Prevalence of Social Anxiety and Its Association With Low Self-Esteem Among Medical Students: A Cross-Sectional Study From Kerala, India.

BACKGROUND: Social anxiety is common among medical students because of academic pressure and frequent evaluations. Low self-esteem may contribute to the development of social anxiety. This study assessed the prevalence of social anxiety and low self-esteem and examined their association among medical students. OBJECTIVES: This study aimed to determine the prevalence of social anxiety and low self-esteem among medical students and to evaluate the association between social anxiety and low self-esteem, as well as their relationship with gender. METHODS: A cross-sectional analytical study was conducted among MBBS students at Believers Church Medical College Hospital, Thiruvalla, Kerala, India, between 2019 and 2021. All MBBS students from the 2016-2021 admission batches were invited to participate through a self-administered online questionnaire (Google Forms, Google LLC, California, USA). Of 600 eligible students, 507 responded (84.5%). Social anxiety was assessed using the Social Interaction Anxiety Scale (SIAS) and self-esteem using the Rosenberg Self-Esteem Scale (RSES). Social anxiety was defined as an SIAS score ≥35 and low self-esteem as an RSES score <20. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, NY, USA). Chi-square tests, odds ratios (ORs), Pearson correlation, and multivariable logistic regression were performed. RESULTS: Social anxiety was identified in 201 (39.64%) participants, while low self-esteem was present in 134 (26.43%). Low self-esteem was significantly associated with social anxiety (χ² = 67.41, p < 0.001; OR =5 .57, 95% confidence interval (CI): 3.62-8.56). Female participants had significantly higher odds of low self-esteem (OR = 2.31, p < 0.001), whereas gender was not independently associated with social anxiety. SIAS and RSES scores showed a significant negative correlation (r = -0.595, p < 0.001). Low self-esteem remained an independent predictor of social anxiety after adjustment for gender (adjusted OR = 5.76, 95% CI: 3.71-8.93; p < 0.001). Most participants reported symptom onset between 15 and 19 years. CONCLUSIONS: Social anxiety and low self-esteem are highly prevalent among medical students. Low self-esteem is independently associated with social anxiety, highlighting the importance of early screening and interventions aimed at improving psychological well-being in this population.