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Behavioral Psychology / Psicología Conductual, Vol. 16, Nº 2, 2008, pp. 163-187
SOCIAL ANXIETY IN 18 NATIONS: SEX AND AGE DIFFERENCES
Vicente E. Caballo
1
, Isabel C. Salazar
2
, María Jesús Irurtia
3
,
Benito Arias
3
, Stefan G. Hofmann
4
and CISO-A Research Team
1
University of Granada (Spain),
2
Pontificia Javeriana University at Cali (Colombia),
3
University of Valladolid (Spain),
4
Boston University (USA)
Abstract
The aim of this study was to examine age and sex differences in 6 dimensions
of social anxiety in a sample of 16,940 people over the age of 16 in 18 countries in
Ibero-America. Participants completed the «Social Anxiety Questionnaire for Adults»
(SAQ-A), which includes the following dimensions: 1. Awkward behavior in socially
embarrassing situations; 2. Interactions with the opposite sex; 3. Interactions with
strangers; 4. Criticism and embarrassment; 5. Assertive expression of annoyance,
disgust or displeasure; and 6. Speaking/performing in public/Talking with people in
authority. The results showed that women reported significantly more anxiety than
men in 88.67% of the social situations covered by the SAQ-A. All but three countries
showed significant sex differences in social anxiety with women reporting greater
anxiety than men. With regards to age, the younger age groups (up to the age of
24) showed greater sex differences in social anxiety depending on the specific social
This study was made possible by a grant from Spain’s Ministry of Science and Technology awarded
to the research project with reference BSO2003-07029/PSCE and co-financed by the European Regional
Development Fund (ERDF).
Stefan G. Hofmann is supported by a grant from the National Institute of Mental Health (MH075889)
and is a consultant for Organon.
We heartily appreciate the collaboration of all the subjects from the different countries who volun-
tarily participated in this study.
The CISO-A Research Team, co-author of this article, is composed of the following researchers:
Argentina
(G. Bragagnolo, A. Ciliberti, M. Correche, L. Gómez, M. Rivarola, P. Robles, S. Savoini, M.
Tapia),
Australia
(T. Oei),
Bolivia
(J. Arce, D. Pinelo),
Brazil
(B. Donato,
Brazil (B. Donato,Brazil
L.
Lourenço,
K. Matos, M. Oliveira,
N. Susin,
R. Teixeira,
M. Wagner
),
Chile
(I. Correa, M. Donoso, K. Garcés, C. Soto),
Colombia
(D. Cáceres,
H. Castañeda, C. Gaviria, J. Gómez, R. Mazo, X. Palacios, B. Ruiz, M. Varela),
Ecuador
(Y. Dávila),
Ecuador (Y. Dávila), Ecuador
El
Salvador
(O. Olmedo, O. Olmedo M.),
Salvador (O. Olmedo, O. Olmedo M.), Salvador
Spain
(P. Bas, M. Fernández, S. Lago, C. Rausell),
Guatemala
(G.
Aguilar, A. Rodríguez),
Mexico
(S. Anguiano, M. Ascencio, G. García, F. Gil, M. González, L. Hernández,
R. Landero, J. Olvera, R. Robles-García, F. Páez, M. Ríos, M. Vila),
Paraguay
(A. Caballero, R. Estigarribia,
Paraguay (A. Caballero, R. Estigarribia, Paraguay
M. Silva),
P
eru
PeruP
(V. Barreda, C. Segura),
Portugal
(R. Barroso, F. Cardoso, P. Carvalho, M. Loureiro),
Portugal (R. Barroso, F. Cardoso, P. Carvalho, M. Loureiro), Portugal
Uruguay
(M. Golberg, M. Lagos), USA (R. Acierno) and
Venezuela
(J. Pellicer).
Correspondence
: Vicente E. Caballo, Faculty of Psychology, University of Granada, 18071 Granada
(Spain). E-mail: vcaballo@ugr.es
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anxiety dimensions. Finally, anxiety and age was positively associated for some social
anxiety dimensions and negatively or U-shaped for others. Although the sample size
was very large, some of the results will require future replication.
KEY WORDS
:
social anxiety, social phobia, age differences, sex differences, cross-
cultural differences, size effect.
Resumen
El objetivo de este estudio consiste en examinar las diferencias asociadas
a la edad y el sexo en 6 dimensiones de la ansiedad social en una muestra de
16.940 sujetos con una edad superior a 16 años en 18 países iberoamericanos. Los
participantes rellenaron el «Cuestionario de ansiedad social para adultos» (CASO-
A), que consta de las siguientes dimensiones: 1. Quedar en evidencia/Hacer el
ridículo, 2. Interacciones con el sexo opuesto, 3. Interacciones con desconocidos,
4. Situaciones de crítica y ridículo, 5. Expresión asertiva de molestia, desagrado o
enfado, y 6. Hablar/actuar en público/Interacción con personas de autoridad. Los
resultados mostraron que las mujeres informaban de más ansiedad que los hombres
en el 88,67% de las situaciones sociales incluidas en el CASO-A. Todos los países,
menos tres, mostraron diferencias significativas en ansiedad social asociadas al sexo,
siendo las mujeres las que informaban de más ansiedad que los hombres. Con
respecto a la edad, los grupos de personas más jóvenes (hasta la edad de 24 años)
mostraban diferencias sexuales en ansiedad social más acusadas dependiendo,
no obstante, de las dimensiones específicas de la ansiedad social. Finalmente, la
ansiedad y la edad estaban asociadas positivamente en algunas dimensiones de
ansiedad social y negativamente o en forma de U en otras. Aunque el tamaño de la
muestra era bastante grande, es necesario que algunos de los resultados obtenidos
en el presente estudio sean replicados en trabajos posteriores.
