Social Anxiety Symptoms Research Articles

Verbal Abuse, Depersonalization, and the Innate Alarm and Defensive Systems: A Single Case Illustration of Treatment with Deep Brain Reorienting

AbstractThis study aimed to a) discuss the neurobiological mechanisms of depersonalization as arising from activation at the brainstem level and b) assess the effectiveness of deep brain reorienting psychotherapy (DBR) with a patient presenting with depersonalization-derealization disorder (DDD). In the first part of the paper, we discuss verbal abuse as a severe form of relational trauma and how it can be connected to depersonalization. It is argued that suddenly aversive experiences engage the brainstem locus coeruleus in widespread noradrenergic activation of the thalamus and cortex such that the balance of functioning within the cortex becomes disturbed and a subjective experience of chronic depersonalization results. In the second part, the single-case study aims to provide initial evidence of how the patient experienced and responded to DBR therapy. Pre- and post-treatment measures consisted of instruments to measure depersonalization, social anxiety symptoms and quality of life. After 43 DBR sessions, the participant's depersonalization and comorbid symptoms decreased significantly. Patients with DDD may benefit from DBR. Future research is required to address generalizability to a larger population.

Sphingosine-1-phosphate receptor 3 activation promotes sociability and regulates transcripts important for anxiolytic-like behavior

We previously demonstrated that sphingosine-1-phosphate receptor 3 (S1PR3) in the medial prefrontal cortex (mPFC) prevents reductions in sociability normally caused by stress. S1PR3 is a ubiquitously expressed G-protein coupled receptor that regulates immune system function, although its regulation of other biological processes is not well understood. Pharmacological activators of S1PR3 might provide important insights for understanding the neural substrates underlying sociability. Here we show that in mice, systemic injections of an S1PR3-specific agonist, CYM5541, promotes sociability in males and females whereas an S1PR3-specific antagonist, CAY10444, increases amygdala activation and increases social avoidance, particularly in females. S1PR3 expression is increased in the mPFC and dentate gyrus of females compared to males. RNA sequencing in the mPFC reveals that S1PR3 activation alters the expression of transcripts related to immune function, neurotransmission, transmembrane ion transport, and intracellular signaling. This work provides evidence that S1PR3 agonists, which have classically been used as immune modulators, might also be used to promote social behavior and, potentially, relieve symptoms of social anxiety. S1PR3 might be an important hub gene for mitigating maladaptive effects of stress as it reduces inflammatory processes, increases transcripts linked to anxiolytic neurotransmission, and promotes social behavior.

The association between chronotype and social anxiety among Chinese university students: a moderated mediation analysis of loneliness and perceived social support

BackgroundSocial anxiety has been a burning problem among contemporary college students in China. Increasing evidence suggests that individual circadian typology–chronotype may play an important role in the development of social anxiety. However, little research has focused directly on examining the association between chronotype and social anxiety, and less is known about the mediating and moderating mechanisms underlying this relationship. The aim of the present study was to investigate the link between chronotype and social anxiety among Chinese college students, and to explore the mediating effect of loneliness and the moderating effect of perceived social support in the association between chronotype and social anxiety.MethodsA cross-sectional design was conducted among 1616 college students (16–29 years old) from several public universities in Northern China, including 1172 females (72.52%) and 444 males (27.48%), with an average age of 19.68 years old (SD = 1.49). All participants completed the standardized self-report questionnaires including the Social Avoidance and Distress Scale, Morningness-Eveningness Questionnaire, UCLA Loneliness Scale, and the Perceived Social Support Scale. Common method bias was performed using Harman’s single-factor test. The mediation and moderation effects were analyzed using SPSS software and PROCESS macros.ResultsChronotype had a negative predictive effect on social anxiety in college students. Specifically, the greater the inclination of individuals' chronotypes toward evening preference, the more pronounced their symptoms of social anxiety would be. Loneliness served as a partial mediator in the relationship between chronotype and social anxiety, accounting for 30.0% of the total effect. In addition, perceived social support, particularly from friends and significant others, was found to play a moderating role in the process of loneliness affecting social anxiety among college students, while support from family did not. Interestingly, the perceived social support displayed a limited protective effect when college students suffered from higher levels of loneliness.ConclusionThese findings deepened our understanding of how and when (or for “whom”) chronotype is related to social anxiety, offering a theoretical foundation and practical insights for preventing and addressing social anxiety risk in young adult university students, particularly those with evening chronotypes.

