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INTRODUCTION
The social distancing required during the COVID-19 pandemic has affected mental health 1,2. As a result, there was a noticeable increase in the prevalence of anxiety and depression. Specifically, anxiety disorders experienced a surge, with affected individuals climbing from approximately 298 million to 374 million worldwide, reflecting a notable 25% growth 3.
The presence of anxiety symptoms, especially social anxiety, becomes relevant in the pandemic and post-pandemic era because socialization has been perceived as a source of contagion and health risks, leading to its avoidance 4. This has been increased in the general population, particularly in women and individuals with lower income levels 5.
Social anxiety is a precipitant factor for poor performance in various areas. People with social anxiety have difficulties in verbal comprehension, spatial visualization, and fluency; their academic performance in tasks such as oral presentations or group work is poor; they also tend to drop out of school, restrict the expression of their emotions, experience challenges in establishing relationships, and use fewer learning strategies 6.
In situations of critical stress, it is especially important to consider protective factors in mental health, such as internal and external resources that allow for more effective coping with stress and risky situations 7,8. Self-esteem is an internal resource that protects and promotes mental health and happiness. It refers to the personal judgement of one's worth, and can be positive or negative, reflecting one's attitude and perception of oneself in various situations 7,9,10. Numerous investigations have provided evidence that individuals with elevated self-esteem tend to experience reduced instances of emotional and behavioral problems 11. Self-esteem affects student academic performance. Low self-esteem is related to insecurity and constant feelings of failure and dissatisfaction, resulting in disinterest and apathy towards classes 12. Low self-esteem is also manifested in academic procrastination 13.
The association between self-esteem and social anxiety has been explored in previous studies, but it is a complex issue and the reported findings have been contradictory. However, evidence suggests that positive self-esteem helps reduce levels of social anxiety, and it influences how people experience and respond to social anxiety differently, based on their gender 14-20.
Thus, this study aimed to contribute to the available evidence on the association between self-esteem and social anxiety in an educational setting in a situation of critical stress, such as a pandemic. This study investigated whether the level of social anxiety experienced by college students was influenced by their self-esteem. Considering that women are especially vulnerable to anxiety 3,5, gender was also considered in this study. We hypothesized that both positive self-esteem and gender would have a significant impact on the overall social anxiety levels of college students during this period. Positive self-esteem is expected to be negatively related to anxiety levels in various social situations, with women presenting more severe symptoms of social anxiety than men.
MATERIALS AND METHODS
This quantitative predictive study used a non-experimental, cross-sectional, and correlational-causal design to examine the relationship between the variables of interest, and to determine the association between positive self-esteem, gender, and social anxiety.
The study included 212 students (66.5% women and 33.5% men), aged between 18 and 28 years (mean 20.24 [1.6]), attending five official and private higher education institutions in the city of Cartagena (Colombia). The sample size was determined based on official records from the Ministry of National Education of Colombia, which estimated, for the first semester of 2021, a population size of university students enrolled in Higher Education Institutions in the department of Bolívar of 45,437 (CI=90%, error = 5.6%), of which 53% were women and 47% men. Participants were selected through a non-random convenience sampling based on the following inclusion criteria:1) being of legal age; 2) being an active university student; 3) not having a clinical history of mental disorders before the pandemic, such as anxiety disorder, depression, personality disorder, psychotic disorder, etc.; and 4) not having consumed psychoactive substances 24 hours before the study.
The Rosenberg Self-Esteem Scale (RSE) 21 was used to assess self-esteem. The scale consists of ten items that assess general self-esteem. Items 1, 3, 4, 5, 7, and 10 explored the positive self-esteem dimension, whereas items 2, 6, 8, and 9 delved into the negative self-esteem dimension 21,22.
To perform this study, a cutoff estimation procedure was adopted based on the mean and standard deviation of the data. These cutoff points were used to classify participants into three levels of self-esteem in relation to the total scale: low (scores 10-23), medium (scores 24-33), and high (scores 34-40). The same process was applied to assess the positive self-esteem dimension by dividing participants into three levels: low (scores <16), medium (scores 16-20), and high (scores >20). The reliability of this instrument in the Colombian population was adequate, with a Cronbach's alpha reliability coefficient of >0.80 21.
