total RSES score (r=-0.481, p<0.001), the ERS score (r=-0.417, p<0.001), and the DUFSS score (r=-0.406, p<0.001). In the multiple regression, SAD symptoms were associated with self-esteem (β=-0.549, p<0.001), ego-resiliency (β=-0.395, p<0.001), and social support (β=-0.346, p<0.001). Conclusion : This study revealed the prevalence of SAD and its negative association with self-esteem, ego-resiliency, and social support among medical students. Our findings indicate that improving self-esteem and ego-resiliency as well as perceived social support may contribute to the management of SAD symptoms among medical students.

Keywords

References

  1. American Psychiatric Association. American Psychiatric Association. DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, Washington, D.C., 2013.
  2. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593-602. https://doi.org/10.1001/archpsyc.62.6.593
  3. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia; London, 2015.
  4. Stein MB, Kean YM. Disability and quality of life in social phobia: epidemiologic findings. Am J Psychiatry 2000;157:1606-1613. https://doi.org/10.1176/appi.ajp.157.10.1606
  5. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med 2006;81:354-373. https://doi.org/10.1097/00001888-200604000-00009
  6. Ratnani IJ, Vala AU, Panchal BN, Tiwari DS, Karambelkar SS, Sojitra MG, et al. Association of social anxiety disorder with depression and quality of life among medical undergraduate students. J Family Med Prim Care 2017;6:243-248. https://doi.org/10.4103/2249-4863.219992
  7. Yucens B, Uzer A. The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students. Psychiatry Res 2018;267:313-318. https://doi.org/10.1016/j.psychres.2018.06.033
  8. Nemeroff CB, Compton MT, Berger J. The depressed suicidal patient. Assessment and treatment. Ann N Y Acad Sci 2001;932:1-23. https://doi.org/10.1111/j.1749-6632.2001.tb05795.x
  9. Worley LL. Our fallen peers: a mandate for change. Acad Psychiatry 2008;32:8-12. https://doi.org/10.1176/appi.ap.32.1.8
  10. Sowislo JF, Orth U. Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychol Bull 2013;139:213-240. https://doi.org/10.1037/a0028931
  11. Block JH, Block J. The role of ego-control and ego-resiliency in the organization of behavior. In: Collins WA editor, Development of cognition, affect, and social relations. Mahwah: Lawrence Erlbaum Associates; 1980. p.39-101.
  12. Werner EE, Smith RE. Journeys from childhood to midlife: Risk, resilience, and recovery. Ithaca, NY: Cornell University Press;2001.
  13. Kyoung M, Min JA, Chae JH. Relationship of affective aymptoms and resilience with childhood abuse in patients with depressive or anxiety disorders. Anx Mood 2013;9:68-73.
  14. Cohen S, Hoberman HM. Positive events and social support as buffers of life change stress. J Appl Soc Psychol 1983;13:99-125. https://doi.org/10.1111/j.1559-1816.1983.tb02325.x
  15. Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull 1985;98:310-357. https://doi.org/10.1037/0033-2909.98.2.310
  16. Maldonado L, Huang Y, Chen R, Kasen S, Cohen P, Chen H. Impact of early adolescent anxiety disorders on self-esteem development from adolescence to young adulthood. J Adolesc Health 2013;53:287-292. https://doi.org/10.1016/j.jadohealth.2013.02.025
  17. Yngve A. Resilience against social anxiety: the role of social networks in social anxiety disorder [dissertation]. Linkoping: Linkoping Univ.;2016.
  18. Torgrud LJ, Walker JR, Murray L, Cox BJ, Chartier M, Kjernisted KD. Deficits in perceived social support associated with generalized social phobia. Cogn Behav Ther 2004;33:87-96. https://doi.org/10.1080/16506070410029577
  19. Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry 2000;176:379-386. https://doi.org/10.1192/bjp.176.4.379
  20. Cho Y, Choi Y, Kim S, Hong S. Factor structure and other psychometric properties of the Social Phobia Inventory in Korean samples. Meas Eval Couns Dev 2018;51:263-280. https://doi.org/10.1080/07481756.2018.1435188
  21. Tsai CF, Wang SJ, Juang KD, Fuh JL. Use of the Chinese (Taiwan) version of the Social Phobia Inventory (SPIN) among early adolescents in rural areas: reliability and validity study. J Chin Med Assoc 2009;72:422-429. https://doi.org/10.1016/S1726-4901(09)70399-5
  22. Sosic Z, Gieler U, Stangier U. Screening for social phobia in medical in-and outpatients with the German version of the Social Phobia Inventory (SPIN). J Anxiety Disord 2008;22:849-859. https://doi.org/10.1016/j.janxdis.2007.08.011
  23. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press;1965.