Mental health in athletes: anxiety sensitivity as a transdiagnostic risk factor

Mental health in athletes: anxiety sensitivity as a transdiagnostic risk factor

Effectiveness of Mindfulness-Based Stress Reduction on Anxiety Disorder: A Systematic Review

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder, and specific phobias, are significant public health concerns that affect millions worldwide and lead to substantial impairments in daily functioning and quality of life. Traditional treatments may not suit everyone, highlighting the need for alternatives like Mindfulness-Based Stress Reduction (MBSR), which emphasizes mindfulness meditation. This systematic review evaluates the effectiveness of MBSR in reducing anxiety symptoms across various anxiety disorders by synthesizing research findings from studies published between January 2013 and April 2024. A comprehensive search was conducted in electronic databases, including PubMed, Semantic Scholar, ScienceDirect, PsycINFO, and Web of Science, using keywords such as “Mindfulness-Based Stress Reduction,” “MBSR,” “anxiety disorder,” and “effectiveness.” Peer-reviewed studies assessing the efficacy of MBSR on anxiety disorders were included, with data extraction and quality assessment performed following PRISMA 2022 guidelines. The search identified 1095 articles, with 13 studies meeting the inclusion criteria for the final analysis, encompassing a total sample size of 751 participants. The studies varied in design, sample size, participant demographics, and targeted anxiety disorders. Findings consistently showed significant reductions in anxiety symptoms among participants receiving MBSR compared to control groups. For GAD, studies reported improvements in anxiety and stress measures such as the Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HAM-A). For SAD, reductions in social anxiety symptoms were observed, with some studies showing comparable effectiveness to CBT. This review presents compelling evidence supporting the efficacy of MBSR in reducing symptoms associated with anxiety disorders. Future research should focus on the long-term effects, impact on diverse demographic groups, and specific mechanisms to improve its clinical applicability.

Efficacy of Acceptance and Commitment Therapy in Social Anxiety Disorder: A Systematic Review and Meta-analysis

Background: Acceptance and commitment therapy (ACT) is a novel third-wave therapy becoming popular in the management of various anxiety disorders. In this systematic review, we wish to gather the data that have been studied to determine the effectiveness of ACT in treating social anxiety disorder (SAD). Methods: This study followed standard systematic review guidelines and was registered with PROSPERO prior to undertaking the review. Databases, namely PubMed, PsycINFO, Ovid MEDLINE, and gray literature (ClinicalTrials.gov, BASE) with relevant keywords, were searched from inception to February 2024. Randomized controlled trials encompassing both clinical and nonclinical populations aged more than 10 years diagnosed with SAD were included. These trials compared ACT with wait list controls (n = 6) and cognitive behavioral therapy (n = 3). The primary outcome focused on the reduction of symptoms associated with social anxiety, while quality of life served as a secondary outcome. Measures of effect were determined through pre-test and post-test mean values, alongside their respective standard deviations. The random effect model was used to calculate pooled effect size. The quality of the included papers was assessed using Cochrane RoB-1. Covidence software was used for the initial selection of studies, and meta-analyses were performed using RevMan software. Results: From the initial 442 study records that were searched, finally 9 studies were included for the systematic review, of which 6 studies were found suitable for meta-analysis. The pooled estimate for studies comparing ACT with wait list found that the overall effect size for social anxiety symptoms was g = −1.28 (95% confidence interval of -1.88, -0.69) favoring ACT intervention significantly. Conclusion: This review found that ACT is efficacious in treating SAD. Most of the studies included were conducted in adolescent females. Varying ACT intervention modalities were incorporated, with the primary outcome assessed using a range of scales. The results of our meta-analysis should be interpreted with caution because of heterogeneity and smaller number of studies being included. ACT can be considered a psychotherapeutic option for the management of SAD.

