This study examined the relationships between social anxiety, shame, and interpersonal suicide risk. It found that shame partially mediated the relationship between social anxiety and feelings of thwarted belongingness, and fully mediated the relationship between social anxiety and perceived burdensomeness. The study involved surveying 259 participants online to assess their levels of social anxiety, experiences of shame, and perceptions of interpersonal suicide risk. Higher social anxiety was correlated with greater shame and interpersonal suicide risk. Shame also correlated with both dimensions of interpersonal suicide risk.

1. Social Anxiety, Interpersonal Suicide Risk,
And the Mediating Role of Shame
Danielle M. Morabito, Kimberly A. Arditte, Ashley M. Shaw & Kiara R. Timpano
University of Miami
INTRODUCTION
• Social Anxiety Disorder (SAD) is characterized by persistent fear
of social situations that interfere in one’s life1
• Individuals with SAD may even be at increased risk for suicide2
• Given this connection, it is imperative for us to better understand
the relationship between SAD and increased suicide risk.
• Considering the nature of social anxiety, research may want to
examine interpersonal risk factors such as thwarted
belongingness and perceived burdensomeness as defined by the
Interpersonal Needs Questionnaire3
• Meanwhile, previous research has linked both social anxiety and
increase suicide risk to experiences of shame4;5
• Shame is defined as an intense negative emotion that
involves feelings of inferiority, powerlessness, and self-
consciousness6
• Given what is known about these constructs, shame may mediate
the relationship between social anxiety and suicide risk.
• Social anxiety has a fairly young age of onset and tends to
remain constant when left untreated7
• Social anxiety has been shown to predict increased shame
over time8
• While social anxiety has been associated with feelings of
thwarted belongingness, shame has been identified as a risk
factor for perceived burdensomeness9
• To date, no study has systematically examined the relations
among these constructs.
• Research in this area could have significant clinical implications
for suicide risk screening and prevention strategies.
METHOD
Participants
• 259 participants were recruited using Amazon Mechanical Turk
• Mean age = 30.81 years (SD = 8.57 years)
• 51% Male; 86% White/Caucasian; 9% Hispanic/Latino
• SIAS (M = 36.19, SD = 21.35)
• Sample mean above clinical cutoff10
• Participants completed the SIAS, ESS, and INQ as part of a
broader study on emotional experiences
• All study procedures were completed online using Qualtrics
Survey Software.
METHOD - CONTINUED
Measures
Social Interaction Anxiety Scale (SIAS)11
• 20 items on a Likert-type scale with responses range from 0 (Not at all
characteristic or true of me) to 4 (Extremely characteristic or true of me).
Experience of Shame Scale (ESS)12
• 25 items with responses ranging from 1 (Not at all) to 4 (Very much)
• Characterological Shame (ESS Char): related to non-physical
characteristics
• Behavioral Shame (ESS Behav): related to specific behaviors
• Bodily Shame (ESS Body): related to physical characteristics
Interpersonal Needs Questionnaire 12-item (INQ-12)3
• 12 items with responses ranging from 0 (Not at all true for me) to 7 (Very
true for me).
• Thwarted Belongingness (INQ Belonging): the painful mental state
resulting from an unmet need for interpersonal connectedness, indicating
social isolation
• Perceived Burdensomeness (INQ Burden): a mental state resulting from
an unmet need for social competence, characterized by the belief that
others would be better off without oneself.
DISCUSSION
• Results revealed significant associations between social anxiety,
shame across all three subscales, and both dimensions of
interpersonal suicide risk.
• The mediation analyses revealed that shame partially mediates
the relationship between social anxiety and thwarted
belongingness and fully mediates the relationship between
social anxiety and perceived burdensomeness.
• Though cross-sectional in nature, results suggest that shame
plays a key role in the relationship between social anxiety
symptoms and interpersonal risk for suicide.
• Future studies should assess constructs in clinical samples and
supplement self-report data with diagnostic interviews.
RESULTS - CONTINUED
Figure 1. Partial Mediation of Social Anxiety Symptoms
and Thwarted Belongingness by Experiences of Shame
Note. * all other ps < .001
Note. * all other ps < .001
Figure 2. Full Mediation of Social Anxiety Symptoms and
Perceived Burdensomeness by Experiences of Shame
ESS
Total ESS
Char ESS
Behav ESS
Body
SIAS
Total .75** .72** .72** .64**
INQ
Belonging INQ
Burden
SIAS
Total .51** .48**
ESS
Total ESS
Char ESS
Behav ESS
Body
INQ
Belonging .52** .55** .46** .40**
INQ
Burden .59** .61** .53** .45**
Note. **p <.001
Aim 1. Examining the relationships between variables
• Social anxiety symptoms were positively correlated with interpersonal
suicide risk.
AIMS
1. To systematically examine the relationships between social
anxiety, various facets of shame, and interpersonal suicide
risk.
2. To determine whether shame mediates the relationship
between social anxiety and interpersonal suicide risk as
measured by feelings of thwarted belongingness and
perceived burdensomeness.
1American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
2Allan, N. P., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2014). Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation. Journal of anxiety disorders, 28(2), 266-275.
3Van Orden, K.A., Witte, T.K., Gordon, K.H., Bender, T.W., & Joiner, Jr., T.E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among
adults. Journal of Consulting and Clinical Psychology, 76, 72–83.
4Bryan, C. J., Ray-Sannerud, B., Morrow, C. E., & Etienne, N. (2013). Shame, pride, and suicidal ideation in a military clinical sample. Journal of affective disorders, 147(1), 212-216.
5Fergus, T. A., Valentiner, D. P., McGrath, P. B., & Jencius, S. (2010). Shame-and guilt-proneness: Relationships with anxiety disorder symptoms in a clinical sample. Journal of anxiety disorders, 24(8), 811-815.
6Tangney, J. P., Miller, R. S., Flicker, L., & Barlow, D. H. (1996). Are shame, guilt, and embarrassment distinct emotions? Journal of Personality and Social Psychology, 70, 1256–1269.
7Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour research and therapy, 36(4), 455-470.
8Lutwak, N., & Ferrari, J. R. (1997). Shame-related social anxiety: Replicating a link with various social interaction measures. Anxiety, stress, and coping, 10(4), 335-340.
Social
Anxiety
Thwarted
Belongingness
Shame
.75 .33
c’: β = .26, t = 3.27, p = .001
Social
Anxiety
Perceived
Burdensomeness
Shame
.75 .52
c’: β = .09, t = 1.14, p = .286
• Social anxiety symptoms were also positively correlated with
experiences of shame.
• Interpersonal suicide risk was positively correlated with all experiences
of shame.
Aim 2. Testing the hypothesized mediation models
• Shame partially mediated the relationship between social
anxiety symptoms and thwarted belongingness (see Figure 1).
• Shame fully mediated the relationship between social anxiety
symptoms and perceived burdensomeness. (see Figure 2).
9Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. J. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575-600.
10Peters, L. (2000). Discriminant validity of the social phobia and anxiety inventory (SPAI), the social phobia scale (SPS) and the social interaction anxiety scale (SIAS). Behaviour Research
and Therapy, 38(9),
943-950.
11Andrews, B., Qian, M., & Valentine, J. D. (2002). Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. British Journal of Clinical Psychology,
41(1), 29-42.
12Van Orden, K.A., Witte, T.K., Gordon, K.H., Bender, T.W., & Joiner, Jr., T.E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal
behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72–83.
RESULTS