Demographic differences in youths

Female participants reported higher social anxiety than males, consistent with prior research. ^{Reference Tang, Liu, Cai, Tian, Shi and Tang25} Biologically, as oestradiol levels rise and fall during the menstrual cycle, the brain’s response to fear changes. When levels are low, fear memories persist more readily and are harder to calm, so social situations can feel much more threatening. ^{Reference White and Graham26} Psychologically, females engage more than males in rumination and post-event self-evaluation, cognitive styles that prolong negative affect and amplify internalising distress, thereby sustaining social anxiety. ^{Reference Johnson and Whisman27}

Age differences were also notable: high school students (<18 years) exhibited the highest levels of social anxiety, followed by postgraduates, with undergraduate students reporting the lowest levels. Several developmental, contextual and role-transition factors can explain the U-shaped age gradient found in this study. First, mid-adolescence is a peak period for social-evaluative concern: puberty-related changes in self-consciousness, heightened peer salience and high-stakes examinations intensify fear of negative evaluation and avoidance learning, producing the highest rates of social anxiety in secondary school samples. ^{Reference La Greca and Harrison28} Second, the dip during undergraduate years may reflect a relatively supportive milieu: universities typically offer greater autonomy, diverse peer networks and structured extracurricular activities that bolster perceived belonging, buffering social anxiety. ^{Reference Conley, Kirsch, Dickson and Bryant29} Finally, social anxiety rises again in postgraduate study because reintegration into competitive academic roles coincides with supervisor dependence and uncertain career prospects; these stressors erode self-efficacy and reactivate avoidance cycles. ^{Reference Evans, Bira, Gastelum, Weiss and Vanderford30} Together, these developmental and environmental shifts map onto the observed U-curve, with adolescent vulnerability, undergraduate reprieve and postgraduate resurgence.

Non-smokers had higher social anxiety (Table 1), but smoking negatively predicted in regression analyses (Table 3). One possible explanation is that socially anxious youths often avoid settings where smoking takes place, whereas more outgoing peers may gravitate towards them. Evidence from a 12-year Finnish twin study (N = 1906) showed that adolescents rated high on social anxiety had lower cigarette use and fewer nicotine-dependence symptoms, probably because they avoided smoking-friendly gatherings (e.g. parties). ^{Reference Savage, Kaprio, Korhonen, Pulkkinen, Rose and Verhulst31} Consistent with longitudinal social network evidence, youths who reported more close friends also admitted lower social anxiety, suggesting that broader peer networks provide a buffer against anxious distress. ^{Reference Van Zalk, Van Zalk, Kerr and Stattin32} In contrast, we found no link between social anxiety and either BMI or household income. The pattern mirrors a United Arab Emirates University survey (N = 553) that reported no correlation between BMI categories and social anxiety scores, and also the population-based Young-HUNT3 study of Norwegian adolescents (N = 6600), in which family income strata did not differentiate full, subclinical or performance-only social anxiety presentations (χ ² = 2.52, P = 0.28). ^{Reference Dalla, Maziek, Hamood, AlRaeesi, Mogharbel and Omran33}

Post-pandemic ‘perfect storm’ drives a surge in youth social anxiety

The findings in Table 2 reveal a strikingly high prevalence of social anxiety symptoms among youths, with 69.55% of participants reporting at least mild levels of social anxiety, substantially higher than those reported in pre-pandemic studies. Previous epidemiological data typically indicated that SAD affected approximately 36% of the youth population globally. ^{Reference Jefferies and Ungar3} The sharp increase observed in this study may reflect the lingering fallout of COVID-19 containment measures, such as lockdowns, remote learning and mask-wearing, which together created a ‘perfect storm’ that heightened youths’ vulnerability to social anxiety.

First, prolonged stay-at-home orders sharply curtailed everyday peer interactions (e.g. classroom chatter, lunchtime conversations, extracurricular activities) that typically provide repeated exposure and gradual mastery of social cues. Without these low-stakes encounters, many youths experienced a kind of ‘deconditioning’: the longer they remained isolated, the more novel and threatening ordinary face-to-face situations felt when restrictions eased. ^{Reference Lorito, Masud, Gladman, Godfrey, Dunlop and Harwood34} Thompson et al ^{Reference Thompson, Mancebo and Moitra35} documented this trajectory, showing that mean social interaction anxiety scale scores rose significantly during lockdown and remained elevated 3 months after schools had reopened, suggesting that symptoms did not spontaneously remit once isolation ended.

