Social Anxiety Symptoms and Suicidal Ideation in a Clinical Sample of Early Adolescents: Examining Loneliness and Social Support as Longitudinal Mediators

“A multiple mediation model was used in lieu of individual mediation models due to its ability to: (a) test competing theories within a single model, and (b) reduce parameter bias due to omitted variables, i.e., other possible mediators (Preacher and Hayes 2008).”

“Recent literature suggests it may not be necessary to show a direct relationship between the independent variable and outcome in order to establish mediation (MacKinnon et al. 2007).”

“[PubMed: 20438238] Van Zalk N, Van Zalk M, Kerr M, Ståttin H. Social anxiety as a basis for friendship selection and socialization in adolescents’ social networks.”

“In order to avoid biased estimates resulting from listwise deletion or other ad hoc missing data procedures, analyses were conducted with all available data using full information maximum likelihood procedures, a method that has been shown to produce efficient, unbiased estimates under both missing completely at rando…”

“As is recommended for longitudinal mediation, the study used multiple time lags (Cole and Maxwell 2003).”

“** p<0.01 a Equal variances not assumed b Symptoms measured with the Diagnostic Interview Schedule for Children (DISC-IV-Adolescent Report; Shaffer et al. 2000) c Number of baseline DISC-IV psychiatric diagnoses (excludes social phobia and major depression) J Abnorm Child Psychol.”

“The transition to adolescence coincides with a dramatic increase in suicidal ideation and attempts (Kessler et al. 1999), making it especially important to study the precursors of suicidality in this age group.”

“…clinical samples has shown that socially anxious adolescents report greater feelings of loneliness (Beidel et al. 2007; Lasgaard et al. 2011a), which has been described as an aversive emotional state resulting from a belief that one’s social relationships are inadequate (Heinrich and Gullone 2006).”

“Confidence intervals resulting from the Monte Carlo approach have been shown to perform as well as other methods such as the bias-corrected bootstrap (Preacher and Selig 2012).”

“Results from the National Comorbidity Study show the lifetime prevalences of suicide ideation, plans, and attempts in adolescents to be 12.1 %, 4.0 %, and 4.1 %, respectively (Nock et al. 2013).”

“For instance, social anxiety in teens has been shown to be negatively associated with perceived social support, including social support from peers and close friends (e.g., Calsyn et al. 2005; LaGreca and Lopez 1998).”

“…and epidemiological samples, researchers have shown that both current and lifetime social anxiety disorder diagnoses are associated with increased risk for suicidal ideation and attempts, even after controlling for depression and other diagnoses (e.g., Nock et al. 2010; Sareen et al. 2005).”

“Social Anxiety and Suicidal Thoughts and Behaviors Anxiety disorders are highly prevalent in adolescence (Costello et al. 1996), and researchers have begun to examine the relationship between anxiety disorders and suicidality in youth.”

“This finding is in keeping with prior research suggesting that social anxiety symptoms are concurrently related to suicidal ideation in adolescents (Nelson et al. 2000; Valentiner et al. 2002) and are longitudinally associated with suicidal ideation in adults (Sareen et al. 2005).”

“…used a latent variable to assess social anxiety and adjusted for baseline depressive symptoms, which, given the high comorbidity of depression and social anxiety in youth (Wittchen et al. 1999), allowed for a stronger test of the unique relationship between social anxiety and suicidal ideation.”

“Given that past ideation and attempts predict future suicidality (Lewinsohn et al. 1994), and completed suicide remains the third leading cause of death among adolescents (Centers for Disease Control and Prevention 2011), it is vitally important to identify additional risk factors for suicidal…”

“with recent ideation or a lifetime attempt from nonsuicidal controls (Gould et al. 1998).”

“Individuals with social anxiety tend to exhibit a heightened sensitivity to negative evaluation and to negatively interpret ambiguous social situations (Stopa and Clark 2000); such biases may negatively influence how socially anxious individuals perceive the level of support they are receiving.”

“The LSDS has been shown to have strong reliability and validity in a non-clinical sample (Parkhurst and Asher 1992).”

“Studies have also shown that adolescent ideation is negatively related to perceived social support from peers and close friends (Rigby and Slee 1999), perceptions of friends’ caring (Babiss and Gangwisch 2009), and connectedness with peers (Czyz et al.”

“…that adolescent ideation and attempts are negatively associated with perceptions of family-related support and connectedness (Czyz et al. 2012; Eskin et al. 2007; Kerr et al. 2006; Yuen et al. 1996), particularly with perceptions of parental support (Babiss and Gangwisch 2009; De Man et al. 1993).”

“Finally, even within their social networks, socially anxious adolescents tend to experience less intimacy with close friends (Vernberg et al. 1992), and report that their parents use a more controlling parental style (Rork and Morris 2009), which may negatively impact how these adolescents perceive…”

“It should be noted, however, that few studies linking social support to suicidality in teens have used clinical samples (e.g., Czyz et al. 2012; Kerr et al. 2006).”

“In fact, prior research suggests that a lack of family-based social support may increase feelings of hopelessness in youth, and that the impact of low family support on suicide risk may occur only indirectly through its relationship with increased hopelessness (Thompson et al. 2005).”

“Psychosocial risk factors for suicidal thoughts and behavior in youth include depression, substance abuse, negative life events, past physical or sexual abuse, and hopelessness (Mazza and Reynolds 1998).”

“This finding is consistent with prior research showing that adolescent loneliness is associated with both social anxiety (Beidel et al. 2007) and increased risk for suicidality (e.g., Schinka et al. 2012).”

