J Korean Neuropsychiatr Assoc.  2016 Nov;55(4):450-457. 10.4306/jknpa.2016.55.4.450.

The Effects of Social Anxiety, Self-Esteem, and Depression on Suicidal Ideation in Korean Adolescents

• An YS
• Jeong SH
• Nam JA
• Kim JE
• Seo DD
• Lee CH
• Choi KS

• KMID: 2361234
• DOI: http://doi.org/10.4306/jknpa.2016.55.4.450

Abstract

OBJECTIVES
The purpose of this study was to investigate the manner by which social anxiety symptoms, self-esteem, and depression influence suicidal ideation in adolescents.
METHODS
This study involved 1320 middle school students. All participants completed several self-assessment questionnaires. Correlations among variables were assessed, and multiple regression analysis was performed to evaluate the relationships between variables and suicidal ideation. Finally, a structural equation model was used to determine the pathways by which the tested variables can influence suicidal ideation.
RESULTS
Symptoms of social anxiety were positively correlated with depression and suicidal ideation, but were negatively correlated with self-esteem. Additionally, multiple regression analysis revealed that social anxiety symptoms, depression, and self-esteem were significantly related to suicidal ideation. The influence of social anxiety symptoms on suicidal ideation was associated with an increase in depression, whereas self-esteem acted as an intermediary between social anxiety symptoms and depression.
CONCLUSION
The results of the present study demonstrate that social anxiety symptoms can directly increase depression and lower self-esteem, which in turn can increase the risk of suicidal ideation. Thus, it may be possible to prevent depression and ultimately lower the risk of suicide in adolescents by pursuing programs designed for the early detection of social anxiety symptoms and by using intervention programs that improve self-esteem.

Keyword

Adolescent; Social anxiety; Self-esteem; Depression; Suicidal ideation

MeSH Terms

Adolescent*
Anxiety*
Depression*
Humans
Self-Assessment
Suicidal Ideation*
Suicide

Figure

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  Fig. 1 Analysis of structural equation model. * : p<0.001 (χ2=99.847, df=2, GFI=0.965, NFI=0.946, TLI=0.841, CFI=0.947, RMSEA=0.193). GFI : Goodness of fit index, NFI : Normed fit index, TLI : Tucker Lewis index, CFI : Comparative fit index, RMSEA : Root mean square error of approximation.

Reference

1. Korea Institute for Health and Social Affairs. Comparison of mortality by cause of death in OECD countries. Seoul: Korea Institute for Health and Social Affairs;2014.

2. Korea National Statistical Office. 2014 annual report on the cause of death statistics. Daejeon: Korea National Statistical Office;2014.

3. King RA, Schwab-Stone M, Flisher AJ, Greenwald S, Kramer RA, Goodman SH, et al. Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. J Am Acad Child Adolesc Psychiatry. 2001; 40:837–846.

4. Watson D, Friend R. Measurement of social-evaluative anxiety. J Consult Clin Psychol. 1969; 33:448–457.

5. Lowry R, Crosby AE, Brener ND, Kann L. Suicidal thoughts and attempts among U.S. high school students: trends and associated health-risk behaviors, 1991-2011. J Adolesc Health. 2014; 54:100–108.

6. Chang EJ. Critical review on the current study of adolescent suicide in Korea. J Future Oriented Youth Soc. 2011; 8:171–195.

7. Kim SW, Kim SY, Yang SJ, Kim JM, Shin IS, Jeong S, et al. Psychosocial correlates of suicidal ideation in middle-school students. J Korean Neuropsychiatr Assoc. 2010; 49:604–610.

8. Arditte KA, Morabito DM, Shaw AM, Timpano KR. Interpersonal risk for suicide in social anxiety: the roles of shame and depression. Psychiatry Res. 2016; 239:139–144.

9. Schneier FR, Johnson J, Hornig CD, Liebowitz MR, Weissman MM. Social phobia. Comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry. 1992; 49:282–288.