PALABRAS CLAVE:
ansiedad social, fobia social, diferencias de edad, diferencias de
sexo, diferencias transculturales, tamaño del efecto.
Introduction
Social anxiety disorder, or social phobia, is one of the most frequent mental
disorders in the world, after depression and alcohol abuse (Davidson, Hughes,
George, & Blazer, 1993, 1994; Kessler, et al.
,
1994; Kessler, Stang, Wittchen, Stein,
& Walters, 1999; Lecrubier, Wittchen, Faravelli, Bobes, Patel, & Knapp, 2000; Magee,
Eaton, Wittchen, McGonagle, & Kessler, 1996; Schneier, Johnson, Hornig, Liebowitz,
& Weissman, 1992; Stein, Walker, & Forde, 1994; Weinstock, 1999), with which,
in turn, it has high comorbidity (Chartier, Walker, & Stein, 2003; Erwin, Heimberg,
Juster, & Mindlin, 2002; Fehm, Beesdo, Jacobi, & Fiedler, 2008; Fogler, 2005; Ham, &
Hope, 2005; Lampe, Slade, Issakidis, & Andrews, 2003; Merikangas, & Angst, 1995;
Morris, Stewart, & Ham, 2005; Swinson, 2005; Weinstock, 1999; Yonkers, Dyck,
& Keller, 2001). Social phobia is highly comorbid with other anxiety disorders (e.g.,
panic disorder, agoraphobia, specific phobia) or other mental disorders. In most
cases (except for specific phobia) social phobia precedes other mental disorders and
appears to serve as a risk factor for their onset (Chartier, et al.
,
2003; Dell’Osso, et
al.
,
2002; Fehm, et al.
,
2008; Lampe, et al.
,
2003; Magee, et al.
,
1996; Merikangas,
165
Social anxiety in 18 nations: sex and age differences
Avenevoli, Acharyya, Zhang, & Angst, 2002; Nelson, et al.
,
2000; Spitzer, Williams,
Gibbon, & First, 1992; Turk, et al.
,
1998; Wittchen, Stein, & Kessler, 1999).
Diagnostic criteria based on the DSM-IV-TR (American Psychiatric Association
[APA], 2000) for social phobia include the fear of social or performance situations
in which embarrassment may occur, associated with avoidance of these situations
or their endurance with intense anxiety or distress. This avoidance or distress
interferes significantly with the person’s normal routine, occupational and academic
performance, social activities and relationships. Social phobia follows a chronic
course and has a negative impact on the individual’s satisfaction with, and quality of,
life (Brunello, et al.
,
2000; Fehm, et al.
,
2008; Kessler, et al.
,
1999; Lecrubier, et al.
,
2000; Safren, Heimberg, Brown, & Holle, 1997; Schneier, et al.
,
1994; Weinstock,
1999; Wittchen, Fuetsch, Sonntag, Müller, & Liebowitz, 2000). Only few people
seek treatment, and when they do it is often because of the comorbid disorders
(Fehm, et al.
,
2008; Magee, et al.
,
1996; Merikangas, et al.
,
2002; Ruscio, Brown,
Chiu, Sareen, Stein, & Kessler, 2008; Schneier, et al.
,
1992; Wittchen, et al.
,
1999).
Individuals who suffer from social phobia tend to spend more time on their
own and avoid personal interaction and contact with others. They tend to be
less successful in initiating and upholding romantic and affective relationships
and friendships. Furthermore, they often find it difficult to improve their level of
education, hold a job, be productive, increase their income, and they have problems
finding social support at a difficult time in their lives (Caballo, 1995; Fehm, et al.
,
2008; Wittchen, et al.
,
2000). Finally, individuals with social phobia often develop
other mental disorders and are exposed to a greater risk of suicide (Caballo, &
Turner, 1994; Davidson, et al.
,
1993; Nelson, et al.
,
2000; Schneier, et al.
,
1992;
Yonkers, et al.
,
2001). Consequences of this nature can be observed especially in
those who have multiple social fears (Ruscio, et al.
,
2008; Wittchen, et al.
,
1999).
In a broader sense, the problems caused by social phobia can even have
a bearing on public health, the economy, and a country’s development due to
the impact the disorder has on work productivity, professional training, and the
opportunities for improving the standards of living (Nardi, 2005; Waghorn, Chant,
White, & Whiteford, 2005; Wittchen, et al.
,
2000), as well as increasing the cost of
treatment (including drugs).
So far, no causal factors for social phobia have been clearly identified, but
correlational studies point to a number of possible etiologies. For example, social
fears are heritable, although the estimated degree of heritability ranges between 28
and 51% (Kendler, Karkowski, & Prescott, 1999; Nelson, et al.
,
2000), and especially
in men (Kendler, Jacobson, Myers, & Prescott, 2002). It has further been suggested
that individuals with an extreme form of social phobia show a greater lability of
their autonomic nervous (Lang, & Stein, 2001; Merikangas, et al.
,
2002). Other
etiological factors related to social phobia include behavioral inhibition (Beidel 1998;
Merikangas, et al.
,
2002; Wittchen, et al.
,
1999); sensitivity to anxiety (Pollock, et
al. 2002); shyness (Furmark, 2000; Kessler, Stein, & Berglund, 1998; Merikangas,
et al.
,
2002; Stein, & Kean, 2000), long periods of separation from one’s parents
during childhood or early adolescence (Wittchen, et al.
,
1999); loss of a very close
relationship with an adult (Chartier, Walker, & Stein, 2001), especially in males
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(DeWit, et al.
,
2005); a history of psychopathology in one’s parents (Chartier, et al.
,
2001; DeWit, et al.
,
2005; Wittchen, et al.
