Social anxiety disorder is now one of the most common mental health challenges in Canada, with a 71% increase in prevalence since 2002, a new analysis showed.

Sometimes referred to as social phobia, the disorder affects nearly 1 in 7 Canadian adults. Characterized by an intense fear of being judged or embarrassed in social situations, it often leads to significant distress, impaired relationships and work performance, reduced quality of life, and substantial economic costs to society, according to the study authors.

“Over the last decade I’ve observed a dramatic increase in incapacitating social anxiety among my students,” principal investigator Esme Fuller-Thomson, PhD, director of the University of Toronto’s Institute for Life Course and Aging in Toronto, told Medscape News Canada. “This prompted our team to investigate whether this trend was reflected at the population level in Canada.”

“What stood out most was just how high the prevalence was among young adults,” she said. “Nearly 1 in 4 Canadians aged 20-24 years met the criteria for social anxiety disorder at some point in their lives, which is strikingly high and deeply concerning.”

The study was published online on June 1 in Psychiatry Research.

Life Course Approach Important

Researchers conducted secondary analyses of the 2022 Mental Health and Access to Care Survey, using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) scale to identify individuals with lifetime occurrence of social anxiety disorder.

In a representative sample of 8716 Canadians aged 20 years or older (51% women; 72% White), 1040 met the lifetime criteria for social anxiety disorder according to the WHO-CIDI scale.

When weighted to address issues such as probability of inclusion, this represented 13.9% of the Canadian population aged 20 years or older having the disorder at some point in their life, which was much higher than reported in a 2002 Canadian survey (8.1%).

There was a negative dose-response relationship between age and social anxiety disorder. For example, the lifetime prevalence was 24.2% among adults aged 20-24 years vs 6.2% among those aged 65 years or older.

Demographic factors associated with higher odds of lifetime social anxiety disorder included being female, Canadian-born, and single. Individuals who experienced childhood parental domestic violence had 30% higher odds of the disorder.

Several factors were associated with increased risk for social anxiety disorder, including chronic pain (45% higher odds), having two or more chronic physical health conditions (more than double the odds), and a lifetime history of alcohol use disorder (60% higher odds).

Individuals with less perceived social support and those who reported spirituality as unimportant also had substantially higher odds of the disorder.

“These findings highlight the importance of a life-course approach to understanding mental health,” Fuller-Thomson said. “Childhood experiences can cast a long shadow on adult mental health.”

Although the study can’t establish causation, “several plausible explanations emerge,” she said. “We suspect that increased reliance on smartphones and social media may be reducing opportunities for face-to-face interaction and the development of social skills. In addition, the isolation associated with the COVID-19 pandemic likely played a role, particularly for young people during a critical developmental period.”

“Clinicians should investigate if their patients are experiencing persistent and excessive fear of social situations, avoidance of everyday interactions, and significant distress in settings such as school, work, or even routine appointments,” she said.

If so, referral to a mental health specialist is often appropriate, she noted, since research suggests that an evidence-based treatment such as cognitive behavioral therapy can be effective.

‘Common and Highly Treatable’

The findings are generally consistent with existing knowledge about social anxiety disorder, according to Martin Antony, PhD, professor and chair in the Department of Psychology at Toronto Metropolitan University in Toronto, who was not involved in the study.

“Social anxiety is common, often begins early in life, and is associated with a range of other difficulties, including depression, substance use problems, elevated perfectionism, chronic health conditions, and impaired social and occupational functioning,” he told Medscape News Canada. “Finding that social anxiety was particularly common among younger adults is also consistent with other recent studies.”

However, Antony warned against overinterpreting the prevalence increase. “I would be cautious about placing too much emphasis on any single prevalence estimate,” he noted. “Prevalence rates often vary across studies because of differences in samples, measures, diagnostic criteria, survey methodology, response rates, interviewer training, and other methodological factors.”

Furthermore, he said, “lifetime prevalence estimates can be influenced by recall bias, particularly among older adults.”

Regarding the pronounced age difference in the study, with approximately one quarter of adults aged 20-24 years reporting lifetime social anxiety disorder, Antony highlighted the need for further investigation. “Whether this reflects a true increase in prevalence, greater awareness, and reporting of symptoms, cohort effects, methodologic differences across surveys, or some combination of these factors remains unclear,” he said.

From a clinical perspective, physicians and other healthcare providers should be aware that “heightened social anxiety is often overlooked because patients may not spontaneously report it, [and] it may present indirectly,” he said. “Individuals may present with depression, loneliness, substance use problems, school or work difficulties, or chronic stress without identifying social anxiety as a primary concern.”

When social anxiety causes significant distress or impairment, referral to a psychologist or other mental health professional with expertise in cognitive behavioral therapy for anxiety disorders is appropriate, he said.

Primary care providers and other health professionals can play an important role by screening for social anxiety, educating patients about the condition, normalizing help-seeking, and encouraging gradual engagement rather than avoidance, he added.

“Social anxiety disorder is common and highly treatable. Many individuals experience substantial improvement when they receive evidence-based care,” Antony concluded.

Funding for the study was not reported. Fuller-Thomson and Antony reported having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.