Understanding the relationship of social anxiety with alcohol use and alcohol-related problems in young people: A meta-analysis

Background and aims: Social anxiety is associated with disparate alcohol-related outcomes among young people. This meta-analysis synthesised the literature to determine what factors (e.g. impulsivity) may account for variance in these outcomes. Methods: Empirical studies reporting the correlation of social anxiety with alcohol use and/or alcohol-related problems (ARPs) among young people (aged 13–29 years) were identified through a systematic literature search. Five random-effects meta-analyses were performed for ARPs, problematic alcohol use, frequency, quantity and quantity by frequency index measures of alcohol use. Seventy studies were included with 233 effect sizes extracted. The average age was 20 years (n = 38 517; 66.2% female). Results: Social anxiety was negatively associated with index alcohol use [number of studies (k) = 28, r = −0.05, 95% confidence interval (CI) = −0.08 to −0.03, t = −4.04, P < 0.001] but statistically non-significant with quantity (k = 21, r = 0.00, 95% CI = −0.04 to 0.05, t = 0.18, P = 0.86) or frequency (k = 18, r = −0.01, 95% CI = −0.06 to 0.05, t = −0.29, P = 0.78) of alcohol use. Social anxiety was statistically significantly positively associated with ARPs (k = 45, r = 0.13, 95% CI = 0.10–0.16, t = 9.93, P < 0.001) and problematic alcohol use (k = 23, r = 0.06, 95% CI = 0.01–0.11, t = 2.68, P = 0.01). Impulsivity was a statistically significant moderator, such that, as the correlation of impulsivity with social anxiety increased, the association of social anxiety with index alcohol use positively increased. Subgroup analyses for ARPs measure used were also statistically significant. Conclusion: Young people with elevated social anxiety appear to drink less alcohol than their peers, but report more problematic alcohol use and alcohol-related problems. Impulsivity may clarify unexpected patterns of lower alcohol consumption, although conclusions remain tentative due to methodological constraints.