“Tracing the impact of childhood adversity on social anxiety in late adolescence: the moderating role of social support and coping strategies”

Introduction

Adverse Childhood Experiences (ACEs) refer to distressing events that take place during early life, such as physical or emotional abuse, neglect, or parental substance abuse [1]. These experiences can profoundly impact a child’s brain development as well as their social, emotional, and behavioural development [2], 3]. Studies have shown that these experiences can affect children’s emotional regulation, increasing vulnerability to stress and anxiety [2], 4]. Social anxiety, in particular, is a common mental health problem among children and adolescents, characterized by excessive and persistent fear or anxiety in social situations [5]. While the effects of ACEs on social anxiety are well-documented in children and adolescents, less is known about the long-term impact of ACEs on social anxiety in young adulthood. Early life stressors, as measured by the Adverse Childhood Experiences (ACE) framework [1], have lasting psychological impacts, potentially increasing the risk of social anxiety [4], [5], [6]. These stressors, including abuse, neglect, parental loss, and other traumatic events, can disturb a child’s sense of emotional safety and impact their physical and mental well-being [3]. ACEs affect psychological, social, and academic outcomes, increasing the risk for mental health disorders like social anxiety [2], 7].

Socially, early life stressors can impact interpersonal dynamics, social competence, and peer interactions, which are critical during the college years [2]. A child who endures a difficult childhood and unsatisfactory parenting may be more vulnerable to numerous phobias [8]. With a 9.1 % incidence among adolescents, social interaction anxiety is a concern that requires attention [9]. [8] study on parenting styles and social interaction anxiety in Indian teenagers showed that social anxiety is prevalent among Indian teens. In India, the traditional joint family and collectivistic culture can both buffer and exacerbate the effects of early adversities, depending on the quality of familial relationships [10]. Collectivist family structures often provide robust support that can mitigate stress, but they can also impose pressure due to high parental expectations and the emphasis on family honor [10], 11]. Furthermore, societal stigma and limited mental health services in collectivistic societies can hinder help-seeking, potentially perpetuating social anxiety [12], 13]. High levels of childhood adversity are linked to increased social anxiety, as unresolved trauma may lead to maladaptive coping strategies like avoidance [9], 14].

Perceived social support (PSS), encompassing emotional, informational, and instrumental support, significantly impacts mental health [15]. It refers to an individual’s belief in the availability and adequacy of support from their social network [16]. Among university students, perceived social support is negatively associated with social anxiety, meaning the higher the level of perceived support is, the lower the level of social anxiety is [17]. However, few studies have examined this relationship in the Indian cultural context, where social structures and support systems differ markedly from those in Western societies [10], 18]. For instance, the joint family system in India often provides a strong support network that can cushion against stress, but it may also add performance pressure due to familial expectations [11]. Additionally, in a collectivistic culture like India, support is often community-oriented, which is different than the more individualistic support systems prevalent in Western cultures [10], 18]. Understanding these dynamics is critical for developing culturally sensitive interventions aimed at reducing social anxiety by strengthening support networks.

Social anxiety is a growing mental health concern among Indian college students, exacerbated by intense academic and social pressures [19], 20]. Coping strategies are crucial in managing these challenges and maintaining well-being [21], 22]. The Brief COPE inventory divides coping into three types: problem-focused, emotion-focused, and avoidant-focused strategies [23]. Problem-focused coping, which directly addresses stressors, is linked to better psychological adjustment and reduced social anxiety symptoms [24]. Emotion-focused coping can help regulate emotional responses but may inadvertently worsen anxiety over time if it does not address underlying problems [25], 26]. Avoidant-focused coping, such as denial or withdrawal, have been associated with poorer mental health outcomes and higher social anxiety [24], 25]. Emerging adults are particularly vulnerable to social anxiety’s impacts, which can impair academic performance and social functioning [27]. Although coping strategies are known to affect social anxiety, gaps remain in the literature, particularly in regards to the use of the Brief COPE among Indian college students.

Considering the unique cultural context and the significant life transition that Indian college students experience, understanding the impact of ACEs on social anxiety in young adults is critical. By examining the relationships between ACEs, perceived social support, and coping strategies, this study aims to discover key factors contributing to social anxiety in this population. This research is especially important given the high prevalence of social anxiety in young adults and its potential to harm academic performance and overall well-being [28]. Investigating these relationships can provide insights to inform future research and help develop culturally tailored interventions and support systems for students.

