A population-based cohort study found that people who were diagnosed with social anxiety disorder (SAD) were less likely to meet a range of educational outcomes — from passing all of their compulsory school subjects to earning a university degree. The study, which included data from over two million Swedish people, was published in the journal Psychological Medicine.
Social anxiety disorder (SAD), one of the most common mental health diagnoses, involves an avoidance of social situations due to fears of being judged or scrutinized by others. The condition often interferes with other parts of life, tends to be chronic, and frequently goes untreated. Study authors Alba Vilaplana-Pérez and her colleagues wanted to investigate how SAD relates to school achievement.
While previous studies have suggested that SAD negatively impacts achievement in school, most of this research has been limited to small sample sizes, has used a cross-sectional design, or has failed to control for potential interfering variables like family factors. Vilaplana-Pérez and her team opted to conduct a population-based cohort study using detailed data from Swedish population registers. These registers include information on psychiatric diagnoses as well as a range of educational outcomes.
The researchers started with a cohort of singleton births in Sweden that occurred between 1973 and 1997. After several exclusions, including the omission of participants with a diagnosed organic brain disorder or intellectual disabilities, the final cohort included 2, 238, 837 individuals, of whom roughly half (51%) were male. The cohort was followed up until 2013.
Of this cohort, 15,755 people were diagnosed with SAD. The researchers used logistic regression models to analyze the associations between having a diagnosis of SAD and obtaining a given educational outcome.
First, participants with SAD were significantly less likely to have passed all of the 16 compulsory education subjects in the Swedish school system. They were also less likely to meet the requirements to move on to upper secondary education.
One of the most striking findings was that people with SAD were 81% less likely to finish upper secondary education. They were also 53% less likely to start university, 65% less likely to finish university, and 42% less likely to earn a post-graduate education.
Moreover, evidence suggested that these differences were more than the result of family factors. The researchers identified a subgroup of families that included two or more full siblings where one child had a diagnosis of SAD and another did not. Comparing these siblings allowed researchers to control for family factors like genetics and educational attainment of the parents. While taking family factors into account did lessen the effects of SAD on educational outcomes, the effects remained significant. “SAD-affected individuals were still substantially impaired across all educational levels compared to their unaffected siblings,” the authors report.
Notably, controlling for gender revealed that females with SAD tended to suffer more academically compared to males with SAD. This gender difference was most apparent for starting a university degree.
The authors note that their study focused exclusively on people with SAD who were seeking treatment and diagnosed by specialists, so the findings may not generalize to people with less severe social anxiety or those without a diagnosis. The findings point to the need for clinical intervention programs, perhaps in schools, to help encourage the academic achievement of young people with SAD. Overall, the researchers say their findings “clearly indicate that SAD is much more than just shyness and can have far-reaching consequences for the individual.”
The study, “Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan”, was authored by Alba Vilaplana-Pérez, Ana Pérez-Vigil, Anna Sidorchuk, Gustaf Brander, Kayoko Isomura, Eva Hesselmark, Ralf Kuja-Halkola, Henrik Larsson, David Mataix-Cols, and Lorena Fernández de la Cruz.