,
1999), particularly of social anxiety (Fyer,
Mannuzza, Chapman, Martin, & Klein, 1995; Lieb, et al.
,
2000; Merikangas, et al.
,
2002); and having suffered from some kind of bullying or sexual abuse (Chartier, et
al.
,
2001; DeWit, et al.
,
2005; Erath, Flanagan, & Bierman, 2007).
There are inconsistent findings with regards to the typical socio-demographic
characteristics of social phobia. Whereas some studies reported that being a woman
with low income and little schooling correlates closely with social phobia (Furmark,
2002; Kessler, et al.
,
1998; Lang, & Stein, 2001; Stein, & Kean, 2000), other studies
(e.g., Eng, Heimberg, Coles, Schneier, & Liebowitz, 2000; Merikangas, et al.
,
2002)
have not found any differences between sexes, level of education, or marital status.
The lifetime prevalence rate of social phobia varies widely between different
countries. For example, based on data from the United States the estimated lifetime
prevalence rate is 12.1% (Kessler, et al.
,
2005; Ruscio, et al.
,
2008). The estimated
lifetime prevalence rate in Netherlands is 7.8% (9.7% in women and 5.9% in men)
(Bijl, Ravelli, & VanZessen, 1998), in Switzerland 5.6%, (7.3% in women and 3.7%
in men) (Merikangas, et al.
,
2002); and in Italy 3.27% with a ratio of 2:1 between
women and men (Faravelli, Zucchi, Viviani, Salmoria, & Perone, 2000). Regarding
the 12-months prevalence rate in some countries it has been estimated to be 2.0%
(2.7% in women and 1.3% in men) in Germany (Fehm, et al.
,
2008) or 2.3% in
Australia, without a significant difference between women (2.5%) and men (2.1%)
(Lampe, et al.
,
2003). This information is sometimes difficult to compare due to the
differences in diagnostic criteria, assessment methods, the number and type of social
situations evaluated, the time when the information is gathered, and the actual
research method itself.
Sex and age differences in social phobia
Some epidemiological studies on social phobia found significant differences
between women and men (Pollard, & Henderson, 1988; Turk, et al.
,
1998), whereas
others did not (Yonkers, et al.
,
2001). According to Pollard, & Henderson (1988),
the ratio between women and men who fulfill the criteria for social phobia, as per
DSM-III (APA, 1980), is 3 to 2. The authors reported the prevalence of four kinds
of social phobia: public speaking or performing (20.6%), writing in front of others
(2.8%), eating in restaurants (1.2%) and the use of public restrooms (0.2%). With
regards to sex differences, it was found that the fears of eating in restaurants and
of writing in public were greater among men, whereas the fears of using public
restrooms and of speaking or performing in public were greater in women.
In a sample of 212 patients with social phobia as defined by DSM-IV (APA, 2000),
Turk, et al. (1998) found no significant sex differences in the social phobia history, the
diagnostic subtypes, the comorbidity with other anxiety disorders, mood disorders,
and avoidant personality disorder. The authors suggested that certain sex differences
might be related to the degree of anxiety rather than the type of the feared social
situation. It is further possible that women are more fearful than men when talking
167
Social anxiety in 18 nations: sex and age differences
with people in authority, acting/performing/giving a talk in front of an audience,
working while being observed, entering a room when others are already seated,
being the centre of attention, speaking up at a meeting, expressing disagreement or
disapproval to people one does not know very well, giving a report to a group and
giving a party. In contrast, men reported more anxiety than women when urinating
in a public bathroom and returning goods to a store. However, it has also been
found that men and women share many social fears, such as informal interaction
situations (e.g., participating in small groups, going to a party or being observed by
others, such as when using a public telephone or when eating in public).
Yonkers, et al. (2001) found that women (56%) were slightly (but not significantly)
more likely to have generalized social phobia than men (47%) in a study of 176
patients with social phobia as defined by DSM-III-R (APA, 1987). Similar results were
reported by Stein, Walker, and Forde (1994) who interviewed 526 people over the
telephone. The results showed that women (67.1%) reported more anxiety than the
men (53.0%) and also reported experiencing it in more than one social situation,
including public speaking, speaking in front of a small group of familiar people,
speaking to strangers, meeting new people, and dealing with people in authority.
However, they did not find differences between men and women in performance
situations, such as writing or eating in front of others and attending social meetings.
In contrast, Wittchen, et al. (1999) observed significant sex differences in four (out of
6) social situations, including eating or drinking in public (6.4% women and 2.4%
men), writing while someone watches (2.8% women and 1.7% men), participating
in social events (6.2% women and 3.0% men) and talking with/to others (social talk)
(8.5% women and 4.2% men). These results were based on a longitudinal study with
3,021 subjects who were between 14 and 24 years old when the study began.
Dell’Osso, et al. (2002) and Dell’Osso, et al. (2003) analyzed sex differences in
social anxiety in 520 high-school students who were on average 18.6 years old. The
authors divided the sample into three groups depending to their social anxiety scores.
The greatest differences between males and females were reported in the group
with the lowest anxiety associated with interpersonal sensitivity, including social fears
and feelings of awkwardness or embarrassment when being the centre of attention,
when performing in front of others (e.g., writing or speaking), or expressing their
feelings to someone. In contrast, the groups with intermediate or high social anxiety
recorded no differences between the sexes in the domains that were assessed.
Merikangas, et al. (2002) analyzed the differences between the sexes in 591
people who took part in a 15-year long longitudinal study. The authors found that
over the course of their lives women were diagnosed with higher rates of clinical
and subclinical social phobia, but there were few sex differences among individuals
who had only some symptoms of the disorder. This study did not specify the social
fears that differentiated women and men.
Concerning age, a number of studies reported that social phobia was more
common in younger individuals (age 15 and 25) and less common in older individuals
(Fehm, et al.
