Child Psychiatry & Human Development

, Volume 47, Issue 4, pp 665–677 | Cite as

Social Phobia and Educational and Interpersonal Impairments in Adolescence: A Prospective Study

  • Klaus Ranta
  • Annette M. La Greca
  • Riittakerttu Kaltiala-Heino
  • Mauri Marttunen
Original Article


We examined longitudinal associations between social phobia (SP) and educational and interpersonal impairments among Finnish adolescents. Participants were 3278 adolescents (9th grade; M age = 15.5 years) who completed measures of SP and depressive symptoms; 2070 participated in follow-up two years later. Indicators for educational and interpersonal functioning were assessed for each sex separately. Multivariate analyses, controlling for depression and relevant socioeconomic covariates, indicated that for boys, age 15 SP predicted slow academic progression, being without a close friend or not having a romantic relationship, and poor support from friends and significant others at age 17. However, for girls, age 15 SP only predicted not having been involved in a romantic relationship by age 17. In conclusion, we found striking sex differences for adolescent SP as a predictor for subsequent educational and interpersonal impairments in late adolescence. SP may have a more devastating effect on boys' social and academic functioning relative to that of girls.


Social anxiety Social phobia Adolescents Impairment 


  1. 1.
    Ruscio AM, Brown TA, Chiu WT, Sareen J, Stein MB, Kessler RC (2008) Social fears and social phobia in the USA: results from the National Comorbidity Survey replication. Psychol Med 38:5–28CrossRefGoogle Scholar
  2. 2.
    Wittchen H-U, Fehm L (2003) Epidemiology and natural course of social fears and social phobia. Acta Psychiatr Scand 108(Suppl. 417):S4–S18CrossRefGoogle Scholar
  3. 3.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington, VAGoogle Scholar
  4. 4.
    Kingery JN, Erdley CA, Marshall KC, Whitaker KG, Reuter TR (2010) Peer experiences of anxious and socially withdrawn youth: an integrative review of the developmental and clinical literature. Clin Child Fam Psychol Rev 13:91–128CrossRefPubMedGoogle Scholar
  5. 5.
    La Greca AM, Lopez N (1998) Social anxiety among adolescents: linkages with peer relations and friendships. J Abnorm Child Psychol 26:83–94CrossRefPubMedGoogle Scholar
  6. 6.
    Vernberg EM, Abwender DA, Ewell KE, Beery SH (1992) Social anxiety and peer relationships in early adolescence. A prospective analysis. J Clin Child Psychol 21:189–196CrossRefGoogle Scholar
  7. 7.
    Blöte AW, Kint MJW, Westenberg PM (2007) Peer behavior toward socially anxious adolescents: classroom observations. Behav Res Ther 45:2773–2779CrossRefPubMedGoogle Scholar
  8. 8.
    Biggs BK, Vernberg EM, Wu YP (2012) Social anxiety and adolescents’ friendships: the role of social withdrawal. J Early Adolesc 32:802–823CrossRefGoogle Scholar
  9. 9.
    Essau CA, Conradt J, Petermann F (1999) Frequency and comorbidity of social phobia and social fears in adolescents. Behav Res Ther 37:831–843CrossRefPubMedGoogle Scholar
  10. 10.
    Wittchen H-U, Stein MB, Kessler RC (1999) Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med 29:309–323CrossRefPubMedGoogle Scholar
  11. 11.
    Ranta K, Kaltiala-Heino R, Rantanen P, Marttunen M (2009) Social phobia in Finnish general adolescent population: prevalence, comorbidity, individual and family correlates, and service use. Depress Anxiety 26:528–536PubMedGoogle Scholar
  12. 12.
    Burstein M, He J-P, Kattan G, Albano AM, Avenevoli S, Merikangas KR (2011) Social phobia in the National Comorbidity Survey—adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry 50:870–880CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B et al (2011) Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 50:32–45CrossRefPubMedGoogle Scholar
