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Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan

Publicated to:Psychological Medicine. 51 (5): 861-869 - 2021-04-01 51(5), DOI: 10.1017/s0033291719003908

Authors: Vilaplana-Pérez, A; Pérez-Vigil, A; Sidorchuk, A; Brander, G; Isomura, K; Hesselmark, E; Kuja-Halkola, R; Larsson, H; Mataix-Cols, D; Fernández de la Cruz, L

Affiliations

Hosp Clin Barcelona, Inst Neurosci, Dept Child & Adolescent Psychiat & Psychol, Barcelona, Spain - Author
Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden - Author
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden - Author
Orebro Univ, Sch Med Sci, Orebro, Sweden - Author
Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden - Author
Univ Valencia, Dept Personalitat Avaluacio & Tractaments Psicol, Valencia, Spain - Author
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Abstract

Social anxiety disorder (SAD) has been linked to academic underachievement, but previous studies had methodological limitations. We investigated the association between SAD and objective indicators of educational performance, controlling for a number of covariates and unmeasured confounders shared between siblings.This population-based birth cohort study included 2 238 837 individuals born in Sweden between 1973 and 1997, followed-up until 2013. Within the cohort, 15 755 individuals had a recorded ICD-10 diagnosis of SAD in the Swedish National Patient Register. Logistic regression models tested the association between SAD and educational performance. We also identified 6488 families with full siblings discordant for SAD.Compared to unexposed individuals, individuals diagnosed with SAD were less likely to pass all subjects in the last year of compulsory education [adjusted odds ratios (aOR) ranging from 0.19 to 0.44] and less likely to be eligible for a vocational or academic programme in upper secondary education [aOR = 0.31 (95% confidence interval [CI] 0.30-0.33) and aOR = 0.52 (95% CI 0.50-0.55), respectively], finish upper secondary education [aOR = 0.19 (95% CI 0.19-0.20)], start a university degree [aOR = 0.47 (95% CI 0.45-0.49)], obtain a university degree [aOR = 0.35 (95% CI 0.33-0.37)], and finish postgraduate education [aOR = 0.58 (95% CI 0.43-0.80)]. Results were attenuated but remained statistically significant in adjusted sibling comparison models. When psychiatric comorbidities were taken into account, the results were largely unchanged.Treatment-seeking individuals with SAD have substantially impaired academic performance throughout the formative years. Early detection and intervention are warranted to minimise the long-term socioeconomic impact of the disorder.

Keywords

adolescentsattainmentepidemiologymental-disordersphobiapopulationprevalencerecognitionschoolsocial anxiety disorderBehavioral treatmentEducational attainmentEpidemiologySocial anxiety disorder

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Psychological Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 5/131, thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychology, Clinical. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.61. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 16.98 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-01, the following number of citations:

  • WoS: 36
  • Europe PMC: 23

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-01:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 206.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 205 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 30.672.
  • The number of mentions on the social network X (formerly Twitter): 15 (Altmetric).
  • The number of mentions in news outlets: 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Sweden.