Furthermore, the Social Anxiety Questionnaire for Adults (SAQ) was employed 23, which is composed of 30 items that enable the assessment of global social anxiety and five dimensions:!) public speaking/interaction with high-ranking people; 2) interaction with the opposite sex; 3) assertive expression of annoyance, displeasure, or anger; 4) being embarrassed or ridiculed; and 5) interaction with strangers. To classify participants into three levels of social anxiety (low, medium, and high), a cutoff point was estimated using means and standard deviations: low (scores 30-63), medium (scores 64-109), and high (scores 110-150). The reliability of this instrument in the Colombian population is adequate, with Cronbach's alpha coefficients ranging from 0.78 to 0.93 24.
The sample collection began with university students who had developed their professional careers at Universidad Tecnológica de Bolívar and filled out an online questionnaire designed for the purposes of the study. In turn, they informed relatives, peers, and friends from other colleges of the study. All subjects participated voluntarily and gave their consent, after which they completed the questionnaires individually and anonymously using the Forms tool in Office 365. Links to access the questionnaires were shared via email, and the participants were allowed to complete them only once. Data were collected between August and September 2021, coinciding with the onset of the fourth peak of the COVID-19 pandemic in Colombia.
The gathering and handling of information adhered to the ethical standards set forth by the Ministry of Health of Colombia and aligned with the ethical principles outlined in the Declaration of Helsinki for research involving human subjects. This study was approved by the Research Committee of Universidad Tecnológica de Bolívar.
For data analysis, SPSS (v.26) and G*Power 3.1 statistical software were used to estimate effect size and statistical power. First, each study variable was characterized through descriptive analyses, and comparisons were made by considering the gender of the participants. For the variables of global self-esteem and global social anxiety, which presented a normal distribution, the parametric Student's t-test was used for comparison. Given that the participants' scores on the positive self-esteem dimension of the RSE and the five dimensions of the SAQ instrument did not follow a normal distribution, the nonparametric Mann-Whitney U test was used for comparison. Normality was checked using the Kolmogorov-Smirnov test (p < 0.05).
Furthermore, the correlation between the positive self-esteem variable and the dimensions of the SAQ instrument was assessed using Spearman's rho correlation coefficient to confirm the hypotheses of the study. Subsequently, the RSE response categories were regrouped to provide a dichotomous treatment for the positive self-esteem dimension 22. A high level of social anxiety was defined as the dependent variable and assigned a value of 1, while 0 was assigned to the remaining levels. We included the items or indicators of the positive self-esteem dimension of RSE and the participant's gender (female) as independent variables or predictors in a binary logistic regression model using the backward stepwise estimation method.
RESULTS
Levels of Self-esteem and Social Anxiety in Young University Students
Of all the participants, 17.9% had low self-esteem, 65.1% had medium self-esteem, and 17% had high self-esteem. In the positive self-esteem dimension of RSE, 29.2% of the participants reported a low level, 36.3% a medium level, and 34.4% a high level.
In terms of social anxiety symptoms, a high level of symptoms was reported by 15.6% of the students, whereas a low level was reported by 18.4% of them. When analyzing the various dimensions of the questionnaire, the following can be observed: in public speaking/interaction with high-ranking persons, 26.9% of the participants reported a low level of anxiety, 49.1% reported a medium level, and 24.1% reported a high level. Regarding interactions with the opposite sex, 26.4% of the participants had a low level of anxiety, 50% had a medium level, and 23.6% had a high level. Regarding assertive expressions of annoyance, displeasure, or anger, 27.8% of the participants showed a low level of anxiety, 51.9% a medium level, and 20.3% a high level. In terms of embarrassment or ridicule, 28.3% of the participants had a low level of anxiety, 45.8% had a medium level, and 25.9% had a high level. Finally, in interactions with strangers, 26.4% of the participants reported a low level of anxiety, 52.4% reported a medium level, and 21.2% reported a high level.
Differences in the variables of interest in this study, positive self-esteem and social anxiety, and their respective dimensions according to the gender of the participants were analyzed (see table 1).
