SINGAPORE – Girls go through a sharp spike in social anxiety – the intense fear of being judged negatively in social situations – between the ages of 8½ and 13. By the age of 13, their social anxiety levels are significantly higher than boys’, according to a new local study led by NTU professor of psychology Setoh Peipei.
If left unchecked, social anxiety problems can have long-term repercussions for mental well-being, interpersonal relationships and academic or work performance later in life, said Prof Setoh. Her study is the first of its kind here to examine how different types of anxiety, such as separation anxiety and physical symptoms of anxiety, progress as children grow into early adolescence. This is defined as between the ages of 10 and 13.
It followed nearly 550 mother-child pairs over seven years. The children were asked at the age of six about their parents’ parenting behaviour, and their mothers also did questionnaires to assess their mental health. The children also completed questionnaires about their anxiety symptoms at the ages of 8½, 10 and 13.
The study was published online on Aug 30 in the journal Research On Child And Adolescent Psychopathology. Prof Setoh’s work comes on the back of national research showing that about four in 10 youth in Singapore experience anxiety symptoms severe enough that affect their daily life and require mental health intervention.
Prof Setoh said early adolescence often coincides with puberty, which is a period marked by complex physical, emotional and social changes for the child.
“During this period, being accepted and liked by their peers become especially important for teenagers’ self-esteem and mental health. As a result, both boys and girls may feel distressed if they struggle to fit in or lack the support needed to navigate these developmental shifts.”
Past research shows that girls face more emotional and social stress during puberty, she said. For example, changes during puberty may heighten their self-consciousness and feelings of shame or embarrassment about their appearance or behaviour. This raises the risk of social anxiety symptoms for girls.
Ms Denise Tan, clinical psychologist at Care Corner Insight, which provides youth mental health and counselling services, said girls are known to overthink more than boys, and are generally more attuned to others’ feelings. Hence, they worry more about how they are perceived by others, which leads to social anxiety, said Ms Tan, who was not involved in the study.
Prof Setoh’s study also examined how caregiving environments shape anxiety symptoms, and findings from the study offer insights to improve mental health screening and intervention efforts.
The 547 mother-child pairs that her team followed are part of the larger Growing Up in Singapore Towards Healthy Outcomes study, the nation’s largest research on how early life factors affect long-term health.
The team of eight was led by Prof Setoh, with Dr Germaine Tng, an NTU research fellow, as the main researcher.
The other researchers come from organisations such as the NUS Yong Loo Lin School of Medicine, A*Star’s Institute for Human Development and Potential, and KK Women’s and Children’s Hospital.
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Other forms of anxiety, such as separation anxiety, obsessive-compulsive symptoms and physical symptoms, tend to decline as children grow up. This is likely because of their growing cognitive abilities, which play a key role in helping them shift their focus away from troubling thoughts, said Prof Setoh. Separation anxiety is excessive distress about being apart from parents or other caregivers, while physical symptoms of anxiety include feeling jittery and having a racing heart. Obsessions are recurring thoughts that are distressing, and compulsions are repetitive behaviours driven by obsessions, such as frequent handwashing.
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Encouraging children to be independent can lower the risk of social anxiety worsening during the teenage years. Supporting the child’s independence and autonomy is crucial for building self-esteem and confidence in navigating new or unfamiliar social situations, Prof Setoh said.
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Meanwhile, children are more likely to develop worse anxiety symptoms in early adolescence if their mothers experience high levels of anxiety and parenting stress during pre-school years. This is because children may learn unhealthy ways of coping or thinking from their mother.
Prof Setoh added: “We need to provide early support for mothers who are experiencing psychological distress on their parenting journey because mothers’ well-being can have long-term impact on the family’s mental health.”
These findings show the importance of screening programmes to identify children at higher risk of social anxiety early, so they can get support before symptoms escalate.
Dr Jared Ng, a psychiatrist at Connections MindHealth who was not involved in the study, said many children who have social anxiety are not recognised or diagnosed early. Their anxiety is often mistaken for shyness or being reserved.
In younger children, he said social anxiety may manifest as headaches or stomach aches as they are afraid of being judged or embarrassed in school or other settings.
He added: “Teenagers often describe a constant fear of being judged, laughed at or being embarrassed. Everyday tasks like presenting in class, eating in the school canteen, or joining peers for activities can feel overwhelming.”
In one case, Dr Ng saw a teenage boy who struggled to speak up in class. This grew into a crippling fear of social interaction. To avoid interaction with others, he left his house only after midnight for long walks, and stopped attending school.
Said Dr Ng: “The important message is that social anxiety is not just a passing phase or a personality trait. If left untreated, it can persist into adulthood and limit a young person’s opportunities. But with early recognition, therapy and a supportive environment at home and in school, young people can learn to manage their fears and thrive socially and emotionally.”