Results

A total of 507 medical students participated out of 600 invited students, yielding a response rate of 84.5%. Females constituted 323 (63.7%) participants, while males constituted 184 (36.3%) (Table 1).

Variable | n (%)
Total participants | 507
Female | 323 (63.7)
Male | 184 (36.3)

Social anxiety was identified in 201 students (39.64%), while 306 students (60.36%) did not meet the cutoff for social anxiety. Low self-esteem was present in 134 students (26.43%), while 373 students (73.57%) had normal self-esteem (Table 2).

Variable | Number of participants (n) | Prevalence
Social anxiety | 201 | 39.64%
Low self-esteem | 134 | 26.43%

A statistically significant association was observed between low self-esteem and social anxiety. Among students with low self-esteem, 93 of 134 (69.40%) had social anxiety, compared with 108 of 373 (28.95%) students with normal self-esteem (Table 3). Students with low self-esteem had 5.57 times higher odds of social anxiety (OR = 5.57, 95% Cl: 3.62-8.56; χ2 = 67.41, p < 0.001).

Self-esteem status | Social anxiety | No social anxiety
Low self-esteem | 93 | 41
Normal self-esteem | 108 | 265

Gender-stratified analysis showed that social anxiety was present in 131 of 323 females (40.56%) and 70 of 184 males (38.04%). This difference was not statistically significant (χ2= 0.31, p = 0.578; OR = 1.11, 95% Cl: 0.77-1.61) (Table 4).

Gender | Social anxiety | No social anxiety
Female | 131 | 192
Male | 70 | 114

Low self-esteem was significantly more common among females, occurring in 103 of 323 females (31.89%), compared with 31 of 184 males (16.85%). Female students had 2.31 times higher odds of low self-esteem than male students (OR = 2.31, 95% CI: 1.47-3.63; χ2 = 13.64, p < 0.001) (Table 5).

Gender | Low self-esteem | Normal self-esteem
Female | 103 | 220
Male | 31 | 153

The most common reported age of onset of social anxiety-related symptoms was 15-19 years, reported by 259 students (51.08%), followed by 10-14 years in 105 students (20.71%) (Table 6). Correlation analysis showed a significant negative relationship between SIAS and RSES scores.

Age group (years) | n (%)
5-9 | 29 (5.72%)
10-14 | 105 (20.71%)
15-19 | 259 (51.08%)
20-24 | 62 (12.23%)
25 or older | 4 (0.79%)
Missing/not applicable | 48 (9.47%)

The mean total SIAS score was 30.77 ± 15.58, with a median of 30, an interquartile range of 19-42, and an observed range of 0-77. The mean total RSES score was 24.54 ± 8.26, with a median of 24, an interquartile range of 19-31, and an observed range of 0-40. Both score distributions deviated significantly from normality on the Shapiro-Wilk test (p < 0.001) (Table 7).

Instrument | Mean ± SD | Median (IQR) | Observed range
Social Interaction Anxiety Sale | 30.77 ± 15.58 | 30 (19-42) | 0-77
Rosenberg Self-Esteem Scale | 24.54 ± 8.26 | 24 (19-31) | 0-40

Pearson correlation was r = -0.595 (p < 0.001), and Spearman correlation was ρ = -0.576 (p < 0.001), indicating that lower self-esteem scores were associated with higher social anxiety scores (Table 8).

Analysis | Correlation coefficient | p value
Pearson correlation | -0.595 | <0.001
Spearman correlation | -0.576 | <0.001

Multivariable logistic regression showed that low self-esteem remained independently associated with social anxiety after adjusting for gender (adjusted OR = 5.76, 95% CI: 3.71-8.93, p < 0.001) (Table 9). Female gender was not independently associated with social anxiety (adjusted OR = 0.84, 95% Cl: 0.56-1.25, p = 0.389).

Predictor | β coefficient | Standard error | Adjusted odds ratio | 95% confidence interval | p value
Low self-esteem | 1.751 | 0.224 | 5.76 | 3.17-8.93 | <0.001
Female gender | -0.177 | 0.206 | 0.84 | 0.56-1.25 | 0.389

Internal consistency was excellent for both instruments, with Cronbach's alpha of 0.923 for the SIAS and 0.870 for the RSES (Table 10).

Instrument | Cronbach's alpha
SIAS | 0.923
RSES | 0.87