Table 1 Descriptive Statistics of the Study Variables according to the Gender of the Participants
| Women | Men | Group Comparison | P | Effect Size | 1-ß | |||
|---|---|---|---|---|---|---|---|---|
| Variables | M (SD) | Me (IQR) | M (SD) | Me (IQR) | ||||
| Positive Self-esteem | 18.6 (4.1) | 18 (18) | 18.2 (4.1) | 19 (18) | U = 4814.5 | 0.649 | - | |
| Social Anxiety (SA) | 85.8 (26.3) | 85 (120) | 78.3 (23.9) | 78 (107) | t(210) = 2.05* | 0.041 | d = 0.28 | 0.46 |
| Dimensions of SA | ||||||||
| Public Speaking/ Interaction with HighRanking Persons | 17.9 (6.6) | 18 (24) | 14.9 (5.4) | 15 (23) | U = 3569.5** | 0.001 | Pest = 0.36 | 0.90 |
| Interaction with the Opposite Sex | 17.5 (6.2) | 17 (24) | 15.8 (6.1) | 15 (24) | U = 4220.0 | 0.062 | - | |
| Assertive Expression of Annoyance, Displeasure or Anger | 15.4 (6.4) | 15 (24) | 15.4 (5.5) | 16 (23) | U = 4830.5 | 0.678 | - | |
| Being Embarrassed or Ridiculed | 19.6 (5.2) | 19 (24) | 17.2 (5.7) | 18 (24) | U = 3794.5** | 0.004 | Pest = 0.38 | 0.83 |
| Interaction with Strangers | 15.5 (6.3) | 15 (24) | 15.1 (5.8) | 15 (22) | U = 4876.5 | 0.759 | - | |
Note. *Statistically significant difference at p < 0.05; "Statistically significant difference at p < 0.01, Student's t-test, and Mann-Whitney U-group comparison test.
Source: own elaboration.
The data shown in table 1 highlight the statistically significant differences between women and men in terms of social anxiety levels. Women exhibited higher levels of general social anxiety, although the effect size of this difference was small. Furthermore, women exhibit higher levels of anxiety when speaking in public and interacting with high-ranking persons, as well as in situations in which they might be embarrassed or ridiculed.
Association between Positive Self-esteem, Gender and Social Anxiety
The data presented in table 2 reveal a significant negative relationship between college students' positive self-esteem during the COVID-19 pandemic and their anxiety levels in various social situations. These findings show that as positive self-esteem increases, social anxiety levels decrease in all dimensions under study, and that such associations are moderate. Therefore, the hypothesis proposed in this study was confirmed.
Table 2 Correlation between Positive Self-esteem and Dimensions of Social Anxiety
| Dimensions of Social Anxiety | |||||
|---|---|---|---|---|---|
| 2 | 3 | 4 | |||
| Positive Self-esteem | -0.418** | -0.393** | -0.441** | -0.367** | -0.463** |
| 1-ß | 0.99 | 0.99 | 0.99 | 0.99 | 1.00 |
Note. **p < 0.001 (Unilateral); 1: Public speaking/interaction; 2: Interaction with the opposite sex; 3: Assertive expression of annoyance, displeasure or anger; 4: Being embarrassed or ridiculed; 5: Interaction with strangers.
Source: own elaboration.
When relating the indicators of positive self-esteem to social anxiety experienced by university students during the pandemic, two of these indicators significantly and negatively predicted elevated levels of social anxiety, and gender was also a predictor variable. This model explained 16.4% (Cox and Snell R2) and 28% (Nagelkerke R2) of the total variance (see table 3). That is, when students have a positive view of themselves and feel capable of doing things as well as others, they experience lower levels of social anxiety. Being a woman was associated with a higher risk of experiencing elevated levels of social anxiety. These findings confirm the study hypothesis, supported by the coefficient (B) of the binary logistic regression and the results of the omnibus test of the model (Chi2 = 32.227; df = 2; p = 0.000).
