Prevalence of Social Phobia among Saudi Medical Students

Transcription

1 Med. J. Cairo Univ., Vol. 85, No. 2, March: , Prevalence of Social Phobia among Saudi Medical Students ALYAH A. ALQARNI, M.B.B.S. 1 ; MOUSA A. ZALAA, M.D. 2 ; AYMAN A. EL-HADAD, M.D. 3 ; RAWAN S. AL-GHAMDI, M.B.B.S. 1 ; SAFIA A. ASIRI, M.B.B.S. 1 ; MEAAD M. AL-THABET, M.B.B.S. 1 ; AYED M.M. ALQAHTANI, M.B.B.S. 4 and OSSAMA A. MOSTAFA, M.D. 5 The Department of Medical Intern, King Khalid University, Abha, Saudi Arabia 1, Psychiatry Consultant, King Khalid University, Abha, Saudi Arabia 2, The Department of Psychiatry, Al-Menoufia University, Egypt 3, Aseer Central Hospital, Abha, Saudi Arabia 4 and The Department of Family & Community Medicine, King Khalid University, Abha, Saudi Arabia 5 Abstract Objectives: To assess prevalence of social phobia among Medical Students at King Khalid University (KKU), Abha, Kingdom of Saudi Arabia, to detect related risk factors and to determine its negative impact on students' psychological health and academic performance. Methods: This study followed a prospective cross-sectional design using the Arabic version of the Social Phobia Scale. A total of 368 medical students at KKU during the academic year ( ). Results: Prevalence of social phobia among KKU medical students was 60%, being significantly more common among males. Students with high social phobia scores were found to show decreased academic performance, avoid oral presentations, show weak performance at clinical examinations and have depressive symptoms. Conclusions: Prevalence of social phobia among KKU medical students is high. Raising medical students' awareness about social phobia is necessary. Early detection and provision of psychiatric assistance is highly recommended to control the symptoms and prevent development of depression. Key Words: Social phobia Prevalence Risk factors Medical students. Introduction SOCIAL phobia, which is also called Social Anxiety Disorder (SAD), is the most common anxiety disorder [1]. It is considered as one of the most common three psychiatric disorders, with major depression disorders and anxiety disorders [2]. Social phobia is defined as a persistent fear of one or more performance situations in which the person is exposed to unfamiliar people. The individual fears that he or she will act in a way or Correspondence to: Dr. Alyah A. Alqarni, The Department of Medical Intern, King Khalid University, Abha, Saudi Arabia show anxiety symptoms that will be embarrassing and humiliating [3]. In western countries, prevalence of social phobia is about 7-13% [4]. Various studies have shown that males are diagnosed with social phobia more than females [5]. Persons with social phobia usually have lower self-esteem than do those without social phobia [6] and they have a significantly lower quality of life, significant impairments in work performance and negative impact on social relationships [7]. Social phobia increases the risk of developing a major depressive disorder and has a high co-morbidity with other mental disorders [8]. This study aims to assess prevalence of social phobia among Medical Students at King Khalid University (KKU); to evaluate and check the relationship between presence of social phobia and academic performance of medical students; and to explore the association between social phobia and other psychiatric disorders among medical students at KKU. Material and Methods This research was conducted during the academic year It followed a cross-sectional study design that was included 368 students at the College of Medicine, KKU. The College of Medicine at KKU was established in Currently, there are 1436 medical students (866 male students and 570 female students) [9]. A self-administered electronic questionnaire was used and distributed to all KKU Medical Students during the academic year