,
2008; Heimberg, Stein, Hiripi, & Kessler, 2000; Magee, et al.
,
1996;
Schneier, et al.
,
1992). This same conclusion is reached by Furmark (2002), who
reviewed large-scale epidemiological studies.
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In general, studies examining community samples with adults and clinical samples
suggest a greater prevalence of social phobia in women than in men and in younger
than in older people (Heimberg, et al.
,
2000; Magee, et al.
,
1996; Wittchen, et al.
,
1999). Given these findings, this study focused on identifying the differences and
similarities between men and women in the majority (16) of countries in Latin
America, Spain and Portugal. Furthermore, the aim was to examine differences and
similarities in social anxiety (in those same countries) between different age groups
and between males and females.
Method
Participants
Sixteen Latin American countries, Portugal and Spain participated in this study.
Table 1 shows the questionnaire scores of the total sample and of men and women
for each country.
Procedure
More than 1,000 people (students and many significant others) were asked to
record social situations over a period of 6 years, generating a pool of more than
10,000 situations from which 512 social situations were finally extracted. These
situations plus four more control items formed the
Social Anxiety Questionnaire
for Adults
(SAQ-A) («Cuestionario de Ansiedad Social para Adultos»; CASO-A) (see
Caballo, et al.
,
2006; Caballo, et al.
,
in press, for a complete description of the entire
procedure).
One hundred and twenty-nine research collaborators from 16 Latin American
countries, Portugal and Spain agreed to assist in the data collection. The specific
countries that participated (and the number of collaborators) were as follows:
Argentina (16), Bolivia (6), Brazil (7), Chile (7), Colombia (16), Costa Rica (1),
Dominican Republic (2), Ecuador (2), El Salvador (2), Guatemala (3), Mexico (35),
Panama (3), Paraguay (3), Peru (8), Portugal (5), Spain (10) Uruguay (2), and
Venezuela (1) (see Caballo, et al.
,
in press).
The SAQ-A was administered to people in these 18 countries that participated in
the study (Table 1). The study focused on the differences between men and women
in the specific items (out of the 512 total items that make up the SAQ-A) and
the dimensions (factors) of this questionnaire that were identified after a series of
analyses. These dimensions were also used to compare the different age groups.
Moreover, 5 age groups were formed: a) individuals up to and including the age
of 18, which are the years prior to entering university, b) individuals between the
ages of 19 and 24, which are the university years, c) individuals between the ages
of 25 and 30, which are the years of post-university training and finding a job, d)
169
Social anxiety in 18 nations: sex and age differences
Table 1
Participants distributed by country in the study with the SAQ-A
Women
Men
All subjects
Country
N
Mean age
(SD)
N
Mean age
(SD)
N
Mean age
(SD)
Argentina
496
30.25
(10.89)
378
28.82
(11.42)
874
30.06
(11.11)
Bolivia
412
24.37
(7.68)
403
23.80
(9.09)
815
24.09
(8.40)
Brazil
695
26.07
(9.48)
542
27.55
(10.79)
1237
26.71
(10.09)
Chile
376
26.90
(10.86)
307
27.91
(11.52)
683
27.35
(11.17)
Colombia
849
24.70
(9.60)
764
25.47
(9.81)
1613
25.06
(9.70)
Costa Rica
204
23.23
(9.42)
122
18.86
(5.82)
326
21.60
(8.52)
Dominican
Republic
286
20.16
(4.61)
216
19.43
(4.36)
502
19.85
(4.51)
Ecuador
353
21.39
(5.43)
142
21.95
(4.91)
495
21.55
(5.29)
El Salvador
146
21.88
7.12)
136
22.83
(6.81)
282
22.34
(6.97)
Guatemala
250
27.02
(10.89)
218
28.73
(10.63)
468
27.82
(10.79)
Mexico
2363
25.14
(10.34)
1921
25.29
(9.68)
4284
25.20
(10.05)
Panama
103
29.06
(12.95)
117
29.69
(11.57)
220
29.39
(12.21)
Paraguay
89
24.62
(8.03)
76
21.91
(6.82)
165
23.37
(7.60)
Peru
972
23.08
(8.37)
1000
23.25
(8.00)
1972
23.16
(8.18)
Portugal
240
27.71
10.01)
278
27.03
(11.16)
518
27.35
(10.64)
Spain
905
22.80
(8.80)
666
27.01
(12.00)
1571
24.58
(10.48)
Uruguay
99
32.39
(12.27)
100
33.43
(10.91)
199
32.91
(11.60)
Venezuela
502
27.17
(10.88)
214
27.34
(11.47)
716
27.20
(11.04)
All the
countries
9340
24.99
(9.82)
7600
25.59
(10.15)
16940
25.26
(9.97)
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individuals between the ages of 31 to 49, which are years of maturity in terms of a
career and of stability in one’s affective life, and e) individuals older than 50, which
are the years when one enjoys one’s achievements.
Instrument
All results were based on the Social Anxiety Questionnaire for Adults (SAQ-A).
Each item was answered on a 7-point Likert scale to indicate the level of uneasiness,
stress, or nervousness to each situation (0 = Not at all, 1 = Very slight, 2 = Slight, 3
= Moderate, 4 = High, 5 = Very high, and 6 = Extremely high).
The analyses (cluster analysis, exploratory and confirmatory factor analysis)
carried out on the
Social Anxiety Questionnaire for Adults (SAQ-A)
with 11 countries
revealed a 6-factor structure solution with 12 items loading on each factor (see
Caballo, et al.