Second, remote learning compounded the problem by shifting virtual academic and social exchanges to screens. Video platforms allow students to mute microphones, turn off cameras or hide behind profile images; these behaviours function as online safety behaviours, mirroring avoidance in vivo and preventing disconfirmation of negative social beliefs. ^{Reference Castelli and Sarvary36} Consequently, socially anxious students may have received fewer corrective experiences (e.g. realising that minor mistakes are usually tolerated), reinforcing catastrophic predictions about being judged. A Finnish nationwide survey (N = 150 000 adolescents) showed that ≥2 months of distance education was associated with a higher risk of clinically relevant social anxiety, even after adjusting for general anxiety and depression. ^{Reference Ranta, Aalto-Setälä, Heikkinen and Kiviruusu37}

Finally, mask-wearing produced a subtler, bidirectional effect. On the one hand, masks can act as a portable safety cue that temporarily buffers self-conscious youths from perceived scrutiny; on the other, they obscure facial expressions and muffle speech, increasing ambiguity in social exchanges. ^{Reference Xia, Xu and Ding16} Ambiguous cues are interpreted more negatively by socially anxious individuals, heightening fears of being misunderstood or negatively evaluated. ^{Reference Carbon38} Moreover, when mandates were lifted, removing the mask required relinquishing this protective barrier, which many youths described as feeling overexposed, leading to spikes in avoidance and worry about appearance or blushing. ^{Reference Aguayo-González, Leyva-Moral, Giménez-Diez, Colom-Cadena, Martínez and Watson15} In a sample of 223 Chinese university students, higher levels of social anxiety significantly predicted a stronger intention to keep wearing masks after mandates were lifted, indicating that face coverings served as both an impression-management aid and an avoidance mechanism. ^{Reference Xia, Xu and Ding16}

These findings offer updated evidence on the severity and scope of social anxiety among youth in the post-pandemic era, underscoring an urgent need for targeted mental health interventions and prevention strategies adapted to this new context. The challenges in early identification have increased due to factors such as the ‘new normal’, including digital learning, prolonged mask-wearing and the shift towards online socialisation, which can obscure typical warning signs. Existing assessment tools and diagnostic methods may no longer fully capture the nuanced presentation of social anxiety in this era, highlighting the need for updated approaches. Consequently, there is a pressing need to develop tailored prevention and treatment strategies that address the unique experiences of youths under these evolving conditions.

Depression as a robust correlate of social anxiety severity

The regression analysis confirmed that depression is closely intertwined with social anxiety severity. Even when controlling for other factors, depression remained a significant predictor in this study. This aligns with literature showing high comorbidity and interdependence between social anxiety and depression in youth. ^{Reference Beesdo, Bittner, Pine, Stein, Höfler and Lieb9} Youths with social anxiety often develop depression, possibly due to the chronic stress of social fear and resultant isolation. Conversely, youths with depression may withdraw from social activities and develop secondary social anxiety. Although causality cannot be determined from the current data, the findings reinforce the importance of screening for depression in socially anxious youth. At the same time, social anxiety should be recognised as a potential early warning sign in the identification of youth at risk of depression.

Why expected buffers failed to predict social anxiety severity

Although sleep disturbances are commonly reported among anxious individuals and are theorised to have a bidirectional relationship with anxiety, the present study found that, after accounting for depression, sleep was not an independent predictor of social anxiety severity. This suggests that the association between poor sleep and social anxiety may be confounded or mediated by depressive symptoms, which themselves can disrupt sleep quality. ^{Reference Ma, Li, Zhang, Zuo, Kong and Yang11} Similarly, perceived social support did not independently predict lower social anxiety in the regression model, despite theoretical expectations that it would function as a protective factor. There are two possible explanations for this: first, measurement limitations. Researchers have argued that brief global support scales may not capture the kinds of support most relevant to socially anxious youths (e.g. coaching for challenging conversations, emotion-focused validation after embarrassing moments). The present study likewise relied on a broad social support index, which may have lacked the granularity needed to detect these subtle but important resources. Qualitative work by Nickerson and Nagle ^{Reference Nickerson and Nagle39} echoes this concern: socially anxious adolescents report valuing highly specific guidance, such as feedback on initiating conversation, yet rarely endorse such needs on general support checklists. ^{Reference Nickerson and Nagle39} Second, cultural filtering of support perceptions: East Asian youths often downplay personal needs to maintain group harmony; support may be re-coded as unwanted attention, especially in socially anxious individuals who already filter social cues negatively. As a result, youths may subjectively discount otherwise supportive environments, and this tendency is further intensified by the negative cognitive biases characteristic of social anxiety.