Efficacy of positive expressive writing in reducing depression and social anxiety symptoms among schoolchildren during COVID-19: A randomized controlled trial.

The COVID-19 pandemic harmed children's mental health, and limited therapy access exacerbates the issue. We studied positive expressive writing (EW) as a psychological intervention for teachers to reduce depression and social anxiety symptoms among schoolchildren. Altogether, 165 Chinese schoolchildren aged 10-15 were randomly assigned to positive EW, memory EW, or control group. EW groups wrote for 10 minutes weekly for 7 weeks about people and things they felt grateful for (positive EW) or memorable in the past week. The control group continued with regular weekly class meetings. All groups measured depression and social anxiety before and after the intervention. Positive EW significantly reduced depression and social anxiety symptoms compared to the control condition (both Cohen's d = -0.45) and reduced social anxiety symptoms compared to memory EW (Cohen's d = -0.32). Therefore, teachers can implement positive EW to support schoolchildren's mental health recovery during and after disasters.

Associations of generalized anxiety and social anxiety symptoms with sleep duration, amount of intense exercise, and excessive internet use among adolescents

BackgroundAmong adolescents, symptoms of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are not only clinically significant but also continuingly increasing. During adolescence, individuals begin to establish distinct, self-determined lifestyle patterns. This study seeks to identify the associations between such lifestyle factors and the prevalence of GAD and SAD symptoms.MethodsThe analyzable sample was based on a cross-sectional, nationally representative survey of Finnish 14–18 year old students from comprehensive schools, general upper secondary schools, and vocational institutions. The sample consisted of 60,252 boys and 71,118 girls, with the mean age of 16.05 years (standard deviation 1.06). Symptoms were identified using the GAD-7 (cutpoint of 10), the Mini-SPIN (cutpoint of 6), and the PHQ-2 (cutpoint of 3). Logistic regression models for both GAD and SAD symptoms were stratified by comorbidity group variables.ResultsGAD symptoms were closely related to excessive internet use and decreased sleep duration among adolescents, regardless of comorbidity with depression or SAD. SAD symptoms were associated with excessive internet use and a lack of intense exercise, independent of comorbid depression or GAD.ConclusionsThe findings underscore the importance of considering lifestyle factors when developing interventions to mitigate GAD and SAD symptoms in adolescents. Interventions and policy recommendations aiming at improving adolescents’ health behaviour and mental health should take into account the intertwining of these factors.

Adolescent social anxiety is associated with diminished discrimination of anticipated threat and safety in the bed nucleus of the stria terminalis.

Social anxiety-which typically emerges in adolescence-lies on a continuum and, when extreme, can be devastating. Socially anxious individuals are prone to heightened fear, anxiety, and the avoidance of contexts associated with potential social scrutiny. Yet most neuroimaging research has focused on acute social threat. Much less attention has been devoted to understanding the neural systems recruited during the uncertain anticipation of potential encounters with social threat. Here we used a novel functional magnetic resonance imaging paradigm to probe the neural circuitry engaged during the anticipation and acute presentation of threatening faces and voices in a racially diverse sample of 66 adolescents selectively recruited to encompass a range of social anxiety and enriched for clinically significant levels of distress and impairment. Results demonstrated that adolescents with more severe social anxiety symptoms experience heightened distress when anticipating encounters with social threat, and reduced discrimination of uncertain social threat and safety in the bed nucleus of the stria terminalis, a key division of the central extended amygdala (EAc). Although the EAc-including the bed nucleus of the stria terminalis and central nucleus of the amygdala-was robustly engaged by the acute presentation of threatening faces and voices, the degree of EAc engagement was unrelated to the severity of social anxiety. Together, these observations provide a neurobiologically grounded framework for conceptualizing adolescent social anxiety and set the stage for the kinds of prospective-longitudinal and mechanistic research that will be necessary to determine causation and, ultimately, to develop improved interventions for this often-debilitating illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceived social support and symptoms of depression and anxiety in emerging adulthood: A Swedish prospective cohort study.