2 658 Prevalence of Social Phobia among Saudi Medical Students The questionnaire consisted of background characteristics and the Arabic validated version of the Social Phobia Scale (SPS). The SPS is a widely used self-report assessment tool for the evaluation of social phobia disorder. It includes 30 statements related to socially phobic concerns of being scrutinized or judged during routine activities. A score of 1 was assigned to a positive response indicating the presence of a symptom of social phobia, while a score of 0 was assigned to a negative response, i.e., an absent socially phobic concern. All scores for each participant medical student were summed up. Student who obtained a total score > 15, i.e., 16 or more were considered to have symptoms of social phobia [10]. Moreover, the study questionnaire included Beck's Depression Inventory to assess the presence of major depressive disorder symptoms among medical students [11]. The statistical analysis of collected data was conducted by using the Statistical Package for Social Sciences (SPSS Version 22). Descriptive statistics (frequency, percentage, mean and standard deviation) were calculated. Significance of differences were assessed using independent samples t- test or ANOVA. p-values less than 0.05 were considered as statistically significant. Results Table (1) shows that more than half of sample (57.1%) were males. Most students were single (95.1%). About two thirds of students (61.3%) were at the clinical years (i.e., 4 th, 5th & 6th) while about one third of them were at their basic years (i.e., 2 nd & 3 rd). Fig. (1) shows that 60% of medical students had symptoms of social phobia. Table (2) shows that symptoms of social phobia were significantly more present among male students (p<0.001), single students (p=0.030) and also more among senior (levels 9-12) than junior (levels 3-8) students (p=0.015). Table (3) shows that medical students with low academic performance, avoidance of presentations low performance at oral or clinical examinations had significantly higher scores for symptoms of social phobia (p< for all variables). Table (4) shows that medical students with frequent experience of low mood, lack of interest, sense of hopelessness, easy fatigability and change in appetite, weight or sleep had significantly higher scores for symptoms of social phobia (p<0.001 for all depressive symptoms). Table (1): Demographic characteristics of the participant medical college students (n=368). Characteristics No. % Gender: Male Female Marital status: Single Married Scholastic years: Second year (levels 3-4) Third year (levels 5-6) Fourth year (levels 7-8) Fifth year (levels 9-10) Sixth year (levels 11-12) Table (2): Students' social phobia scores (mean ± SD) according to their sociodemographic characteristics. Characteristics No. Mean SD p-value Gender: Male Female <0.001 Marital status: Single Married Academic level: Table (3): Association between students' academic performance and social phobia score. Students' academic performance No. Mean±SD p-value Last year's academic achievement: High (grades: A/B/C) ±6.1 Low (grades: D/F) ±5.4 <0.001 Avoidance of presentations: No ±5.9 Yes ±5.7 <0.001 Performance in oral and clinical exams: High ±6.5 Moderate ±5.8 Low ±4.2 <0.001

3 Alyah A. Alqarni, et al. 659 Table (4): Students' scores for social phobia (mean ±SD) according to presence of depressive symptoms. Students' academic performance No. Mean±SD p-value Frequent experience of low mood: Absent ±6.0 Present ±5.4 <0.001 Lack of interest: Absent ±6.1 Present ±5.4 <0.001 Sense of hopelessness: Absent ±6.0 Present ±5.8 <0.001 Easy fatigability: Absent ±6.1 Present ±5.8 <0.001 Change in appetite, weight, or sleep: Absent ±6.3 Present ±5.8 <0.001 Absent, Present, 149, 40% 219, 60% Fig. (1): Proportion of students with symptoms of social phobia. Discussion This cross-sectional study revealed a high prevalence of social phobia symptoms among King Khalid University Medical Students (60%). This high prevalence of symptoms of social phobia among medical students in in accordance with that stated by Al-Naggar [12] determined the prevalence of the most common phobias and associated factors among university students. This finding is similar to that reported by Gill and Mohamed, who found that a high of 56% of medical students in Malaysia had symptoms of social phobia [13]. However, a higher prevalence for symptoms of social phobia (85%) among medical students was reported by Raboch [14] in Prague, Czech Republic, while a lower prevalence for symptoms of social phobia (22%) among medical students was reported by Kjeldstadli et al., [15] in Norway. Shah and Kataria [1] reported that prevalence of social phobia among university students in India was 19.5%. Momani and Jaradat [16] reported that the overall prevalence of social phobia among university students in Jordan was 17.7%. This wide variation in reported prevalence rates for social phobia by different studies may be due to using different study tools and discrepancies in communities and study populations. The current study showed that mean scores for symptoms of social phobia were significantly higher among male, single and senior medical students. Results of the present study are in accordance with those of Alkhathami et al., [17], who found that males had higher social phobia scores than females. Nevertheless in the western world, social phobia was found to be more common among females, especially during adolescent age groups [18]. The higher prevalence of social phobia among non-married persons was explained by Hart et al., [19], who stated that single persons are more likely to meet criteria for avoidant personality disorder. They also exhibit greater fear and avoidance in both social interaction and performance situations. The high score for social phobia among males may be attributed to the higher cultural burdens compared with females in the Saudi Community. Moreover, it seems that senior medical students are required to spend more time with their textbooks and references than junior ones on the expense of their social life. Hence, they may be more exposed to social phobia than junior students. The present study revealed that medical students with high scores for social phobia avoid taking presentations and tend to show lower academic achievements and oral/clinical examinations. These findings are in agreement with those reported by previous studies, which reported significantly low academic and work productivity by individuals with social phobia [20,21]. Furmark et al., [4] stated that social phobia is significantly associated with less likely to marry, more likely to get divorced, and have reduced productivity that can lead to increased dependence on family, society, and country. Moreover, social phobia has been associated with impairment in most areas of functioning including education, employment, family relationships, friendships/ social network, and other interests [22,23].