Stigma: a key driver of youth social anxiety

The study found that stigma is also a significant predictor of anxiety severity. This suggests that youths who feel ashamed of their anxiety, or feel that others would judge them for it, tend to have more severe symptoms. This could operate in several ways. Stigma might worsen social anxiety by adding an extra layer of anxiety about the anxiety: for instance, being afraid that one’s anxious behaviours (like trembling or avoiding eye contact) will be noticed and mocked. This meta-anxiety can amplify avoidance and fear, thereby raising overall severity.

Additionally, feeling stigmatised can discourage youths from seeking help or opening up about their fears, potentially prolonging or intensifying social anxiety symptoms. This challenge is particularly pronounced in late adolescence and early adulthood, a developmental stage marked by heightened sensitivity to social evaluation and a still-forming sense of self-worth. Intervention efforts should aim to reduce stigma – for example, through anti-stigma campaigns and anonymous support services.

To break the stigma–anxiety spiral highlighted in this study, two policy moves are paramount. First, mandate annual, school-wide mental health screenings in all lower and upper secondary schools, using brief validated tools for social anxiety, depression and stigma attitudes; early detection will bring hidden cases into view and link students to counselling or digital self-help resources. Second, launch youth-centred anti-stigma campaigns on platforms popular with adolescents, such as BiliBili, WeChat Channels and Douyin, that normalise everyday anxiety, share recovery stories and portray help-seeking as a mark of strength.

Avoidance as a key mechanism of internalised stigma

A notable finding of this study is that, among the dimensions of social anxiety, avoidance behaviour uniquely correlates with internalised stigma whereas fear and physical symptoms do not. This suggests that avoidance may play a pivotal role in how individuals with social anxiety internalise stigma. Avoidance behaviours, often employed to mitigate immediate anxiety, can inadvertently reinforce negative self-perceptions and social stereotypes, thereby perpetuating internalised stigma. ^{Reference Ohse, Hadžić, Mohammed, Peperkorn, Fox and Krutzki40} This cycle not only maintains the severity of social anxiety but also hinders individuals from seeking help due to the fear of judgement. ^{Reference Avramchuk, Plevachuk and Suvalo41} Clinically, these findings underscore the importance of targeting avoidance behaviours in therapeutic interventions, such as behavioural therapy and virtual reality-based exposure, to reduce social anxiety and associated functional impairments. By addressing avoidance, not only can the cycle of anxiety be disrupted, but the internalised stigma associated with social anxiety can also be alleviated. This dual approach may enhance treatment efficacy and encourage individuals to seek the support they need.

Recommendations

Clinically, these results underscore the importance of targeting avoidance with evidence-based techniques that also reduce self-stigma. Two options stand out: (a) cognitive–behavioural therapy with graded exposure, which pairs stepwise social challenges with cognitive restructuring to disconfirm catastrophic beliefs, and has consistently strong effects in youth; and (b) virtual reality exposure therapy, which offers realistic yet controllable social simulations and achieves treatment gains similar to in vivo exposure, while also being highly acceptable to youths who may refuse face-to-face exercises. This study highlights the urgent need to bridge the widening gap between adolescents’ evolving mental health needs and outdated support systems – aptly captured by the metaphor, ‘The feet have grown, but the shoes have not changed size’.

Limitations

Despite its strengths, this study has several limitations. First, the online recruitment method may have limited sample representativeness, introducing selection bias toward tech-savvy or urban youth. Second, another key limitation is the reliance on self-report instruments, which are susceptible to social desirability and recall biases, particularly for sensitive constructs such as stigma. Future studies should incorporate multi-method assessments, including clinician-rated interviews and behavioural tasks, to cross-validate self-reports. Third, the modest R ² value of 0.24 in the final model indicates that, while depression and stigma are important predictors of social anxiety, a substantial proportion of variance remains unexplained. This suggests that other unmeasured factors, such as parenting style, peer bullying, family functioning or academic stress, may also play meaningful roles. Future research should incorporate these additional psychosocial and contextual variables to build a more comprehensive predictive model.