,
in press):
1. Awkward behavior in socially embarrassing situations;
2. Interactions with the opposite sex; 3. Interactions with strangers; 4. Criticism and
embarrassment; 5. Assertive expression of annoyance, disgust or displeasure; and
6. Speaking/performing in public/Talking with people in authority.
Results
Sex differences
A comparison between men and women in the individual items of SAQ-A
showed that women scored significantly higher than men in most of the items (454
of the 512 situations). Table 2 shows the 15 items with the largest sex difference
in which women scored higher than men. As can be seen, most of the items (10)
are related to social interaction situations involving the opposite sex. Some of
these situations describe relatively uncommon or unusual social situations, such
as item 493 (
sleeping with a person of the opposite sex whom I just met)
, item
140 (
someone of the opposite sex seeing me naked
), or item 164 (
someone of the opposite sex seeing me naked), or item 164 (someone of the opposite sex seeing me naked
watching a
pornographic movie in front of someone of the opposite sex
). The other situations
pornographic movie in front of someone of the opposite sex). The other situations pornographic movie in front of someone of the opposite sex
are related to strangers (2 items), friends (2 items), and superiors/teachers (1 item).
Cohen’s
d
is small in most cases.
d is small in most cases.d
There were only 17 out of 512 items in which men scored significantly higher
than women. The sex differences in these items were relatively small. Table 3 shows
12 of the items with the largest sex difference in which men scored higher than
women. It should be noted that the sex differences are very small as suggested
by Cohen’s
d
. Most of the situations have to do with expressing/receiving positive
feelings or specific informal social situations (birthday, wedding). The other five
situations involve talking to people on the phone in front of other people, running
into the same person many times throughout the day, expressing love to one’s
parents or other people, and listening to a close family member’s love problems.
171
Social anxiety in 18 nations: sex and age differences
Table 2
Means (M), standard deviations (SD) and other psychometric data regarding
the fifteen situations with the largest sex difference in which women scored
higher than men
Women
Men
Items
M (SD)
M (SD)
t
df
p
d
45. Being stared at by a group of
people of the opposite sex
3.38
(1.94)
2.73
(1.90)
23.90
16929
0.000000
0.34
96. Going to a porn movie with
friends
3.54
(2.00)
2.63
(1.98)
29.33
16890
0.000000
0.47
140. Someone of the opposite
sex seeing me naked
4.33
(1.88)
3.38
(1.97)
31.82
16919
0.000000
0.46
143. Telling a friend that he/she
smells of sweat
3.45
(1.77)
2.76
(1.76)
25.18
16921
0.000000
0.49
164. Watching a pornographic
movie in front of someone of the
opposite sex
3.64
(1.93)
2.88
(1.91)
25.77
16902
0.000000
0.39
175. Being with someone of the
opposite sex who is naked
3.66
(1.92)
2.70
(1.92)
32.56
16901
0.000000
0.40
181. Taking an oral exam or
presenting a report out aloud
3.38
(1.83)
2.71
(1.75)
24.19
16936
0.000000
0.50
200. Going alone to a bar for a
drink
2.97
(1.89)
2.14
(1.80)
29.06
16907
0.000000
0.37
223. Getting in a car with
someone I do not know
3.08
(1.78)
2.35
(1.65)
27.32
16908
0.000000
0.45
254. A person insistently making
sexual advances on me
3.65
(1.65)
2.91
(1.65)
28.72
16901
0.000000
0.43
343. Being openly stared at by
someone of the opposite sex
3.14
(1.72)
2.50
(1.08)
24.59
16905
0.000000
0.45
362. Asking someone attractive
of the opposite sex for a date
3.59
(1.89)
2.72
(1.79)
30.65
16929
0.000000
0.45
377. Going to a bar where there
are only people of the opposite
sex
3.07
(1.75)
2.43
(1.67)
24.33
16914
0.000000
0.37
493. Sleeping with a person of
the opposite sex whom I just met
4.13
(1.93)
2.90
(1.94)
40.96
16859
0.000000
0.64
497. Getting caught by my
parents in an awkward situation
with my boyfriend/ girlfriend
4.33
(1.76)
3.49
(1.84)
30.15
16889
0.000000
0.47
Note:
Size effect
, Cohen’s
d
: 0.2 <
d
< 0.5= small; 0.5 <
d < 0.5= small; 0.5 < d
d
< 0.8= medium; 0.8 <
d < 0.8= medium; 0.8 < d
d
= large.
d = large.d
More important than the differences in individual items appear to be the
differences in the 6 factors of the SAQ-A (see Caballo, et al.
,
in press). The results
in these 6 factors were compared by age and sex overall and by sex within each
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Table 3
Means (M), standard deviations (SD) and other psychometric data regarding
the twelve situations with the largest sex difference in which men scored higher
than women
Women
Men
Items
M (SD)
M (SD)
t
df
p
d
11. Showing affection and love to
my parents
1.61
(1.78)
1.79
(1.79)
-6.60
16914
0.000000
0.10
53. Going to a colleague’s birthday
party
0.99
(1.42)
1.11
(1.47)
-5.68
16935
0.000000
0.08
72. Going to the hair salon/barber
shop
1.08
(1.50)
1.24
(1.56)
-7.00
16909
0.000000
0.10
109. Opening a gift in front of other
people
1.53
(1.62)
1.65
(1.57)
-4.67
16927
0.000003
0.08
113. Introducing two people
1.19
(1.44)
1.34
(1.46)
-6.98
16915
0.000000
0.10
125. Being congratulated for my
birthday
1.46
(1.68)
1.66
(1.64)
-7.63
16923
0.000000
0.12
138. Congratulating someone
1.20
(1.54)
1.39
(1.56)
-7.88
16927
0.000000
0.12
157. Cheering someone up
1.54
(1.59)
1.65
(1.59)
-4.63
16926
0.000004
0.07
170. My mother entering the
bathroom when I am naked
2.47
(2.00)
2.92
(1.93)
-14.87
16907
0.000000
0.23
189. Making a date with someone
of the same sex
1.61
(1.68)
1.72
(1.64)
-4.25
16906
0.000021
0.07
322. Going to a wedding
1.49
(1.59)
1.61
(1.56)
-5.00
16903
0.000001
0.08
424. Celebrating my birthday with
friends
1.48
(1.65)
1.60
(1.60)
-4.76
16913
0.000002
0.07
Note:
Size effect
, Cohen’s d: 0.2 <
d
< 0.5= small; 0.5 <
d < 0.5= small; 0.5 < d
d
< 0.8= medium; 0.8 <
d < 0.8= medium; 0.8 < d
d
= large.