  14. 14.
    Aderka IM, Hofmann SG, Nickerson A, Hermesh H, Gilboa-Schechtman E, Marom S (2012) Functional impairment in social anxiety disorder. J Anxiety Disord 26:393–400CrossRefPubMedGoogle Scholar
  15. 15.
    Rodebaugh TL, Fernandez KC, Levinson CA (2009) Social phobia and perceived friendship quality. J Anxiety Disord 23:897–903CrossRefGoogle Scholar
  16. 16.
    Gren-Landell M, Tillfors M, Furmark T, Bohlin G, Anderson G, Svedin CG (2009) Social phobia in Swedish adolescents: prevalence and gender differences. Soc Psychiatry Psychiatr Epidemiol 44:1–7CrossRefPubMedGoogle Scholar
  17. 17.
    Chartier MJ, Walker JR, Stein MB (2001) Social phobia and potential childhood risk factors in a community sample. Psychol Med 31:307–315CrossRefPubMedGoogle Scholar
  18. 18.
    van Ameringen M, Mancini C, Farvolden P (2003) The impact of anxiety disorders on educational achievement. J Anxiety Disord 17:561–571CrossRefPubMedGoogle Scholar
  19. 19.
    Kessler RC (2003) The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatr Scand 108(Suppl. 417):19–27CrossRefGoogle Scholar
  20. 20.
    Beidel DC, Turner SM, Young BJ, Ammerman RT, Sallee FR, Crosby L (2007) Psychopathology of adolescent social phobia. J Psychopathol Behav Assess 29:47–54CrossRefGoogle Scholar
  21. 21.
    Spence SH, Donovan C, Brechman-Toussaint M (1999) Social skills, social outcomes, and cognitive features of childhood social phobia. J Abnorm Psychol 108:211–221CrossRefPubMedGoogle Scholar
  22. 22.
    La Greca AM, Harrison HM (2005) Adolescent peer relations, friendships, and romantic relationships: do they predict social anxiety and depression? J Clin Child Adolesc Psychol 34:49–61CrossRefPubMedGoogle Scholar
  23. 23.
    La Greca AM, Davila J, Landoll RR, Siegel R (2010) Dating, romantic relationships and social anxiety in young people. In: Alfano CA, Beidel DC (eds) Social anxiety disorder in adolescents and young adults: translating developmental research into practice. American Psychological Association, Washington, pp 93–105Google Scholar
  24. 24.
    Glickman AR, La Greca AM (2014) The Dating Anxiety Scale for Adolescents: scale development and associations with adolescent functioning. J Clin Child Adolesc Psychol 33:566–578CrossRefGoogle Scholar
  25. 25.
    Davila J, Beck JG (2002) Is social anxiety associated with impairment in close relationships? A preliminary investigation. Behav Ther 33:427–446CrossRefGoogle Scholar
  26. 26.
    Kashdan TB, Volkmann JR, Breen WE, Han S (2007) Social anxiety and romantic relationships: the costs and benefits of negative emotion expression are context-dependent. J Anxiety Disord 14:263–279Google Scholar
  27. 27.
    La Greca AM, Mackey ER (2007) Adolescents’ anxiety in dating situations: the potential role of friends and romantic partners. J Clin Child Adolesc Psychol 36:522–533CrossRefPubMedGoogle Scholar
  28. 28.
    Caspi A, Elder GH, Bem DJ (1998) Moving away from the world: life-course patterns of shy children. Dev Psychol 24:824–831CrossRefGoogle Scholar
  29. 29.
    Kerr M, Lambert WW, Bem DJ (1996) Life-course sequelae of childhood shyness in Sweden: comparison with the United States. Dev Psychol 32:1100–1105CrossRefGoogle Scholar
  30. 30.
    Xu Y, Schneier F, Heimberg RG, Princisvalle K, Liebowitz MR, Wang S et al (2012) Gender differences in social anxiety disorder: results from the national epidemiologic sample on alcohol and related conditions. J Anxiety Disord 26:12–19CrossRefPubMedGoogle Scholar
  31. 31.
