|Year : 2022 | Volume
| Issue : 3 | Page : 181-187
Evaluating the impact of sociodemographics and BMI on social anxiety among the students of the University of Sharjah
Emad Eddin Dalla, Abdulrahman Maziek, Shorouq Hamood, Hayat AlRaeesi, Afaf Mogharbel, Shamma Omran
College of Medicine, University of Sharjah, Sharjah, UAE
|Date of Submission||10-Mar-2022|
|Date of Decision||01-Apr-2022|
|Date of Acceptance||05-Apr-2022|
|Date of Web Publication||03-Jun-2022|
Emad Eddin Dalla
College of Medicine, University of Sharjah, Sharjah
Source of Support: None, Conflict of Interest: None
Background: The association between social anxiety and specific confounders such as body mass index (BMI) and gender has not been studied in the UAE yet. This study aims to assess the impact of sociodemographics and BMI on social anxiety levels among the university students. Methods: A questionnaire-based cross-sectional study was performed on 578 students using a modified version of the established and validated self-administered “Social Anxiety Questionnaire-Adult 30” (SAQ-A30), which aims to assess social anxiety across five different dimensions. Furthermore, height and weight measurements were obtained using manual scales to calculate the participants’ BMI. Results: About 553 students were eligible for data analysis. Based on analytical tests, the female gender was associated with increased social anxiety (P<0.05). In addition, negative changes of body self-perception were associated with increased social anxiety scores among college students (P<0.0001). However, we found no correlation between social anxiety levels and different BMI groups among the university students. Conclusion: Social anxiety levels increase based on gender and change of body self-perception after entering college in students.
Keywords: Anxiety, BMI, college, gender, SAQ-A30, students
|How to cite this article:|
Dalla EE, Maziek A, Hamood S, AlRaeesi H, Mogharbel A, Omran S. Evaluating the impact of sociodemographics and BMI on social anxiety among the students of the University of Sharjah. Adv Biomed Health Sci 2022;1:181-7
|How to cite this URL:|
Dalla EE, Maziek A, Hamood S, AlRaeesi H, Mogharbel A, Omran S. Evaluating the impact of sociodemographics and BMI on social anxiety among the students of the University of Sharjah. Adv Biomed Health Sci [serial online] 2022 [cited 2022 Aug 8];1:181-7. Available from: http://www.abhsjournal.net/text.asp?2022/1/3/181/346561
| Background|| |
Social anxiety is a prevalent issue among many young adults, especially those entering college . There is a lack of awareness about social anxiety and its outcomes. It is unknown whether sociodemographics and body mass index (BMI) can contribute to social anxiety at the college level, warranting further investigation . According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), social anxiety is defined as a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech) .
Individuals with social anxiety often manifest broader fears of social inadequacy, criticism, and negative evaluation by others . They also experience low levels of positive emotions, which negatively interfere with their social connectedness .
Various tools are available to assess social anxiety . From self-administered scales to structured diagnostic interviews, these assessment tools can evaluate various aspects of social anxiety. The most commonly tools used are the Brief Social Phobia Scale (BSPS) , the Social Phobia Inventory (SPIN) , and the Leibowitz Social Anxiety Scale (LSAS) . These tools exhibit high efficacy and validity in clinical and/or self-administration.
The purpose of this research is to assess the impact of sociodemographics and BMI on social anxiety levels among students who are 18 years of age and above.
| Materials and methods|| |
A total of 578 participants (male = 340, female = 238) were enrolled in the study. The students were recruited using non-probability convenient sampling, which allowed the assessment of many subjects in a short period. The participants used their mobile phones to complete the questionnaire.
Participants were students in colleges of Medicine, Pharmacy, Dentistry, Health Sciences, and male campuses of Engineering/Applied Sciences. All participants were 18 years old or above and spoke fluent Arabic and/or English. The exclusion criteria consisted of students in apparent distress during data collection.
During the five visits, informed consent was obtained, and the objective of the study was explained to the participants. Additionally, any questions regarding the given questionnaire and the purpose of the study were answered.
The instrument used for assessment in this study is the “Social Anxiety Questionnaire for Adults” (SAQ-A30), which identifies generalized social phobia and specific social phobia . This questionnaire was the most appropriate and effective method to use as it targets the research population [students aged ≥ 18 years] and can be used in multicultural environments due to its prior validation ,,.
This self-administered instrument is composed of 30 items divided into five dimensions, with each question being rated on a 5-point scale that assesses the level of unease, stress, or nervousness. The range of the scale starts from 1 = “not at all or very slight level of unease, stress, or nervousness” to 5 = “very high or extremely high level of unease, stress, or nervousness.”
The SAQ-A30 assesses five social anxiety dimensions:
- • F1: Speaking in public/talking with people in authority.