d = large.d
country. Initially, the total sample of men was compared with the total sample of
women in the 6 factors. Women scored significantly higher than men in all factors
(all ps< 0.001). We used Cohen’s
d
to examine the effect size of these differences.
d to examine the effect size of these differences. d
Table 4 shows the results of these differences. As can be seen, all differences were
small (
d
< 0.40), particularly in Factor 5: Assertive expression of annoyance, disgust
or displeasure (
d=
-0.13).
When comparing men and women in these same 6 factors by country, very
similar results were found as in Table 4. Figures 1 to 6 displays the differences in
each factor. Figure 7 shows the differences in the total SAQ-A. Differences between
men and women are consistent across most countries, although these differences
173
Social anxiety in 18 nations: sex and age differences
Table 4
Size effect (Cohen’s
d
) of the differences between men and women in the six
d) of the differences between men and women in the six d
factors of the SAQ-A
Factors
Sex
N
M (SD)
t
df
p
d
F1
Men
Women
7470
9172
35.27 (13.81)
39.64 (14.07)
-20.09
16640
0.000
0.31
F2
Men
Women
7428
9145
29.90 (12.60)
32.72 (12.93)
-14.13
16571
0.000
0.22
F3
Men
Women
7441
9176
30.25 (14.72)
35.37 (15.07)
-21.99
16615
0.000
0.34
F4
Men
Women
7449
9142
30.14 (13.51)
35.07 (14.24)
-22.84
16214
0.000
0.36
F5
Men
Women
7472
9134
25.38 (12.94)
27.16 (13.59)
-8.65
16229
0.000
0.13
F6
Men
Women
7434
9139
33.26 (12.53)
36.81 (12.69)
-18.02
16571
0.000
0.28
Total
Men
Women
6916
8453
184.18 (68.28)
207.00 (69.80)
-20.36
15367
0.000
0.33
Note: F1= Awkward behavior in socially embarrassing situations; F2= Interactions with the opposite sex;
F3= Interactions with strangers; F4= Criticism and embarrassment; F5= Assertive expression of anno-
yance, disgust or displeasure; and F6= Speaking/performing in public/Talking with people in authority
Figure 1
Differences between men and women within each participant country in Factor 1:
Awkward behavior in socially embarrassing situations
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Figure 2
Differences between men and women within each participant country in Factor 2:
Interactions with the opposite sex
Figure 3
Differences between men and women within each participant country in Factor 3:
Interactions with strangers
175
Social anxiety in 18 nations: sex and age differences
Figure 4
Differences between men and women within each participant country in Factor 4:
Criticism and embarrassment
Figure 5
Differences between men and women within each participant country in Factor 5:
Assertive expression of annoyance, disgust or displeasure
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Figure 6
Differences between men and women within each participant country in Factor 6:
Speaking/performing in public/Talking with people in authority
Figure 7
Differences between men and women within each participant country in total
score of SAQ-A
177
Social anxiety in 18 nations: sex and age differences
are usually small (Cohen’s
d
< 0.40). However, there was a considerable degree
of variation in the sex differences between the various countries. While the sex
differences were moderate (e.g., Brazil, Colombia, Spain, Ecuador, El Salvador,
Dominican Republic), or high (e.g., Panama) in some countries, they were non-
existent or very small in others (e.g., Uruguay, Costa Rica, Portugal) (see size effects
in table 5).
Table 5
Size effect (Cohen’s
d
) of the differences between men and women
d) of the differences between men and women d
in 18 countries
Factors and total score
Countries
F1.
Awkward
behavior
F2.
Opposite
sex
F3.
Strangers
F4.
Criticism
F5.
Assertive
expression
F6.
Speaking
in public
Total
SAQ-A
Argentina
0.23
0.18
0.37
0.37
0.12
0.31
0.33
Bolivia
0.20
0.15
0.13
0.26
0.00
0.36
0.23
Brazil
0.44
0.34
0.44
0.54
0.20
0.37
0.46
Chile
0.33
0.34
0.34
0.38
0.07
0.46
0.37
Colombia
0.41
0.22
0.42
0.44
0.22
0.35
0.41
Costa Rica
0.02
0.06
0.17
0.02
0.05
0.20
0.07
Dominican
Republic
0.45
0.26
0.47
0.32
0.16
0.49
0.43
Ecuador
0.44
0.28
0.48
0.37
0.26
0.40
0.49
El Salvador
0.26
0.43
0.25
0.43
0.33
0.47
0.42
Guatemala
0.21
0.13
0.40
0.32
0.03
0.29
0.25
Mexico
0.32
0.24
0.29
0.31
0.16
0.24
0.30
Panama
0.57
0.46
0.72
0.62
0.66
0.51
0.75
Paraguay
0.29
0.23
0.44
0.44
0.07
0.33
0.29
Peru
0.23
0.20
0.37
0.32
0.19
0.21
0.29
Portugal
0.05
0.01
0.10
0.02
0.09
0.04
0.02
Spain
0.45
0.15
0.13
0.26
0.00
0.36
0.23
Uruguay
0.01
0.21
0.39
0.19
0.11
0.05
0.06
Venezuela
0.30
0.17
0.43
0.35
0.17
0.12
0.38
Note:
Size effect
, Cohen’s
d
: 0.2 <
d
< 0.5= small; 0.5 <
d < 0.5= small; 0.5 < d
d
< 0.8= medium; 0.8 <
d < 0.8= medium; 0.8 < d
d
= large.
d = large.d
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Differences by age
The entire sample was divided into five age groups within men and women.
