January 16, 2024

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Hsiao-ching Chu, PsyD, A-CBT, DBT-LBC, representing NSAC Avon, Connecticut, and examines the 2023 article by Leigh, Chiu, & Ballard, “Social Anxiety and Suicidality in Youth: A Systematic Review and Meta-Analysis.”

Past research findings have found an overlap between symptoms of social anxiety disorder (SAD) and key suicide risk factors. For example, individuals suffering from SAD often experienced a marked and persistent fear of being humiliated or rejected by others as well as feelings of social isolation and loneliness. Moreover, perceived burdensomeness and thwarted belonginess seemed to be the crucial factors in the development of suicidal behaviors. These are also characteristics of socially anxious individuals. Finally, SAD has also been identified as a key diagnosis in the familial aggregation of suicidal behaviors.

More studies have been published in recent years, but there has been a lack of studies on youth. The authors believed that a review of studies examining the association between SAD and suicidal behaviors in adolescents could have important clinical implications for the possibility that better early treatment of SAD could reduce the risk of later suicidal behaviors. They focused on social anxiety as a potential modifiable risk factor because cognitive conceptualizations and related treatments could potentially be utilized to better identify and reduce suicide risk in youth.

Meta-analyses of 16 studies were conducted to examine the association between social anxiety and suicidality in youth (aged 10-25 years). The authors examined the concurrent association between SAD and its symptomatology with lifetime suicide attempts, current suicidal ideation, and suicide risk; the prospective relationship between SAD and suicidal behavior; and moderators of these associations.

The results showed that social anxiety was associated cross-sectionally with suicide attempts, suicidal ideation, and suicide risk. Specifically, the mean effect size for the meta-analysis examining association between social anxiety and lifetime suicide attempts (r= 0.10, 95% CI: 0.04, 0.15), current suicidal ideation (r=0.22,95% CI: 0.02, 0.41), and current suicide risk (r=0.24, 95% CI: 0.05, 0.41) were found to be statistically significant. The authors further indicated that the results suggest that higher levels of social anxiety were associated with the presence of suicide attempts; more frequent suicidal ideation; and higher current suicide risk.

For clinicians: What are your thoughts regarding treatment plans and a clinical approach for the clients whose symptoms of SAD were identified as key variables to increasing their suicidal behaviors? What considerations might shape your treatment plans and approach?

Leigh, Eleanor, Chiu, Kenny, & Ballard, Elizabeth D. Social Anxiety and Suicidality in Youth: A Systematic Review and Meta-Analysis. Research on Child and Adolescent Psychopathology, vol. 51, April, 2023.


Hsiao-ching Chu, PsyD, A-CBT, DBT-LBC
Representing NSAC Avon, Connecticut
(Cognitive Behavioral Services of Connecticut)