- ∘ Questions: S3, S6, S11, S17, S22, S25.
- • F2: Interactions with strangers.
- ∘ Questions: S9, S12, S14, S16, S18, S20.
- • F3: Interactions with the opposite sex.
- ∘ Due to cultural sensitivity in the UAE and the surrounding community traditions, five questions from this subcategory were removed as they would be inappropriate to ask our participants. However, one question (S5) of this subcategory was asked even though no further analysis was performed.
- • F4: Assertive expression of annoyance, disgust, or displeasure.
- ∘ Questions: S2, S4, S8, S10, S13, S23.
- • F5: Criticism and embarrassment.
- ∘ Questions: S1, S7, S15, S19, S21, S24.
Each social anxiety dimension has six questions randomly spread out in the questionnaire. Five questions (Q1–Q5) were added as a section before the SAQ-A30 to learn more about the demographics and other factors related to the participants.
The questionnaire was administered using a QR (Quick Response) code that was linked to a Google Form. The participants scanned the QR code and filled the questionnaire form using their mobile phones. The submission of the form required answering all the questions, which excluded the possibility of missing data.
As the original SAQ-A30 was only translated into the English language, and due to the lingual variety of the targeted population, the questionnaire was translated into the Arabic language to assess a larger population within the UAE. A pilot study was conducted on January 26, 2020 across 20 randomly selected participants, in which the subjects were provided with questionnaires in Arabic and English languages. Next, we asked the students if they could discern any notable difference between the two versions (subjects were all native Arabic speakers and appeared to be fluent in English). The pilot study was timed, and the questionnaire took an average of 7 min to complete in both the English and Arabic versions, the students reported no major difference between the two versions. After the pilot study was completed, minor adjustments were performed to the questionnaire according to the participants modifying any ambiguous questions.
BMI was measured using a manual height-and-weight scale taken from the clinical laboratories of College of Medicine. BMI calculation was done immediately after measuring the height and weight of each participant using a mobile application, which later was authenticated and double-checked via Statistical Package for the Social Sciences (SPSS) using the following formula: weight/(height^2) .
For data collection, the team was divided into three smaller groups, each group consisting of two members. One member was assigned to take consent, explain the reasoning and process of the study, and administer the questionnaire, whereas the other member would measure the height and weight and calculate the BMI. All participants were asked to remove their shoes and any extra weight during measurement.
During the entire process, participants’ confidentiality was maintained by ensuring that the data collected would only be available for the viewing of the research team. Also, the lack of documentation for any names or ID numbers resulted in more anonymity.
The data collected from the participants were exported from Google Forms as an Excel sheet and then imported into SPSS (version 25). Brief analysis and inspection of the data were performed, and outliers and miscalculated BMI values were removed from the data set. BMI calculation was via SPSS for more precise analysis.
Data analysis was performed on all confounding variables by using parametric tests [independent sample T-test and analysis of variance (ANOVA) test] except for the effect college had on body self-perception and analysis of BMI and social anxiety because the data were skewed.
| Results|| |
Out of the 578 questionnaires completed during data collection, only 553 responses remained valid following the data cleaning process. These included 58.95% (n = 326) males and 41.05% (n = 227) females. When asked about social status, 99.22% (n = 510) participants reported not being in a relationship, whereas 7.78% (n = 43) reported being in a relationship. The majority of the participants said that they were living with relatives 81.19% (n = 449), followed by 13.92% (n = 77) of the participants who were living alone at the time and 4.88% (n = 27) of the participants who were living with non-relatives. About 38.7% of the (n = 214) participants reported a positive change in body self-perception following entering college. In comparison, 35.26% (n = 195) of the participants reported that their self-perception did not change, and only 26.04% (n = 144) of the participants reported an adverse change in self-perception [Table 1].
Body mass index
The BMI findings of the 553 study participants were classified into the four different categories as follows :
Underweight (BMI <18.5 kg/m2): 7.4% (n = 41).
Normal weight (18.5 kg/m2 ≤ BMI ≤ 24.9 kg/m2): 55.69% (n = 308).
Overweight (25 kg/m2 ≤ BMI ≤ 29.9 kg/m2): 25.49% (n = 141).
Obese (BMI ≥ 30 kg/m2): 11.39% (n = 63).
In the study population, gender had a significant effect on the outcomes of the parameters F1 “Speaking in public/talking with people in authority” (P<0.0005), F4 “Assertive expression of annoyance, disgust, or displeasure” (P<0.0005), and F5 “Criticism and embarrassment” (P<0.0005). However, gender had no significant role in affecting the results of the F2 parameter, which is “Interactions with strangers” (P=0.387) [Table 2].
|Table 2: Effects of gender and social status on the factors affecting social anxiety.|
Click here to view
Social status was not a significant confounder in terms of the effect on F1, F2, F4, and F5 outcomes (P>0.05) [Table 2].