“Among the constructs found in the Interpersonal Theory of Suicide, thwarted belongingness has been shown to be uniquely associated with social anxiety symptoms (Davidson et al. 2011).”

“The Present Study Prior research suggests that socially anxious adolescents are at increased risk for suicidal thoughts and behaviors (Nelson et al. 2000; Valentiner et al. 2002).”

“Research has shown that loneliness is associated with increased risk for recent suicidal ideation and behavior in community samples of adolescents (Roberts et al. 1998; Schinka et al. 2012) and for lifetime attempts (Rossow and Wichstrom 1994) in an epidemiological sample of youth.”

“It should be noted, however, that few studies linking social support to suicidality in teens have used clinical samples (e.g., Czyz et al. 2012; Kerr et al. 2006).”

“Research has shown that feelings of loneliness are highest during adolescence (Perlman and Landolt 1999), and that socially anxious teens report even greater feelings of loneliness than non-anxious teens (e.g., Beidel et al. 2007).”

“In contrast, however, Lasgaard et al. (2011b) found that loneliness did not predict suicidal ideation in high school students, after controlling for depression.”

“Several specific anxiety disorders have been linked to adolescent suicidality, including panic disorder, generalized anxiety disorder, and separation anxiety disorder (for a review, see Hill et al. 2011).”

“[PubMed: 20438238] Van Zalk N, Van Zalk M, Kerr M, Ståttin H. Social anxiety as a basis for friendship selection and socialization in adolescents’ social networks.”

“Research has shown that rates of suicidal ideation and attempts are especially high in the 12 months following discharge (e.g., Gunnell et al. 2008), making this timeframe a particularly important period for understanding the trajectory of suicidal ideation in these high-risk teens.”

“Doing so may be of broader psychological benefit to these teens: A study of a 12-week social effectiveness intervention found that reductions in loneliness mediated overall treatment outcome in socially anxious youth (Alfano et al. 2009).”

“…that adolescent ideation and attempts are negatively associated with perceptions of family-related support and connectedness (Czyz et al. 2012; Eskin et al. 2007; Kerr et al. 2006; Yuen et al. 1996), particularly with perceptions of parental support (Babiss and Gangwisch 2009; De Man et al.…”

“Behaviorally, socially anxious individuals tend to withdraw from social interaction, exhibit poorer social skills, and have a smaller network of friends (Miers et al. 2010; Van Zalk et al. 2011), which may diminish the actual social support received.”

“…that adolescent ideation and attempts are negatively associated with perceptions of family-related support and connectedness (Czyz et al. 2012; Eskin et al. 2007; Kerr et al. 2006; Yuen et al. 1996), particularly with perceptions of parental support (Babiss and Gangwisch 2009; De Man et al. 1993).”

“Loneliness is associated with feelings of hopelessness in adolescents (Page 1991), and a domain-specific form of social hopelessness has been linked to suicidal ideation in young adults (Heisel et al. 2011).”

“2012) and for lifetime attempts (Rossow and Wichstrom 1994) in an epidemiological sample of youth.”

“The Present Study Prior research suggests that socially anxious adolescents are at increased risk for suicidal thoughts and behaviors (Nelson et al. 2000; Valentiner et al. 2002).”

“Research has shown that feelings of loneliness are highest during adolescence (Perlman and Landolt 1999), and that socially anxious teens report even greater feelings of loneliness than non-anxious teens (e.g., Beidel et al. 2007).”

“These results held for both younger and older youth (Strauss et al. 2000).”

“Both social skills training and loneliness-focused cognitive behavioral therapy have been shown to reduce feelings of loneliness in teens (Adams et al. 1988; McWhirter and Horan 1996), and practitioners may find it helpful to employ these techniques with socially anxious adolescents.”

“Both social skills training and loneliness-focused cognitive behavioral therapy have been shown to reduce feelings of loneliness in teens (Adams et al. 1988; McWhirter and Horan 1996), and practitioners may find it helpful to employ these techniques with socially anxious adolescents.”

“…that adolescent ideation and attempts are negatively associated with perceptions of family-related support and connectedness (Czyz et al. 2012; Eskin et al. 2007; Kerr et al. 2006; Yuen et al. 1996), particularly with perceptions of parental support (Babiss and Gangwisch 2009; De Man et al. 1993).”

“Loneliness is associated with feelings of hopelessness in adolescents (Page 1991), and a domain-specific form of social hopelessness has been linked to suicidal ideation in young adults (Heisel et al. 2011).”

“%) took part in the final assessment, a retention rate that is consistent with previous longitudinal studies of adolescent suicide ideators and attempters (see Boergers and Spirito 2003, for a review).”

“Characterized by a fear of social situations, social anxiety disorder involves physical symptoms such as blushing and trembling, cognitive symptoms such as worry and negative self-evaluation, and a pattern of behavioral avoidance (Mesa et al. 2011).”

“The association between loneliness and suicidality supports the theory [32] that thwarted belongingness and perceived burdensomeness are major determinants of suicidality (see also [33]).”

“…select cases where loneliness plays a more central role, such as mediating the relationship between social anxiety and subsequent suicidal ideation during adolescence (Gallagher et al., 2014), or the prediction of suicide attempt later in life, specifically early adulthood (Johnson et al., 2002).”

“participants (Fulginiti et al, 2018; Gallagher et al. 2014; Hom et al. 2019; Joiner and Rudd, 1996; Kleiman et al., 2017 Study 1; Kleiman et al., 2017, Study 2; Pietrzak et al., 2017; Schinka et al., 2013) while Salzinger (2007) recruited predominantly Hispanic participants (54%).”