Change And Associated Factors Of Social Anxiety Symptoms Among Children In One Rural Area Of Anhui Province: A 2-year Fellow-up Study

Objective To explore the longitudinal development trend of social anxiety symptoms among children in one rural area of Anhui China, and to examine the developmental differences of social anxiety symptoms in different age, gender, and left-behind status; and to assess the longitudinal relationships between social anxiety symptoms and socio-demographic, family environment and psychosocial factors, in order to provide evidence for early intervention related to childhood social anxiety symptoms.Methods At baseline, children in grades 3–9 from three secondary schools and five elementary schools in Changfeng County of Anhui Province were recruited by cluster sampling methods to complete the initial assessment. Questionnaires about children’s physical and mental health and related life experience were applied to assess the socio-demographic, family environment, and psychosocial factors and social anxiety symptoms. Children in grades 3, 4, and 7(at baseline) from all the selected schools were invited to participate in the follow-up surveys. The data collection involved a baseline survey and two follow-up assessments. These two follow-up assessments were spaced approximately 12 months apart and covered 2 years using the same questionnaires. A total of 816 children completed the three assessments. The difference in social anxiety symptoms between the three assessments was examined using repeated measures analysis of variance. Generalized estimating equations(GEE) were used to assess the longitudinal relationships between related factors and social anxiety symptoms.Results Prevalence of children’s social anxiety was 15.7%, 15.2%, and 16.4% at the three assessments, respectively; but the difference was not statistically significant. Children’s mean Social Anxiety Scales for Children(SASC) scores were 5.6(SD = 3.7), 5.3(SD = 3.8), and 5.3(SD = 4.1) at the three assessments, respectively, the difference was statistically significant. Mean SASC scores declined slightly for male children over the 2-year follow-up period, but remained relatively constant for female children. Besides, the SASC scores of left-behind children were slightly declined from 5.9 to 5.6 over follow-up period, but the difference was not statistically significant. For non-left-behind children, the SASC scores remained relatively constant. Multivariable logistic regression analysis(GEEs) indicated that the greater age, good family function, the higher level of quality of life, positive coping, and the higher level of self-esteem were protective factors for childhood social anxiety symptoms, while depressive symptoms and negative coping were risk factors for childhood social anxiety symptoms.Conclusions Overall, social anxiety symptoms showed a stable pattern over time but with the noticeable rate at the primary and secondary school age. Besides, the 2-year trajectories of changes in children social anxiety symptoms among different subgroups tended to be somewhat diverse. From the point of longitudinal assessment, social anxiety symptoms are associated with age, family function, quality of life, coping styles, depression, and self-esteem. These findings suggested that social anxiety symptoms are dynamic and changing construct during childhood, which notice that social anxiety symptoms may be reduced by appropriate intervention. Early intervention aiming to these identified risk and protective factors may provide scientific evidence for reducing childhood social anxiety symptoms and promoting children’s health development.