10. Gallagher M, Prinstein MJ, Simon V, Spirito A. Social anxiety symptoms and suicidal ideation in a clinical sample of early adolescents: examining loneliness and social support as longitudinal mediators. J Abnorm Child Psychol. 2014; 42:871–883.

11. Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Bobes J, Beidel DC, et al. Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 1998; 59:Suppl 17. 54–60.

12. Wittchen HU, Fehm L. Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatr Clin North Am. 2001; 24:617–641.

13. Wittchen HU, Stein MB, Kessler RC. Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med. 1999; 29:309–323.

14. Acarturk C, de Graaf R, van Straten A, Have MT, Cuijpers P. Social phobia and number of social fears, and their association with comorbidity, health-related quality of life and help seeking: a population-based study. Soc Psychiatry Psychiatr Epidemiol. 2008; 43:273–279.

15. Fehm L, Beesdo K, Jacobi F, Fiedler A. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Soc Psychiatry Psychiatr Epidemiol. 2008; 43:257–265.

16. Wittchen HU, Fehm L. Epidemiology and natural course of social fears and social phobia. Acta Psychiatr Scand Suppl. 2003; (417):4–18.

17. Last CG, Hersen M, Kazdin A, Orvaschel H, Perrin S. Anxiety disorders in children and their families. Arch Gen Psychiatry. 1991; 48:928–934.

18. Stein MB, Walker JR, Forde DR. Public-speaking fears in a community sample. Prevalence, impact on functioning, and diagnostic classification. Arch Gen Psychiatry. 1996; 53:169–174.

19. Hyu JH, Cho YR. The influences of self-discrepancy and social anxiety on academic adjustment in university students. Korea J Cogn Behav Ther. 2005; 5:85–100.

20. Beidel DC, Turner SM, Morris TL. Psychopathology of childhood social phobia. J Am Acad Child Adolesc Psychiatry. 1999; 38:643–650.

21. Essau CA, Conradt J, Petermann F. Frequency and comorbidity of social phobia and social fears in adolescents. Behav Res Ther. 1999; 37:831–843.

22. Last CG, Perrin S, Hersen M, Kazdin AE. DSM-III-R anxiety disorders in children: sociodemographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry. 1992; 31:1070–1076.

23. Beidel DC, Turner SM, Young BJ, Ammerman RT, Sallee FR, Crosby L. Psychopathology of adolescent social phobia. J Psychopathol Behav Assess. 2007; 29:46–53.

24. Baek HJ, Hwang HJ. The effects of parents-related variables and self-related variables on children's emotional and behavioral problems. Korean J Dev Psychol. 2006; 19:1–27.

25. Bos AER, Huijding J, Muris P, Vogel LRR, Biesheuvel J. Global, contingent and implicit selfesteem and psychopathological symptoms in adolescents. Pers Individ Differ. 2010; 48:311–316.

26. Courtney EA, Gamboz J, Johnson JG. Problematic eating behaviors in adolescents with low self-esteem and elevated depressive symptoms. Eat Behav. 2008; 9:408–414.

27. Lee SH, Chun JS. The influence of stress on suicidal ideation among male and female adolescents: focusing on the moderating effects of self-esteem. Ewha J Soc Sci. 2012; 28:173–202.

28. Hong YS. The effects of life stress and psychosocial resources for adolescent suicidal behaviors [dissertation]. Seoul: Yonsei University;2004.

29. Park JY. The effects of risk and protective factors on adolecent suicide. Korea J Youth Stud. 2009; 16:249–272.

30. Grant KE, Compas BE, Stuhlmacher AF, Thurm AE, McMahon SD, Halpert JA. Stressors and child and adolescent psychopathology: moving from markers to mechanisms of risk. Psychol Bull. 2003; 129:447–466.

31. Schimel J, Landau M, Hayes J. Self-esteem: a human solution to the problem of death. Soc Pers Psychol Compass. 2008; 2:1218–1234.

32. Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, ten Have M, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry. 2005; 62:1249–1257.