Research methodology

Results

This study investigates the relationship between early life stressors, social anxiety, perceived social support, and coping mechanisms used by Indian college students. In this study responses of 210 subjects who fall within the ages of 17–21 years was collected. Purposive sampling was the sampling technique used in this study. Descriptive statistics such as means, standard deviations, ranges, and measures of skewness and kurtosis for key variables – Adverse Childhood Experiences (ACE), Social Interaction Anxiety Scale (SIAS), Multidimensional Scale of Perceived Social Support (MSPSS), and the three coping strategies measured by the Brief COPE Inventory (Problem-Focused Coping (PFC), Avoidant-Focused Coping (AFC), and Emotion-Focused Coping (EFC)) – were calculated and Pearson correlation analyses were performed to examine the relationships between these variables. Regression analyses were conducted to determine the predictive power of ACE and MSPSS on SIAS. Additionally, Repeated Measure ANOVA was used to compare the effectiveness of the different coping strategies in managing social interaction anxiety, followed by pairwise comparisons to further explore the differences between these strategies.

As shown in Table 1, the Mean and SD (Standard Deviation) of Adverse Childhood Experiences Test (ACE), indicate variability in early life stressors among participants. The Mean and SD of Social Anxiety (SIAS) suggest a broad range of social anxiety levels within the sample. The Multidimensional Scale of Perceived Social Support (MSPSS) showed a higher mean score, reflecting varied perceived social support. Problem-Focused Coping (PFC), Avoidant-Focused Coping (AFC), and Emotion-Focused Coping (EFC) Mean and SD scores highlight the different reliance on coping mechanisms within the sample.

As shown in Table 2, significant correlations emerged between key variables of interest. ACE scores exhibited a positive correlation with SIAS, in contrast, the MSPSS scores showed a significant negative correlation with SIAS. Moreover, Avoidant-focused coping was positively correlated with ACE & SIAS.

Linear regression analysis demonstrated that ACE scores significantly predict SIAS scores (B=3.067, SE=0.721, p<0.001), accounting for approximately 8 % of the variance in social anxiety levels among participants (R²=0.08, Adjusted R²=0.076). This result shown in Table 3 indicates that for each unit increase in ACE score, there is an associated increase of approximately 3.067 points on the SIAS, highlighting the profound impact that early life stressors have on social anxiety. The model’s overall fit was confirmed as statistically significant with an F-value of 18.088 (p<0.001), underscoring the robustness of the relationship between these variables.

Table 4 reveals a negative association between MSPSS & SIAS. Specifically, an increase in perceived social support is associated with a decrease in social anxiety scores. The regression model, with MSPSS as the predictor and SIAS as the dependent variable, presents an R-squared value of 0.038, indicating that approximately 3.8 % of the variance in SIAS scores is accounted for by variations in MSPSS scores. The adjusted R-squared value is slightly lower at 0.033, providing a more conservative estimate after adjusting for the degrees of freedom. The ANOVA results show that the regression model is statistically significant at 0.005, supporting the validity of the model. The regression coefficient for MSPSS is significant at the 0.005 level. This suggests a substantive inverse relationship between MSPSS and SIAS, where higher levels of perceived social support are linked to lower levels of social anxiety.

From Table 5, we can infer that there was a statistically significant difference in coping strategies used by the students, Mean value indicating that Emotion Focused Coping (EFC) is used most followed by Problem Focused Coping (PFC) and Avoidant Coping (AFC).

Discussion

This research aims to investigate the relationships between adverse childhood experiences (ACEs), social anxiety (SIA), perceived social support (PSS), and coping strategies among Indian students. The prevalence of adverse childhood experiences (ACEs) among Indian students is significant. For instance, research by [31] found high levels of reported childhood adversity among Indian youth. Social anxiety is prevalent among college students in India, influenced by the competitive educational environment and familial expectations [11], 32]. Perceived social support (PSS) is a key contributor to psychological resilience and overall mental health in Indian student populations. The findings from several studies indicate that students with a high level of perceived social support tend to have better mental health outcomes and reduced level of social anxiety [15], 33]. Social support systems in India, often involving close family ties and community networks, provide emotional and instrumental assistance that helps buffer the effects of stress and anxiety [34].

The study found a moderate positive correlation between ACEs and social anxiety (SIAS), suggesting that individuals who have experienced more early-life adversity are more likely to exhibit higher levels of social anxiety. This aligns with prior findings that emphasize the lasting impact of childhood adversity on mental health outcomes [1]. The relationship between ACE-SIAS is compounded by the significant negative correlation between ACE and Perceived social support, highlighting a critical area for intervention. Individuals with higher ACE scores not only experience an increased level of social anxiety but also perceive less social support, which could exacerbate their anxiety symptoms. Higher levels of perceived social support are associated with lower levels of social anxiety, underscoring the protective role of social support in reducing anxiety, especially in the context of Indian college students who face significant academic and social pressures [35]. The findings suggest that a holistic perception of social support, encompassing emotional, informational, and instrumental support from various sources, may be more effective in reducing social anxiety. The protective role of perceived social support is evident in its negative correlation with SIAS and AFC, and its positive correlation with PFC and EFC. The results indicate that strengthening social support systems may serve as an effective approach in mitigating social anxiety and promoting more adaptive coping mechanisms.

