Social Anxiety Symptoms and Suicidal Ideation in a Clinical Sample of Early Adolescents: Examining Loneliness and Social Support as Longitudinal Mediators
Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens, although this research largely has been cross-sectional and has not examined potential mediators of this relationship. A clinical sample of 144 early adolescents (72 % female; 12–15 years old) was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months post-baseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived social support were assessed via structured interviews and self-report instruments. Structural equation modeling revealed a significant direct relationship between social anxiety symptoms at baseline and suicidal ideation at 18 months post-baseline, even after controlling for baseline depressive symptoms and ideation. A second multiple mediation model revealed that baseline social anxiety had a significant indirect effect on suicidal ideation at 18 months post-baseline through loneliness at 9 months post-baseline. Social anxiety did not have a significant indirect effect on suicidal ideation through perceived social support from either parents or close friends. Findings suggest that loneliness may be particularly implicated in the relationship between social anxiety and suicidality in teens. Clinicians should assess and address feelings of loneliness when treating socially anxious adolescents.
KeywordsAdolescents Social anxiety Suicidal ideation Loneliness Social support
This work was supported in part by the National Institute of Mental Health grants R01-MH59766 and R01-MH85505 awarded to Mitchell J. Prinstein.
Conflict of Interest
The authors declare that they have no conflict of interest.
- Alfano, C. A., Pina, A. A., Villalta, I. K., Beidel, D. C., Ammerman, R. T., & Crosby, L. E. (2009). Mediators and moderators of outcome in the behavioral treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 945–953.PubMedCentralPubMedCrossRefGoogle Scholar
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: Author.Google Scholar
- Arbuckle, J. (2010). IBM SPSS Amos 19 user’s guide. Crawfordville: Amos Development Corporation.Google Scholar
- Byrne, B. M. (2009). Structural equation modeling with AMOS: Basic concepts, applications, and programming (2nd ed.). New York: Routledge.Google Scholar
- Centers for Disease Control and Prevention. (2011). WISQARS fatal injury reports. Retrieved November 26, 2011, from http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html.
- Gould, M. S., King, R., Greenwald, S., Fisher, P., Schwab-Stone, M., Kramer, R., . . . & Shaffer, D. (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 915–923.Google Scholar
- Harter, S. (1985). Manual for the social support scale for children. Denver: University of Denver.Google Scholar
- Joiner, T. E. (2005). Why people die by suicide. Cambridge: Harvard University Press.Google Scholar
- Mesa, F., Nieves, M. M., & Beidel, D. C. (2011). Clinical presentation of social anxiety disorder in adolescents and young adults. In C. A. Alfano & D. C. Beidel (Eds.), Social anxiety in adolescents and young adults: Translating developmental science into practice (pp. 11–27). Washington: American Psychological Association.Google Scholar
- Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., et al. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 9, 1–11. doi:10.1001/2013.jamapsychiatry.55. Advance online publication.Google Scholar
- Reynolds, W. M. (1985). Suicidal ideation questionnaire. Odessa: Psychological Assessment Resources.Google Scholar
- Schinka, K. C., Van Dulmen, M. H. M., Bossarte, R., & Swahn, M. (2012). Association between loneliness and suicidality during middle childhood and adolescence: longitudinal effects and the role of demographic characteristics. The Journal of Psychology: Interdisciplinary and Applied, 146, 105–118.CrossRefGoogle Scholar
- Shaffer, D., Fisher, P., Lucas, C., Dulcan, M., & Schwab-Stone, M. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.PubMedCrossRefGoogle Scholar
- Strauss, J., Birmaher, B., Bridge, J., Axelson, D., Chiappetta, L., Brent, D., et al. (2000). Anxiety disorders in suicidal youth. Canadian Journal of Psychiatry, 45, 739–745.Google Scholar
- Yuen, N., Andrade, N., Nahulu, N., Makini, G., McDermott, J. F., Danko, G., . . . Waldron, J. (1996). The rate and characteristics of suicide attempters in the Native Hawaiian adolescent population. Suicide and Life-Threatening Behavior, 26, 27–36.Google Scholar