The number of subjects in each age group is shown in Table 6. Figures 8 to 14
show differences between men and women in the 6 factors and the total SAQ-A
throughout the 5 age groups. Among individuals at the age of
18 or younger
and
also among individuals between
19 to 24 years of age,
women scored significantly
higher than men (
p
< 0.001) in all factors. The effect sizes were consistently small.
Among individuals between the ages of
25 and 30
, women scored significantly
higher than men (
p
< 0.001) in all factors except F5: Assertive expression of
annoyance, disgust or displeasure (
p
< 0.05). The effect sizes were consistently
small. Of the
31 to 49 year-olds
, women scored significantly higher than men (
p
<
0.001) in all the factors except F5: Assertive expression of annoyance, disgust or
displeasure (n.s.). The effect sizes were consistently small. Among individuals at the
age
50 or older
, women scored significantly higher than men (
p
< 0.001) in three
factors (F1, F3 and F4), but also in F5: Assertive expression of annoyance, disgust
or displeasure (
p
< 0.01), F6: Speaking/performing in public/Talking with people in
authority (
p
< 0.01) and F2: Interactions with the opposite sex (
p
< 0.05). The size
effects were small, except in F3: Interactions with strangers and F4: Criticism and
embarrassment, which approached medium (
d
> 0.40). Generally speaking, the sex
differences in the SAQ-A decreased with age in all 6 factors and also the overall
score on the SAQ-A for individuals between the ages of 18 or younger and 49 years
of age. However, the differences between men and women were significant in two
factors (F3: Interactions with strangers and F4: Criticism and embarrassment) and in
the overall score on the SAQ-A for 50-year old or older individuals.
Table 6
Number of subjects in each age group
Age groups
18 years or under
19-24 years
25-30 years
31-49 years
50 years or older
Number of
subjects
Men= 1575
Women= 1898
Men= 3229
Women= 4418
Men= 1030
Women= 1125
Men= 1276
Women= 1327
Men= 371
Women= 430
When comparing the age groups in the 6 factors and in the SAQ-A total score,
there were no statistically significant differences between the five groups in F1:
Awkward behavior in socially embarrassing situations
. In other words, this dimension
seems to be independent of age. The factor F2:
Interactions with the opposite sex
is stable for individuals age 18 or younger and 30, but the sex difference appears to
emerge in individuals at the age of 31. However, the sex difference in F3:
Interactions
with strangers
seems was weaker in older than in younger individuals. Similarly,
with strangers
seems was weaker in older than in younger individuals. Similarly, with strangers
the sex difference in factor F4:
Criticism and embarrassment
was smaller in older
Criticism and embarrassment was smaller in older Criticism and embarrassment
179
Social anxiety in 18 nations: sex and age differences
Figure 8
Differences between men and women by age groups in the Factor 1: Awkward
behavior in socially embarrassing situations
Figure 9
Differences between men and women by age groups in Factor 2: Interactions with
the opposite sex
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Figure 10
Differences between men and women by age groups in Factor 3: Interactions with
strangers
Figure 11
Differences between men and women by age groups in Factor 4: Criticism and
embarrassment
181
Social anxiety in 18 nations: sex and age differences
Figure 12
Differences between men and women by age groups in Factor 5: Assertive
expression of annoyance, disgust or displeasure
Figure 13
Differences between men and women by age groups in Factor 6: Speaking/
performing in public/Talking with people in authority
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Figure 14
Differences between men and women by age groups in the total score of the
SAQ-A
than younger individuals, particularly for people at the age of 25 or older. The sex
difference in factor F5:
Assertive expression of annoyance, disgust or displeasure
seems to be negatively associated with age. Finally, the sex difference in factor F6:
Speaking/performing in public/Talking with people in authority
seems to be negatively
Speaking/performing in public/Talking with people in authority
seems to be negatively Speaking/performing in public/Talking with people in authority
associated with age from age 18 and younger to 30 years of age, but appears to be
positively associated with age for individuals at the age of 31 or older.
Discussion
This study focused on sex and age differences in social anxiety. The sample we
chosen was very broad and came from a very diverse sample of countries. The
majority of countries shared the same language (Spanish); the language of two of
the countries was Portuguese. The items measured a wide variety of social situations
(512). These items were generated by a large number of individuals over the course
of a long period of time and across different situations, without considering existing
literature on the subject. Both the variety of situations and the numerous samples
provide a solid foundation for the results that we obtained.
Considering all the countries in the study jointly, the results quite clearly showed
that women report greater anxiety than men in just about all the social situations
and in all the dimensions that make up the social anxiety construct (Caballo, et al.
,
in
press). When considering the specific social situations, women reported significantly
183
Social anxiety in 18 nations: sex and age differences
higher scores than men in almost all of the assessed situations (88.67%). The sex
differences we observed were considerably greater than those reported by other
authors (e.g., Pollard, & Henderson, 1988; Stein, et al.
,
1994; Turk, et al.
,
1998;
Wittchen, et al.
