May 28, 2025
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 NSAC Associate, Taylor Wilmer, PhD, ABPP. The article, Social Anxiety Symptoms and Their Relationship with Suicidal Ideation and Depressive Symptoms in Adolescents: A Prospective Study, examines the mediating relationship of social anxiety, depression, and suicidal ideation across a two-year time frame in a large UK sample of adolescents and young adults.
Social anxiety and depression commonly co-occur, such that those with social anxiety are nearly four times more likely to develop depression than those without social anxiety (Stein et al., 2001). The impact of co-morbid social anxiety and depression is particularly detrimental, resulting in greater functional impairment and higher rates of suicidality than when social anxiety occurs alone (Mineka, Watson, & Clark, 1998). However, little research has examined these relationships prospectively, particularly during adolescence when both social anxiety and depression commonly emerge. Chiu, Stringaris, and Leigh (2025) sought to understand the impact of social anxiety symptoms on future depression and suicidal ideation in a non-clinical youth population. Their study was strengthened by their large sample size, adolescent and emerging adulthood age range (ages 14-24), and the use of three longitudinal data collection timepoints to test their mediation model.
A community sample of adolescents and young adults (N=2,397) completed an assessment battery at baseline, one-year follow-up, and two-year follow-up that included measures of social anxiety, depression, and suicidal ideation. Researchers hypothesized that baseline social anxiety symptoms would predict variance in suicidal ideation at year two, mediated through depression symptoms at year one. They also hypothesized that social anxiety symptoms would predict variance in depression symptoms at year two, mediated through depression symptoms at year one. Their results supported both hypotheses, even after controlling for age, sex, baseline suicidal ideation, baseline generalized anxiety, and baseline depressive symptoms.
The findings of this study suggest that social anxiety may play a specific role in both the persistence of depression symptoms and elevation in risk for suicidal ideation in young people, and that depression may serve as the pathway for both of these relationships. In other words, teens with social anxiety may be more likely to develop depression, which then contributes to the persistence of depression and subsequent suicidality over time.
When considering the real-world implications, the authors highlighted that social relationships become especially important during the adolescent years. They suggested that teens with social anxiety may be more likely to withdraw socially or experience negative interpersonal events, leading to feelings of worthlessness and hopelessness. The intersection of social withdrawal, perceived rejection, and mounting depression could contribute to feelings of thwarted belongingness and perceived burdensomeness, two drivers of suicidal ideation.
Reflecting on the clinical implications of their work, the authors recommended comprehensive screening for depression and suicidal ideation when supporting youth with social anxiety. They also emphasized the importance of identifying social anxiety early and intervening quickly in order to buffer adolescents from these delirious future consequences. Although this study provides useful insight into the longitudinal relationships between these related factors, future research would benefit from examining social anxiety, depression, and suicidal ideation in a clinical sample with using multi-informant data collection.
For Clinicians:
In what ways have you observed the intersection of social anxiety and depression in your clinical practice? How have you addressed social anxiety symptoms in youth when depression is also part of their clinical presentation?
Chiu, K., Stringaris, A., & Leigh, E. (2025). Social anxiety symptoms and their relationship with suicidal ideation and depressive symptoms in adolescents: A prospective study. JCPP Advances, 5(1).
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Taylor Wilmer, PhD, ABPP
NSAC Associate