Accommodation status was a significant confounder in affecting the outcomes of F2 “Interactions with strangers” (P=0.028) and F5 “Criticism and embarrassment” (P=0.024) parameters. However, this confounder had no significant effect on the outcomes of parameters F1 “Speaking in public/talking with people in authority” (P>0.005) and F4 “Assertive expression of annoyance, disgust, or displeasure” (P>0.005) [Table 3].
|Table 3: Effects of accommodation status on the factors affecting social anxiety.|
Click here to view
The effect of entering college on body self-perception was a significant confounder relating to F5 only “Criticism and embarrassment” (P=0.001). At the same time, there was no significant effect across the rest of the parameters F1, F2, and F4 (P>0.005) [Table 4].
|Table 4: Effects of self-perception of the participants on the factors affecting social anxiety.|
Click here to view
There was no significant relationship between BMI and various factors associated with social anxiety [Table 5]. Regression analysis for the confounding variables in relation to the social anxiety parameters (F1, F2, F4, and F5) was performed. This analysis was based on the following equation of regression: “Regression equation: Y = a + b (x),” in which:
|Table 5: Effects of BMI and social status on factors affecting social anxiety.|
Click here to view
Y= outcome/a= constant/b= P-value/x= confounding variable.
Note: Reference group is male for gender; does not change for perception; living alone/non-relative for accommodation.
Findings showed that gender had a significant effect on the examined parameters (P<0.05) [Table 6]. Previous literature observations further validated this finding [10, 14, 15], which shows consistency across different studies in different settings. The regression analysis also showed a significant correlation between change of perception negatively (in the confounding variable “effect of entering college on body self-perception”) and social anxiety scores in parameter F5 (P = 0.0005) [Table 6].
| Discussion|| |
We assessed the association between social anxiety levels and sociodemographics and different BMI groups among 18-year-old or older students.
The results revealed that gender had a significant correlation with changes in social anxiety, with females being more vulnerable than males. This finding is consistent with previous reports showing that women are generally more likely to develop stress and anxiety disorders than men [16,17].
We found no association between BMI and the level of social anxiety among the participants. While the exact cause may remain unknown, we provide the following justifications for this finding.
First, the self-perception of a student may not determine confidence level or level of social anxiety.
Second, some students might have underestimated their previous social experiences, leading to inaccurate answers. Additionally, they may have misunderstood the general concept of the study and the meaning behind the term “social anxiety.”
Third, most of the participants were categorized under the “normal” BMI category, leading to an underrepresentation of students with extreme BMIs.
Finally, it is possible that social anxiety is not a robust measure to be correlated with BMI in normal range. Conversely, underweights and obese people exhibit a more robust association between BMI and social anxiety . Thus, a high proportion of students with normal BMI in our cohort may explain the absence of association between BMI and social anxiety.
Anxiety is among leading triggers of common psychiatric conditions, such as depression and bipolar disorders . Evidence has shown that the symptoms of anxiety and depression are closely correlated with poor physical health and well-being in cross-sectional and longitudinal studies . Although social anxiety does not meet the requirements of any national priority guidelines in the UAE, we decided to incorporate this problem for further investigation. This was partly because of abundance of the potential risk factors of anxiety in the UAE, such as obesity, chronic diseases, cultural issues, and diverse social status. This was the first study to use the SAQ-A30 questionnaire to assess social anxiety for adults in the UAE. Performing this study on a particular population (university students) allows the results to be more specific, as certain parameters like age are similar.
Strengths of this study include the adequate sample size of 553 participants, which provides us with more accurate means and a smaller margin of error. Another strength is the ethnic, geographic, and social variation among the study participants, which reduced the possibility of a selection bias in the results. An additional strength is the independent validation of the questionnaire elsewhere . Since the SAQ-A30 is divided into five dimensions, this also allows us to assess different aspects of social anxiety.
Limitations and recommendations
Inferential statistics from this study were limited due to multiple reasons. The study participants were mostly in the young adult category. This might influence their relationships and/or accommodation status, which in turn could have been a causative factor of social anxiety levels.
Future studies may consider expanding the data sampling to incorporate other universities and majors in the UAE. In addition, a rigorous characterization of various geographical, academic, and lifestyle differences is required to dissect their potential effects on social anxiety.
The SAQ-A30 has pre-defined cut-off values to dissect various levels of anxiety and the existence of an anxious state. Due to geographical differences and response rate, the cut-off values are regionally defined and are dependent on the receiver operating characteristics analysis of each setting to be determined. However, due to some alterations in our modified SAQ-A30, we could not use or define cut-off values for the study participation.