The transition from adolescence to young adulthood, often referred to as 'emerging adulthood', is a challenging period in life, and mental health problems are common. Although a large number of studies have shown that social support is linked with fewer mental health problems, few longitudinal studies have examined these associations during this life phase. The aim of the current study was to examine the associations between perceived social support from different sources - family, friends and significant other - at age 17-18 and symptoms of depression and anxiety at age 20-21. Data were obtained from the cohort study Futura01 based on a Swedish national sample of adolescents attending grade 9 in 2016/2017. We used survey information from 2019 (age 17-18) and 2022 (age 20-21) and linked registry information (N=2722). Symptoms of depression and anxiety were measured by the Patient Health Questionnaire-4 (PHQ-4) at age 20-21. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) at age 17-18. Control variables included sociodemographic characteristics and indicators of mental health problems at age 17-18. Binary logistic regressions were performed. When mutually adjusting for all sources of perceived social support, family support at age 17-18 had inverse associations with symptoms of both depression and anxiety at age 20-21. Perceived support from friends was associated with subsequent symptoms of anxiety only. Perceived social support can be a protective factor against mental health problems in emerging adulthood. The family serves a particularly important source of social support.

Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study.

Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking. A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of "being there," during VR exposure with anxiety measures and treatment response was examined. In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured. The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response. Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents.

A single-session feedback training modifies interpretation bias in individuals with high social anxiety: A randomized controlled trial.

The ability to interpret facial expressions accurately is important to adaptive social functioning. Social anxiety disorder is associated with a biased interpretation of facial emotions. This study aimed to demonstrate the effects of feedback training on modifying interpretation bias in individuals with high social anxiety. A total of 451 university students were screened, and 69 participants with high social anxiety were randomly assigned to either a training (n = 37) or a control (n = 32) group. Participants completed pre-questionnaires on social anxiety and depression symptoms, then performed a single session of experiment, followed by post-questionnaires on social anxiety symptoms. In the experiment, participants viewed an ambiguous facial expression and rated the intensity on a continuous scale. The training group received feedback that presented their ratings alongside the actual intensity, allowing them to accurately assess their emotional perception bias through trial-by-trial feedback. The control group received no feedback. The training group showed a significant reduction in interpretation bias for happy and angry faces after the experiment, while the control group did not. However, although the training group's social anxiety symptoms decreased post-experiment, the difference was not statistically significant compared to the control group. These findings provide preliminary evidence that the feedback training targeting dimensional ratings of emotions may be a promising option for correcting interpretation bias in individuals with high social anxiety. Future research could implement multiple sessions of training to potentially reduce both interpretation bias and social anxiety symptoms and verify the long-term effects.

Childhood predictors of avoidant personality disorder traits in adolescence: a seven-wave birth cohort study.

Although it is widely assumed that avoidant personality disorder (AvPD) originates in childhood, there is little prospective research to substantiate this claim. We therefore aimed to determine whether presumed childhood risk factors predict AvPD traits at 16 years. A population-based sample (n = 1,077; 50.9% female) from the 2003 and 2004 birth cohorts in (blinded for review) Norway was examined biennially from 4 to 16 years. The number of AvPD traits at the age of 16 was assessed with the structured clinical interview for DSM-5 personality disorders and regressed on the intercept and growth in child risk and protective factors until the age of 14. The prevalence of AvPD at the age of 16 was 3.2% (95% CI: 2.2-4.1). Higher levels and an increased number of social anxiety symptoms over time, as well as increased negative affectivity/neuroticism, predicted a higher number of AvPD traits. When the levels and changes in these factors were adjusted for, less and decreasing extraversion forecasted more AvPD traits, as did declining self-worth, higher levels of parental AvPD traits, and increased onlooking behavior. Neuroticism, low extraversion, social anxiety symptoms, passive onlooking behavior, and low self-worth predicted a higher number of AvPD traits in adolescence, as did more AvPD traits in parents. Efforts to enhance self-worth, reduce social anxiety, and promote peer interaction among onlooking children may reduce the development of AvPD traits in adolescence.

Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats

BackgroundCompared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvement differ between these treatment formats. ObjectiveTo examine candidate change processes in an online therapist-guided cognitive therapy intervention for social anxiety disorder (iCT-SAD), and compare the results to the corresponding face-to-face therapy (CT-SAD). MethodsData from a randomised controlled trial (n = 99) were analysed using Multilevel Structural Equation Models, incorporating the temporal precedence of the process variable, and disaggregating the within- and between-subject components of the predictors. These examined three candidate change processes: self-focused attention, negative social cognitions, and depressed mood. Moderated mediation models provided an additional test of the moderating effect of treatment format. ResultsNegative social cognitions and self-focused attention were supported as significant mediators of clinical improvement in both CT-SAD and iCT-SAD. Effects were of similar strength and moderated mediation was not observed. There was also evidence of cyclical relationships between social anxiety symptoms and these process variables. Depressed mood also emerged as a significant but weak mediator in CT-SAD, but not in iCT-SAD. Moderated mediation was not observed. ConclusionThe online format of therapy showed a similar pattern of change processes to face-to-face treatment, with self-focused attention and negative social cognitions mediating clinical improvement in both treatments. Efforts to improve the efficacy and efficiency of SAD interventions by targeting these factors may therefore be equally applicable to online and face-to-face interventions.

Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice

BackgroundSudden gains are large symptom improvements between consecutive therapy sessions. They have been shown to occur in randomised controlled trials of internet-delivered psychological interventions, but little is known about their occurrence when such treatments are delivered in routine clinical practice. ObjectiveThis study examined the occurrence of sudden gains in a therapist-guided internet-delivered Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in the UK NHS talking therapies for anxiety and depression (formerly known as IAPT services). It aimed to assess whether sudden gains were associated with better therapy outcomes, and examine changes in process variables around the period of sudden gains. MethodsThe study examined sudden gains based on the Liebowitz Social Anxiety Scale. Of 193 treated patients, 146 provided sufficient data to permit analysis. Linear mixed effects models were used to examine the impact of sudden gains on clinical outcomes, and examine changes in negative social cognitions, self-focused attention, and depressed mood. ResultsSeventy sudden gains were found among 57 participants. The occurrence rate of sudden gains was 39 %. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas changes in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints. ConclusionsApproximately 2 in 5 patients experienced a sudden gain whilst accessing the iCT-SAD intervention in routine practice. They were associated with better clinical outcomes following treatment compared to those who did not experience a sudden gain.

Anxiety and depression associated with social inequity indicators in patients with end-stage renal disease

ObjectiveDetermine the association between social inequality indicators and symptoms of anxiety and depression in patients with end-stage chronic kidney disease (ESRD). MethodsA cross-sectional analytical study was conducted in Tacna, Peru, involving patients with ESRD between July 1st and September 30th, 2023. Social inequality indicators included type of social insurance, educational level, and economic support. Anxiety and depression were assessed using the Hopkins Symptom Checklist-25 (HSCL-25). ResultsA total of 207 ESRD patients were surveyed; 52.7 % were male, with a median age of 62 years (IQR 52–70). Symptoms of anxiety and depression were present in 43 % and 65.2 % of participants, respectively. In the adjusted model, anxiety symptoms were more prevalent among those with comprehensive health insurance coverage (aPR: 1.42; IC95 %: 1.0–2.0) and older adults (aPR: 1.72; 1.2–2.4) and less prevalent among males (aPR: 0.48; 0.3–0.7). Depression symptoms were less prevalent among those who were economically self-sufficient (aPR: 0.60; 0.4–0.8) and more prevalent in patients with anxiety symptoms (aPR: 1.77; 1.4–2.2). ConclusionAnxiety and depression symptoms are common in patients with ESRD. We identified that social inequality indicators such as unemployment and type of health insurance were associated with higher anxiety and depression symptoms. Policies focusing on the social determinants of health are necessary, especially for vulnerable populations such as patients with ESRD.