4 660 Prevalence of Social Phobia among Saudi Medical Students This study revealed significant associations between students' social phobia score and their depressive symptoms, including decreased mood, lack of interest, a sense of hopelessness, fatigue, change in appetite, weight and sleep. Gill and Mohammad recognized that social phobia is highly associated with other conditions, such as depression [13]. Moreover, Stein et al., [23,24] found that the association between social phobia and depressive symptoms is mainly among individuals aged 18 to 24 years. In Saudi Arabia, Bassiony [25] reported that 58% of patients with social phobia had another current psychiatric disorder, 41% of patients had current depression, and 92.5% of them developed it after the onset of social phobia. He suggested that early recognition and treatment of social phobia may prevent the occurrence of depression. Several reports from clinical and nonclinical studies [26-30] suggest that social phobia predicts an increased risk for depression. In conclusion, prevalence of social phobia is relatively high among King Khalid University Medical Students. Also, social phobia is significantly associated with lower academic performance and depressive symptoms. Raising awareness about social phobia among medical students is necessary. Early detection and provision of psychiatric assistance is highly recommended to control the symptoms and prevent development of depression. References 1- SHAH P.S. and KATARIA L.: Social phobia and its impact in Indian university students, The Internet Journal of Mental Health, 6: 2, BENER A., ABOU-SALEH M.T., DAFEEAH E.E. and BHUGRA D.: The prevalence and burden of psychiatric disorders in primary health care visits in Qatar: Too little time? Journal of Family Medicine and Primary Care, 4 (1): 89, BÖGELS S.M., ALDEN L., BEIDEL D.C., CLARK L.A., PINE D.S., STEIN M.B. and VONCKEN M.: Social anxiety disorder: Questions and answers for the DSM_V. Depression and Anxiety, 27 (2): , FURMARK T.: Social phobia: Overview of community surveys. Acta Psychiatrica Scandinavica, 105 (2): 84-93, CHAN V.W.: Gender differences associated with social phobia: A developmental perspective. University of Toronto Journal of Undergraduate Life Sciences, 4 (1): 82-5, AL-GELBAN K.S., AL-AMRI H.S. and MOSTAFA O.A.: Prevalence of depression, anxiety and stress as measured by the depression, anxiety, and stress scale (DASS-42) among secondary school girls in Abha, Saudi Arabia. Sultan Qaboos University Medical Journal, 9 (2): 140-7, WITTCHEN H.U. and BELOCH E.: The impact of social phobia on quality of life. International clinical psychopharmacology, 11: 15-23, OHAYON M.M. and SCHATZBERG A.F.: Social phobia and depression: Prevalence and comorbidity. Journal of Psychosomatic Research, 68 (3): , King Khalid University. Website: RAULIN M.L. and WEE J.L.: The development and initial validation of a scale to measure Social Fear. Journal of Clinical Psychology, 40 (3): 780-4, BECK A.T., RIAL W.Y. and RICKETS K.: Short form of depression inventory: Cross-validation. Psychol. Rep., 34 (3): , AL-NAGGAR R.A.: Prevalence and associated factors of phobia and social anxiety among university students. ASEAN Journal of Psychiatry, 13 (2): , GILL J. and MOHAMMAD S.: P Social anxiety among medical undergraduate students in Malaysia. European Psychiatry, 25: 347, RABOCH J.: Prevalence of social phobia among medical students. European Psychiatry, 11 (4): 374s, KJELDSTADLI K., TYSSEN R., FINSET A., HEM E., GUDE T., GRONVOLD N.T., et al.: Life satisfaction and resilience in medical school-a six-year longitudinal, nationwide and comparative study. B.M.C. Med. Educ., 6 (48): 1-8, MOMANI F. and JARADAT A.M.: Social Phobia among University Students: Prevalence and Socio-Demographic Factors. Jordan Journal of Social Sciences, 4 (1): 71-88, ALKHATHAMI S., KAVIANIA H. and SHORTA E.: Social anxiety among adolescents and its relation to quality of life. European Proceedings of Social & Behavioural Sciences, eissn: , LÓPEZ L.J., RUIZ J., ALCÁZAR A.I., RODRÍGUEZ J.A., RODRÍGUEZ J.O. and MONTESINOS M.D.: Social Anxiety Scale for Adolescents (SAS-A): Psychometric properties in a Spanish-speaking population. International Journal of Clinical and Health Psychology, 5 (1): 85-97, HART T.A., TURK C.L., HEIMBERG R.G. and LIE- BOWIT M.R.: Relation of marital status to social phobia severity. Depression and Anxiety, 10: 28-32, TIMOTHY J.B. and ATEZAZ S.: Social anxiety disorder: A common unrecognized mental disorder. Am. Fam. Physician, 60 (8): , DAVIDSON J.R.T., HUGHES K.L., GEORGE L.K., et al.: The epidemiology of social phobia: Findings from the Duke Epidemiologic Catchment Area Study. Psychol. Med., 23: , SIMON N.M., OTTO M.W., KORBLY N.B., PETERS P.M., NICOLAOU D.C. and POLLACK M.H.: Quality of life in social anxiety disorder compared with panic disorder and the general population. Psychiatr. Serv., 53: 714-8, 2002.

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