The ACE-SIAS regression analysis not only indicates a positive correlation between ACE and social anxiety levels suggesting that individuals who were exposed to traumatic events during childhood are likely to exhibit higher levels of social anxiety in adulthood, but also reveals that ACE scores explained approximately 8 % of variation in social anxiety scores, underscoring the lasting impact of childhood adversity on mental health outcomes. The cultural emphasis on academic and social achievement in India, coupled with the potential for family-related stressors, can exacerbate the detrimental impact of adverse childhood experiences (ACEs) on the development of social anxiety among Indian college students [11], 36].

A significant negative relationship was found between perceived social support and social anxiety, suggesting that greater perceived social support is linked to reduced social anxiety symptoms. This finding is consistent with the stress-buffering model, which theorizes that social support can mitigate the adverse effects of stress [33]. Regression analysis further demonstrated that perceived social support significantly predicted social anxiety levels, accounting for 3.8 % of the variance. This highlights the protective role of social support in reducing anxiety, especially in the context of emerging adults living in India who face significant educational and societal demands [35]. By mitigating the effects of ongoing stressors, perceived social support helps alleviate social anxiety symptoms, thus acting as a buffer against the long-term impacts of ACEs. The importance of perceived social support is particularly salient in the Indian context, where familial and community expectations can place significant pressure on college students [11], 37]. In collectivistic cultures like India, the joint family system and strong social connections traditionally help mitigate stress and anxiety [10]. However, with rapid urbanization and modernization, these support structures may be evolving, potentially altering their effectiveness in reducing social anxiety among college students [10].

Analysis of the three coping strategies reveals that Emotion Focused Coping (EFC) is the most employed coping strategy among the students, followed by Problem Focused Coping (PFC), and finally, Avoidant Focused Coping (AFC). The significant differences in the use of these strategies highlight the varying ways students manage stress and anxiety. Emotion-focused coping is positively correlated with social anxiety symptoms, indicating that individuals with social anxiety may rely on emotional regulation to cope with their fears. Research has shown that individuals who are socially anxious often have difficulty recognizing and regulating their emotions and may benefit from seeking emotional support from others [38], 39]. While this approach can provide short-term relief, research suggests that over-reliance on emotion-focused coping may exacerbate social anxiety in the long run, as it does not focus on the root causes of the problem [27], 40], 41].

Indian culture emphasizes the importance of maintaining harmony, avoiding confrontation, and relying on social support systems [10], 42]. Students may be more inclined to use EFC strategies, such as seeking emotional support from family and friends, to cope with stress while avoiding direct problem-solving approaches that could be seen as disruptive to social relationships [21], 22]. Additionally, Indian college students often face immense academic pressure and high expectations from their parents. The fear of failure and the desire to meet these expectations can lead to increased stress and anxiety [11], 19]. Students may turn to EFC strategies, such as positive reappraisal and acceptance, to manage their emotions and maintain a positive outlook in the face of academic challenges [43], 44]. Finally, in some parts of India, there may be a lack of awareness and limited access to professional mental health resources, causing students to rely more on EFC strategies, such as engaging in religious activities or seeking emotional support from peers, as they have fewer options for seeking formal help in managing their anxiety.

The findings also indicate the use of AFC, although the least frequent, suggesting that some students might still resort to avoidance as a coping mechanism, which can have implications for long-term mental health outcomes. The study did find a significant positive correlation between Social Anxiety (SIAS) and Avoidant-Focused Coping (AFC) scores, highlighting a critical aspect of how individuals manage their anxiety. This finding is consistent with previous research suggesting that those with higher levels of social anxiety are more likely to engage in avoidant coping strategies [27], 45], 46]. Avoidant coping, which includes behaviours such as denial, distraction, and substance use etc. can lead to long-term anxiety as it reinforces the cycle of fear [23], 24], 47]. This study highlights the critical role of perceived social support and coping strategies in mitigating the effects of ACEs on social anxiety. The findings emphasize the need for interventions promoting problem-focused coping and enhancing social support networks.

Conclusions

This study underscores the significant impact of Adverse Childhood Experiences (ACEs) on social anxiety among Indian college students, revealing that higher ACE scores are associated with increased social anxiety. Higher levels of perceived social support are associated with lower levels of social anxiety, highlighting its protective role. The reliance on emotional-focused coping strategies and the use of avoidant coping strategies call for targeted interventions to promote more adaptive coping mechanisms. Culturally sensitive mental health interventions focusing on enhancing social support and fostering effective coping strategies are essential for addressing the mental health needs of Indian college students. Future research should explore longitudinal impacts and regional differences to inform tailored interventions.