Additionally, the Social Anxiety Questionnaire has not been validated in the Arabic-speaking countries. Also, the translation of the SAQ-A30 into the Arabic language has not been verified, which necessitates a study for validation of the SAQ-A30 in those regions. Further investigation regarding the negative effect college had on body self-perception is required to establish a more thorough and elaborate conclusion about the significance of the findings concerning social anxiety.
| Conclusion|| |
This study concludes that the presence of female gender significantly affected social anxiety levels. It also showed a significant correlation between change of perception negatively in the confounding variable “effect of entering college on body self-perception” and social anxiety scores in the parameter. There was no association between social anxiety and BMI among students. This topic requires further research across the population of the UAE.
The authors thank Dr. Rizwan Qaisar from the University of Sharjah on his assistance and guidance for this publication.
ED conceived the research idea. All the authors conducted the research. ED and AM performed the statistical analysis. All authors contributed substantially to the write-up of the article and all take responsibility of the content of the publication.
The study was conducted according to the national regulations in the UAE and was approved by the Ethics and Research Committee at the University of Sharjah on February 2, 2022.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
Data availability statement
Data are available from the corresponding author on reasonable request.
| References|| |
Schry AR, Roberson-Nay R, White SW. Measuring social anxiety in college students: A comprehensive evaluation of the psychometric properties of the SPAI-23. Psychol Assess 2012;24:846-54.
Al-Yateem N, Bani Issa W, Rossiter RC, Al-Shujairi A, Radwan H, Awad M, et al
. Anxiety related disorders in adolescents in the United Arab Emirates: A population based cross-sectional study. BMC Pediatr 2020;20:245.
Barnhill JW. DSM-5®
Clinical Cases: Psychiatry Online. 5th ed. Arlington, VA: American Psychiatric Association;2013.
Cox BJ, Fleet C, Stein MB. Self-criticism and social phobia in the US National Comorbidity Survey. J Affect Disord 2004;82:227-34.
Taylor CT, Pearlstein SL, Stein MB. The affective tie that binds: Examining the contribution of positive emotions and anxiety to relationship formation in social anxiety disorder. J Anxiety Disord 2017;49:21-30.
de Lima Osório F., Crippa JA, Hallak JEC, Loureiro SR. Social anxiety disorder, fear of public speaking, and the use of assessment instruments. Different views of anxiety disorders. IntechOpen 2011;185-99.
Davidson JR, Miner CM, De Veaugh-Geiss J, Tupler LA, Colket JT, Potts NL. The brief social phobia scale: A psychometric evaluation. Psychol Med 1997;27:161-6.
Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry 2000;176:379-86.
Beard C, Rodriguez BF, Moitra E, Sibrava NJ, Bjornsson A, Weisberg RB, et al
. Psychometric properties of the Liebowitz Social Anxiety Scale (LSAS) in a longitudinal study of African Americans with anxiety disorders. J Anxiety Disord 2011;25:722-6.
Caballo VE, Salazar IC, Arias B, Irurtia MJ, Calderero M, Grana JL, et al
. Validation of the Social Anxiety Questionnaire for Adults (SAQ-A30) with Spanish university students: Similarities and differences among degree subjects and regions. Behav Psychol Psicología Conductual 2010;18: 5-34.
Caballo VE, Salazar IC, Irurtia MJ, Arias B, Hofmann SG; CISO-A Research Team. The multidimensional nature and multicultural validity of a new measure of social anxiety: The Social Anxiety Questionnaire for Adults. Behav Ther 2012;43:313-28.
Caballo VE, Arias B, Salazar IC, Irurtia MJ, Hofmann SG; CISO—A Research Team. Psychometric properties of an innovative self-report measure: The Social Anxiety Questionnaire for Adults. Psychol Assess 2015;27:997-1012.
Prevention. CfDCa. About Adult BMI. 2020. Available from: www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Accessed 3 February 2021.
DeJesusa RS, Breitkopfb CR, Ebbert JO. Associations between anxiety disorder diagnoses and body mass index differ by age, sex and race: A population based study. Clin Pract Epidemiol Ment Health 2016;12: 67-74.
Asher M, Aderka IM. Gender differences in social anxiety disorder. J Clin Psychol 2018;74:1730-41.
McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 2011;45:1027-35.
Maeng LY, Milad MR. Sex differences in anxiety disorders: Interactions between fear, stress, and gonadal hormones. Hormones Behav 2015;76:106-17.
DeJesus RS, Breitkopf CR, Ebbert JO, Rutten LJ, Jacobson RM, Jacobson DJ, et al
. Associations between anxiety disorder diagnoses and body mass index differ by age, sex and race: A population based study. Clin Pract Epidemiol Ment Health 2016;12:67-74.
Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al
; WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004;291:2581-90.
Niles AN, O’Donovan A. Comparing anxiety and depression to obesity and smoking as predictors of major medical illnesses and somatic symptoms. Health Psychol 2019;38:172-81.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]