  24. Bae HN, Choi SW, Yu JC, Lee JS, Choi KS. Reliability and validity of the Korean version of the Rosenberg Self-Esteem Scale (K-RSES) in adult. Mood Emot 2014;12:43-49.
  25. Block J, Kremen AM. IQ and ego-resiliency: conceptual and empirical connections and separateness. J Pers Soc Psychol 1996;70:349-361. https://doi.org/10.1037/0022-3514.70.2.349
  26. Yoo SK, Shim HW. Psychological protective factors in resilient adolescents in Korea. Korean J Educ Psychol 2002;16:189-206.
  27. Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC functional social support questionnaire: measurement of social support in family medicine patients. Med Care 1988;26:709-723. https://doi.org/10.1097/00005650-198807000-00006
  28. Suh SY, Im YS, Lee SH, Park MS, Yoo T. A study for the development of Korean version of the Duke-UNC functional social support questionnaire. J Korean Acad Fam Med 1997;18:250-260.
  29. Cheng SH, Sun ZJ, Lee IH, Lee CT, Chen KC, Tsai CH, et al. Factors related to self-reported social anxiety symptoms among incoming university students. Early Interv Psychiatry 2017;11:314-321. https://doi.org/10.1111/eip.12247
  30. Hakami RM, Mahfouz MS, Adawi AM, Mahha AJ, Athathi AJ, Daghreeri HH, et al. Social anxiety disorder and its impact in undergraduate students at Jazan University, Saudi Arabia. Ment Illn 2017;9:7274.
  31. Baptista CA, Loureiro SR, de Lima Osorio F, Zuardi AW, Magalhaes PV, Kapczinski F, et al. Social phobia in Brazilian university students: Prevalence, under-recognition and academic impairment in women. J Affect Disord 2012;136:857-861. https://doi.org/10.1016/j.jad.2011.09.022
  32. Ministry of Health and Welfare. The survey of mental disorders in Korea, 2016.
  33. Turk CL, Heimberg RG, Orsillo SM, Holt CS, Gitow A, Street LL, et al. An investigation of gender differences in social phobia. J Anxiety Disord 1998;12:209-223. https://doi.org/10.1016/S0887-6185(98)00010-3
  34. Choi HM, Kim NH, Lim SW, Oh KS. Gender differences in the symptomatic characteristics of social phobia patients in one university hospital. Anx Mood 2008;4:62-67.
  35. Alkhathamia S, Kaviania H, Shorta E. Social anxiety among adolescents and its relation to quality of life. Eur Proc Soc Behav Sci 2014;218:228.
  36. Yoon HJ, Seo EH, Kim JJ, Choo IH. Neural correlates of self-referential processing and their clinical implications in social anxiety disorder. Clin Psychopharmacol Neurosci 2019;17:12-24. https://doi.org/10.9758/cpn.2019.17.1.12
  37. Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther 2007;36:193-209. https://doi.org/10.1080/16506070701421313
  38. Iancu I, Bodner E, Ben-Zion IZ. Self esteem, dependency, self-efficacy and self-criticism in social anxiety disorder. Compr Psychiatry 2015;58:165-171. https://doi.org/10.1016/j.comppsych.2014.11.018
  39. Glashouwer KA, Vroling MS, de Jong PJ, Lange WG, de Keijser J. Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder. J Behav Ther Exp Psychiatry 2013;44:262-270. https://doi.org/10.1016/j.jbtep.2012.11.005
  40. de Jong PJ, Sportel BE, de Hullu E, Nauta MH. Co-occurrence of social anxiety and depression symptoms in adolescence: differential links with implicit and explicit self-esteem? Psychol Med 2012;42:475-484. https://doi.org/10.1017/S0033291711001358
  41. Block J, Block JH. Venturing a 30-year longitudinal study. Am Psychol 2006;61:315-327. https://doi.org/10.1037/0003-066X.61.4.315
  42. Klohnen EC. Conceptual analysis and measurement of the construct of ego-resiliency. J Pers Soc Psychol 1996;70:1067-1079. https://doi.org/10.1037/0022-3514.70.5.1067
  43. Galatzer-Levy IR, Bonanno GA. Heterogeneous patterns of stress over the four years of college: associations with anxious attachment and ego-resiliency. J Pers 2013;81:476-486. https://doi.org/10.1111/jopy.12010
  44. Jun WH, Lee G. The role of ego-resiliency in the relationship between social anxiety and problem solving ability among South Korean nursing students. Nurse Educ Today 2017;49:17-21. https://doi.org/10.1016/j.nedt.2016.11.006
  45. Rodebaugh TL. Social phobia and perceived friendship quality. J Anxiety Disord 2009;23:872-878. https://doi.org/10.1016/j.janxdis.2009.05.001
  46. Baltaci O, Hamarta E. Analyzing the relationship between social anxiety, social support and problem solving approach of university students. Educ Sci 2013;38:226-240.
  47. Moak ZB, Agrawal A. The association between perceived interpersonal social support and physical and mental health: results from the national epidemiological survey on alcohol and related conditions. J Public Health 2010;32:191-201. https://doi.org/10.1093/pubmed/fdp093