A self-guided virtual reality solution for social anxiety: Results from a randomized controlled study

ObjectiveThe study examines the efficacy of a mobile application, oVRcome, which offers self-managed virtual reality exposure therapy combined with cognitive-behavioural techniques to treat social anxiety disorder. MethodsA randomized controlled trial (RCT) was conducted over six weeks with a waitlist delayed treatment group and follow-ups at 12 and 18 weeks. Participants were adults living in New Zealand with moderate to severe social anxiety disorder, as measured by the Liebowitz Social Anxiety Scale (LSAS). The primary focus was on the change in LSAS scores from baseline to the sixth week. All analyses utilized the intention-to-treat data. ResultsOut of 126 randomized participants, 81 completed the six-week follow-up. The retention rate at week 6 was 67.5%. The reduction in LSAS scores was significantly greater in the active group compared to the waitlist delayed treatment group (active group mean = −35.7 [SD = 24.0]; waitlist group: mean = − 2.2 [SD = 13.5]; p < 0.001), for an effect size of 1.8. ConclusionsThe study demonstrates that oVRcome can effectively reduce social anxiety symptoms, offering a viable self-guided treatment option. Trial registryClinicalTrials.gov ID NCT05576259.

Negative Affect Following Dating Application Use is Predicted by Social Anxiety Symptoms and Match Rate.

Social rejection is a common and unavoidable experience for users of dating apps. Research suggests that socially anxious individuals may be particularly likely to use dating apps to establish intimate relationships, given their preference for online (vs. face-to-face) communication. However, social anxiety (SA) symptoms are associated with heightened negative affect and decreased prosocial behavior following social rejection, suggesting that exposure to dating app rejection has deleterious consequences in this population. This study examined whether SA symptoms and social rejection (vs. acceptance) feedback interact to predict participants' negative and positive affect and social engagement with dating app matches. Participants (N = 128) evaluated for SA symptoms were randomly assigned to receive high or low match rate feedback on a simulated dating application task. SA symptoms were negatively associated with positive affect following high match rate feedback and positively associated with negative affect following low match rate feedback. SA symptoms were negatively associated with self-reported likelihood of contact initiation with matches. Results suggest that high socially anxious individuals are more susceptible to negative repercussions of social rejection on dating applications.

Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults

Abstract Background Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference. Methods This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms. Results Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p &amp;lt; 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p &amp;lt; 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p &amp;lt; 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p &amp;lt; 0.05) predicted use of mental health services. Conclusions Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.

Exploring the Relationship Between Social Media Use and Symptoms of Depression and Anxiety Among Children and Adolescents: A Systematic Narrative Review.

Social media use is ubiquitous to the lives of children and adolescents. The body of research investigating its potential impact on mental health has risen exponentially. We systematically reviewed the present literature exploring potential linkages between social media use and symptoms of depression and anxiety in this vulnerable group. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework, articles were searched across Medline, EMBASE, CINAHL, and PsycINFO databases from inception to February 2024. Quantitative studies with social media as exposure and anxiety/depressive symptoms as outcomes in children and adolescents 5-18 years of age were included. Of the 4850 studies retrieved, 67 fulfilled the inclusion criteria. The most frequent measures of social media were "time spent on social media" and "frequency of use." Depressive symptoms were the outcome of 61 studies, whereas anxiety was measured in 27 studies. Most studies were of fair quality (n = 53). A meta-analysis was not possible due to study heterogeneity. Our review shows that (1) problematic social media use is associated with depressive and anxiety symptoms among children and adolescents, (2) duration of social media use was more consistently linked with anxiety and depression in girls compared with boys, and (3) mediating and moderating mechanisms were sleep deprivation, social comparison, and feedback-seeking behaviors, exercise, social support, and type of social media use. Qualitative work and robust large-scale longitudinal observations using a person-specific approach are needed to further our understanding of the impact of social media use on depression and anxiety in children and adolescents.