33. Beidel DC, Turner SM, Morris TL. A new inventory to assess childhood social anxiety and phobia: the Social Phobia and Anxiety Inventory for Children. Psychol Assess. 1995; 7:73–79.

34. La Greca AM, Stone WL. Social anxiety scale for children-revised: factor structure and concurrent validity. J Clin Child Psychol. 1993; 22:17–27.

35. Moon HS, Oh KJ. A validation study of the korean social anxiety scale for children and adolescents. Korean J Clin Psychol. 2002; 21:429–443.

36. Cho MJ, Kim KH. Diagnostic validity of the CES-D (Korean version) in the assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc. 1993; 32:381–399.

37. Shin MS. An empirical study of the mechanism of suicide: validation of the scale for escape from the self [dissertation]. Seoul: Yonsei University;1992.

38. Bae HN, Choi SW, Yu JC, Lee JS, Choi KS. Reliability and validity of the Korean version of the rosenberg self-esteem scale (K-RSES) in adult. J of Kor Soc for Dep and Bip Disorders. 2014; 12:43–49.

39. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990; 107:238–246.

40. Hong SH. The criteria for selecting appropriate fit indices in structural equation modeling and their rationales. Korean J Clin Psychol. 2000; 19:161–177.

41. Nelson EC, Grant JD, Bucholz KK, Glowinski A, Madden PAF, Reich W, et al. Social phobia in a population-based female adolescent twin sample: co-morbidity and associated suicide-related symptoms. Psychol Med. 2000; 30:797–804.

42. Iancu I, Bodner E, Ben-Zion IZ. Self esteem, dependency, self-efficacy and self-criticism in social anxiety disorder. Compr Psychiatry. 2015; 58:165–171.

43. van Tuijl LA, de Jong PJ, Sportel BE, de Hullu E, Nauta MH. Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: a longitudinal study in adolescents. J Behav Ther Exp Psychiatry. 2014; 45:113–121.

44. Hedman E, Ström P, Stünkel A, Mörtberg E. Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PLoS One. 2013; 8:e61713.

45. Hoyer J, Wiltink J, Hiller W, Miller R, Salzer S, Sarnowsky S, et al. Baseline patient characteristics predicting outcome and attrition in cognitive therapy for social phobia: results from a large multicentre trial. Clin Psychol Psychother. 2016; 23:35–46.

46. Kwon TY. Identifying latent classes in adolescents' suicide ideation changes and testing ecological factors as determinants of classes. Ment Health Soc Work. 2012; 40:89–118.

47. Kandel DB, Raveis VH, Davies M. Suicidal ideation in adolescence: depression, substance use, and other risk factors. J Youth Adolesc. 1991; 20:289–309.

48. Glashouwer KA, Vroling MS, de Jong PJ, Lange WG, de Keijser J. Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder. J Behav Ther Exp Psychiatry. 2013; 44:262–270.

49. Shin SC, Kim MK, Yun KS, Kim JH, Lee MS, Moon SJ, et al. The Center for Epidemiologic Studies-Depression Scale (CES-D): its use in Korea-standardization and factor structure of CES-D. J Korean Neuropsychiatr Assoc. 1991; 30:752–767.

50. Cho MJ, Kim KH. Use of The Center for Epidemiologic Studies-Depression (CES-D) Scale in Korea. J Nerv Ment Dis. 1998; 186:304–310.

51. Cho SJ, Jeon HJ, Kim MJ, Kim JK, Kim SU, Lyoo IK, et al. Prevalence and correlates of depressive symptoms among the adolescents in an urban area in Korea. J Korean Neuropsychiatr Assoc. 2001; 40:627–639.

52. Sung KM. Comparison of CES-D and RADS-2-K in measuring adolescent depression. J Korean Soc Sch Health. 2016; 29:53–62.

53. Swanson JW, Linskey AO, Quintero-Salinas R, Pumariega AJ, Holzer CE 3rd. A binational school survey of depressive symptoms, drug use, and suicidal ideation. J Am Acad Child Adolesc Psychiatry. 1992; 31:669–678.