    Adams RE, Laursen B, Wilder D (2001) Characteristics of closeness in adolescent romantic relationships. J Adolesc 24:353–363CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    La Greca AM, Prinstein MJ (1999) The peer group. In: Silverman WK, Ollendick TH (eds) Developmental issues in the clinical treatment of children and adolescents. Allyn and Bacon, Needham Heights, pp 171–198Google Scholar
  33. 33.
    Fröjd S, Marttunen M, Pelkonen M, von der Pahlen B, Kaltiala-Heino R (2006) Perceived financial difficulties and maladjustment outcomes in adolescence. Eur J Public Health 16:542–548CrossRefPubMedGoogle Scholar
  34. 34.
    Connor KM, Davidson JRT, Churchill LE, Sherwood A, Foa E, Weisler RH (2000) Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry 176:379–386CrossRefPubMedGoogle Scholar
  35. 35.
    Johnson HS, Inderbitzen-Nolan HM, Anderson ER (2006) The Social Phobia Inventory: validity and reliability in an adolescent community sample. Psychol Assess 18:269–277CrossRefPubMedGoogle Scholar
  36. 36.
    Ranta K, Kaltiala-Heino R, Rantanen P, Tuomisto MT, Marttunen M (2007) Screening social phobia in adolescents from general population: the validity of the Social Phobia Inventory (SPIN) against a clinical interview. Eur Psychiatry 22:244–251CrossRefPubMedGoogle Scholar
  37. 37.
    Achenbach TM (1991) Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. University of Vermont, BurlingtonGoogle Scholar
  38. 38.
    Blumenthal JA, Burg MM, Barefoot J, Williams RB, Haney T, Zimet G (1987) Social support, type A behavior, and coronary artery disease. Psychosom Med 49:331–340CrossRefPubMedGoogle Scholar
  39. 39.
    Katainen S, Räikkönen K, Keltikangas-Järvinen L (1999) Adolescent temperament, perceived social support, and depressive tendencies as predictors of depressive tendencies in young adulthood. Eur J Pers 13:183–207CrossRefGoogle Scholar
  40. 40.
    Vernberg EM (1990) Experiences with peers following relocation during early adolescence. Am J Orthopsychiatry 60:466–472CrossRefPubMedGoogle Scholar
  41. 41.
    Beck AT, Beck RW (1972) Screening depression patients in family practice. A rapid technic. Postgrad Med 52:81–85PubMedGoogle Scholar
  42. 42.
    Bennett DS, Ambrosini PJ, Bianchi M, Barnett D, Metz C, Rabinowich H (1997) Relationship of Beck depression inventory factors to depression among adolescents. J Affect Disord 45:127–134CrossRefPubMedGoogle Scholar
  43. 43.
    Raitasalo R (2007) Mood questionnaire. Finnish modification of the short form of the Beck Depression Inventory. The Social Insurance Institution, Helsinki (Book in Finnish)Google Scholar
  44. 44.
    Kaltiala-Heino R, Rimpelä M, Rantanen P, Laippala P (1999) Finnish modification of the 13-item Beck Depression Inventory in screening an adolescent population for depressiveness and positive mood. Nord J Psychiatry 53:451–457CrossRefGoogle Scholar
  45. 45.
    Beck AT, Rial WY, Rickels K (1974) Short form of depression inventory: cross-validation. Psychol Rep 34:1184–1186PubMedGoogle Scholar
  46. 46.
    Johnson J, McCutcheon S (1980) Assessing life stress in older children and adolescents: preliminary findings with the life events checklist. In: Sarason IG, Spielberger CD (eds) Stress and anxiety, vol 7. Hemisphere, Washington, pp 111–125Google Scholar
  47. 47.
    Epkins CC, Heckler DR (2011) Integrating etiological models of social anxiety and depression in youth: evidence for a cumulative interpersonal risk model. Clin Child Fam Psychol Rev 14:329–376CrossRefPubMedGoogle Scholar
  48. 48.
    Starr LR, Davila J (2008) Differentiating interpersonal correlates of depressive symptoms and social anxiety in adolescence: implications for models of comorbidity. J Clin Child Adolesc Psychol 37:337–349CrossRefPubMedGoogle Scholar