Table 3 Indicators of Positive Self-Esteem and Gender as Predictors of Low Levels of Social Anxiety
| Predictor variables | Yes (%) | No (%) | B | S.E. | Wald | df | Exp(B) | 95% CI Exp(B) | |
|---|---|---|---|---|---|---|---|---|---|
| LLCI | ULCI | ||||||||
| Positive self-esteem Indicators (Items) | |||||||||
| I am capable of doing things as well as most other people do | 78.3% | 21.7% | -1.095* | 0.473 | 5.362 | 1 | 0.335 | .150 | .934 |
| I have a positive view of myself | 71.7% | 28.3% | -1.720** | 0.469 | 13.465 | 1 | 0.179 | .079 | .489 |
| Gender (woman) | - | - | 1.140* | 0.508 | 5.032 | 1 | 3.127 | 1.155 | 8.466 |
Note. Binary logistic regression coefficient: *p < 0.05. ** p < 0.001; LLCI: lower limit of the confidence interval; ULCI: Upper limit of the confidence interval.
Source: own elaboration.
DISCUSSION
The results of the present study contribute to the existing literature on the impact of the pandemic on the mental health of young university students 2,25-27, and the role of positive self-esteem as a protective factor for mental health 7,9,10. Approximately 15% of the study sample experienced elevated levels of social anxiety during the pandemic, similar to the findings of a previous study on a young population 28. This finding is relevant in the educational context, as a significant correlation has been found between high levels of social anxiety and low academic performance over time 6,29-31.
Although most participants had an average level of self-esteem, a significant percentage of the students in the studied sample had low self-esteem (17.9%). This finding is relevant in the educational context, as a low level of self-esteem in young people increases the risk of perceiving certain factors in the academic environment as threatening 32, and it has also been associated with factors such as the perception of little control, few resources for social interaction, social isolation, and high levels of stress 33.
This study reaffirmed the association between self-esteem and social anxiety. Students with positive self-esteem presented low levels of social anxiety, which is consistent with previous research conducted by Caballo et al. 15 and Iancu et al. 18 in the pre-pandemic context. Students with positive self-perception who felt capable of performing as well as their peers (two indicators of positive self-esteem) experienced low levels of social anxiety 14,19,20. This may be explained by the fact that positive self-esteem helps people feel more confident and secure in social situations, thus reducing the likelihood of negative self-evaluation or fear of social rejection 34.
Gender was a predictor of social anxiety in the sample. Our results showed that women present with a greater severity of social anxiety symptoms than men 35,36,37. This may be attributed to various aspects, such as socialization processes that foster greater sensitivity to the feelings and expectations of others, as well as the experience of gender discrimination or violence, which may generate anxiety in social situations. This may also be associated with sex-related differences in the stress response system 35,36. This finding adds to the available, sometimes contradictory, evidence on the relationship between gender and social anxiety, especially during the developmental stages of late adolescence and young adulthood, which have been understudied in terms of anxiety trajectories 28.
Our results support the notion that positive self-esteem is closely linked to psychological well-being 38, and acts as a protective factor against the negative influence of stress and social anxiety symptoms during the COVID-19 pandemic. Therefore, positive self-esteem is an attenuating factor of social anxiety symptomatology in young college students in addition to other attenuating factors previously reported in the literature, such as high socioeconomic status and a history of socialization with friends 28. Optimism, self-confidence, and positive self-perception in students can counteract the cognitive distortions associated with social performance, thus improving emotional, practical, and cognitive adjustment in young university students 7.
The COVID-19 pandemic has made it necessary to prioritize addressing the effects on the mental health of students. The findings described here on the predictive effect of positive self-esteem on social anxiety levels are useful for developing programs, policies, and recommendations that promote self-care and positive self-esteem as a strategy to combat the increase in anxiety caused by COVID-19, improve the academic performance of university students, and contribute to overcoming difficulties in the management, quality, and equity of education. Moreover, gender should be considered when implementing strategies or programs to ensure their effectiveness and efficiency.
This study has some limitations, such as the small sample size, which consisted exclusively of university students with no clinical history of mental disorders prior to the pandemic. Furthermore, data collection through the Office 365 Forms tool did not allow checking for possible biases generated by unwanted extraneous variables at the time of application.
For future research, we suggest expanding the sample size to include people with a history of mental disorders, exploring the effects on students at other educational levels, applying the instruments in a face-to-face setting where the influence of external variables can be controlled, and investigating the possible causes of the differences between men and women, considering aspects such as gender roles, social expectations, economic opportunities, and experiences of gender-related abuse and sexism throughout life.