,
1999). Our results suggest that women systematically perceive
social situations with a greater degree of anxiety than men. Irrespective of whether
or not this finding is related to biological and genetic factors, the person’s education,
culture, other environmental factors, or the interaction between environment and
predisposing factors, it appears that women tend to experience greater anxiety in
social situations. These differences become more acute when the situations involve
awkward or difficult circumstances of interaction with the opposite sex and being
exposed to observation (and probably appraisal) by persons of the opposite sex. It
is likely that an interaction between biological predispositions linked to sex and a
different style of education for women may be the most consistent explanation.
Men reported greater anxiety than women in a few situations (17 items), but
the differences were small. However, they have to be taken into account, given
the tendency for women to report greater anxiety in general. Interestingly, most
of these 17 situations are related to expressing or receiving positive feelings (e.g.,
affection, love, congratulations, etc) and involve festive or informal social events
(e.g., birthdays, weddings). Nonetheless, our results suggest that men did not
report more anxiety than women in any of the situations that are normally included
in social anxiety questionnaire, except for «Talking on the phone in front of other
people.» This finding is contrary to the study by Turk, et al. (1998). It would seem
that situations of this nature are related to better socialization, and it may be that
women find it easier than men to socialize, perhaps because of differences in the
socializing aspects of their upbringing (e.g., sex role).
When comparing men and women in the 6 factors of the SAQ-A (comprising
several situations that share similar characteristics), the same pattern was found as
in the case of individual items. Women scored more highly than men in the SAQ-A
total score and on each one of the factors in the majority of countries. Therefore, the
sex differences remained relatively constant. In most countries, the sex differences
were generally small, except for the relatively large sex difference in «Assertive
expression of annoyance, disgust or displeasure» in Panama. Furthermore, no sex
differences in SAQ-A were found in two of the countries (Costa Rica and Portugal)
and one in which the data are mixed (Uruguay). Whether these findings reflect real
differences in these countries or constitute a sampling problem will require further
research. In the case of Costa Rica, for example, men were considerably younger
than women, and men in this country were also younger than the men in all of the
other countries. This might be a significant methodological issue.
An examination of the sex differences by age groups in the various dimensions
of social anxiety suggested that women consistently report more anxiety than men
in all age groups and in all factors, as well as in the overall score on SAQ-A. The
sex difference was the smallest in the factor «
Assertive expression of annoyance,
disgust or displeasure
». Interestingly, the scores in a number of dimensions was
negatively associated with age (
Interactions with strangers, Assertive expression of
annoyance, disgust or displeasure, Criticism and embarrassment
), whereas it was
annoyance, disgust or displeasure, Criticism and embarrassment), whereas it was annoyance, disgust or displeasure, Criticism and embarrassment
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positively associated with others (
Interactions with the opposite sex
). The 5
Interactions with the opposite sex). The 5Interactions with the opposite sex
th
factor
appears to remain relatively similar across the age groups (
Awkward behavior in
appears to remain relatively similar across the age groups (Awkward behavior in appears to remain relatively similar across the age groups (
social embarrassing situation
), whereas the 6
th
factor seems to have a U-shaped
relationship with age (
Speaking/performing in public/Talking with people in authority
).
Speaking/performing in public/Talking with people in authority). Speaking/performing in public/Talking with people in authority
Although social phobia decreases in late life (e.g., APA, 2000), the difficulty in dealing
with certain types of situations (e.g., Interactions with the opposite sex, Speaking/
performing in public/Talking with people in authority) may not decrease with age. This
may explain the findings in our study. Considering the scant research on this subject,
we suggest that more research be conducted on this issue. Previous work suggests
that women experience a greater level of anxiety than men in most social situations,
although these differences are generally small. Our analysis of sex differences in the
dimensions of social anxiety supports this notion. Moreover, the differences between
males and females in these dimensions appear be dependent on the age groups.
We suggest that future studies attempts to replicate our study with larger sample
sizes in certain countries. Furthermore, including other countries (e.g., English-
speaking countries) would provide important information on sex differences across
different cultural groups.
Final note:
Although currently they are not part of the CISO-A Research Team, we want to thank the
following people for their collaboration in some phase of the research:
Argentina
(E. Barinaga, M.
Battaglia,
M. Fariz, R. Gómez, M. Milanesio, A. Villafañe),
Bolivia
(J. Gómez, J. Pérez, L. Sologuren, E. Sotomayor),
Brazil
(M. Cardoso, M. Sacramento, E. Silvares),
Brazil (M. Cardoso, M. Sacramento, E. Silvares), Brazil
Chile
(A. Prieto),
Colombia
(G. Cajiao, G. Ceballos, A.
Meneses, Á. Orozco, A. Pérez, P. Sanabria, D. Ulloa),
Costa Rica
(M. Barquero, V. Leiva, A. Soto),
Ecuador
(S. Mancheno),
Spain
(E. Calvete, M. García, I. Guerrero, J. Moriana, I. Orue, J. Piedra),
Guatemala
(N. Martínez),
Mexico
(E. Aguilar, J. Aguilar, I. Alcalá, T. Alfaro, L. Bautista, I. Blanquel, G. Canseco, V.
Cárdenas, Y. Cienfuegos, E. Duarte, L. Fierros, M. Flores, H. García, Ó. Horcasitas, A. López, B. Ramos, H.
Rodríguez, L. Sánchez, N. Santaella, P. Santos, M. Silva, R. Tenorio, V. Vega, J. Zepeda, J. Vargas F., J. Vargas
M.),
Panama
(A. Martínez, M. Pérez, J. Tunon),
Peru
(J. Montero, M. J. Salazar, C. Velásquez, F. Quiroz, M.
M. Salazar, L. Rodríguez),
Portugal
(R. Meneses),
Portugal (R. Meneses), Portugal
Dominican Republic
(J. Jiménez, V. Rodríguez).
Dominican Republic (J. Jiménez, V. Rodríguez).Dominican Republic
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á
a y trastornos psiquiáa y trastornos psiqui
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