  49. 49.
    Pompili M, Innamorati M, Gonda X, Serafini G, Sarno S, Erbuto D et al (2011) Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: a prospective follow-up study. J Affect Disord 150:216–222CrossRefGoogle Scholar
  50. 50.
    Kessler RC, Foster CL, Saunders WB, Stang PE (1995) Social consequences of psychiatric disorders, I: educational attainment. Am J Psychiatry 152:1026–1032CrossRefPubMedGoogle Scholar
  51. 51.
    Baptista CA, Loureiro SR, de Lima Osorio F, Zuardi AW, Magalhaes PV, Kapczinski F et al (2012) Social phobia in Brazilian university students: prevalence, under-recognition and academic impairment in women. J Affect Disord 136:857–861CrossRefPubMedGoogle Scholar
  52. 52.
    Gelabert GE, Muñiz A, Binelli C, Ortiz AE, Subirà S, Martin-Santos R (2012) Perfectionism in social anxiety disorder: gender differences. Eur Psychiatry 27(Suppl 1):1CrossRefGoogle Scholar
  53. 53.
    Ingles CJ, Piqueras JA, Garcia-Hernandez JM, Garcia-Lopez LJ, Delgado B, Ruiz-Esteban C (2011) Gender and age differences in cognitive, psychophysiological and behavioural responses of social anxiety in adolescence. Psychol Spain 15:80–86Google Scholar
  54. 54.
    Ranta K, Junttila N, Laakkonen E, Uhmavaara A, La Greca AM, Niemi PM (2012) Social Anxiety Scale for Adolescents (SAS-A): measuring social anxiety among Finnish adolescents. Child Psychiatry Hum Dev 43:574–591CrossRefPubMedGoogle Scholar
  55. 55.
    McLeod JD, Uemura R, Rohrman S (2012) Adolescent mental health, behavior problems, and academic achievement. J Health Soc Behav 53:482–497CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    DeLisi M, Vaughn MG (2014) Foundation for a temperament-based theory of antisocial behavior and criminal justice system involvement. J Crim Just 42:10–25CrossRefGoogle Scholar
  57. 57.
    Rapee R, Bögels SM, van der Sluis CM, Craske MG, Ollendick T (2012) Annual research review: conceptualising functional impairment in children and adolescents. J Child Psychol Psychiatry 53:454–468CrossRefPubMedGoogle Scholar
  58. 58.
    Rose AJ, Rudolph KD (2006) A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys. Psychol Bull 132:98–131CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Nielsen KE, Cairns SL (2009) Social anxiety and close relationships: a hermeneutic phenomenological study. Can J Couns 43:178–197Google Scholar
  60. 60.
    Davila J (2008) Depressive symptoms and adolescent romance: theory, research, and implications. Child Dev Perspect 2:26–31CrossRefGoogle Scholar
  61. 61.
    Davila J, Stroud CB, Starr LR, Miller MR, Yoneda A, Hershenberg R (2009) Romantic and sexual activities, parent–adolescent stress, and depressive symptoms among early adolescent girls. J Adolesc 32:909–924CrossRefPubMedGoogle Scholar
  62. 62.
    Fröjd S, Kaltiala-Heino R, Marttunen M (2011) Does problem behaviour affect attrition from a cohort study on adolescent mental health? Eur J Public Health 21:306–310CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Klaus Ranta
    • 1
  • Annette M. La Greca
    • 2
  • Riittakerttu Kaltiala-Heino
    • 3
    • 4
  • Mauri Marttunen
    • 1
    • 5
    • 6
  1. 1.Department of Adolescent PsychiatryHelsinki University Hospital (HUS)HelsinkiFinland
  2. 2.Department of PsychologyUniversity of MiamiCoral GablesUSA
  3. 3.Medical SchoolUniversity of TampereTampereFinland
  4. 4.Department of Adolescent PsychiatryTampere University HospitalTampereFinland
  5. 5.University of HelsinkiHelsinkiFinland
  6. 6.Department of Mental Health and Substance Abuse ServicesNational Institute for Health and WelfareHelsinkiFinland

Personalised recommendations