Adverse Childhood Experience, Parental Bonding, and Fatherhood as Parenting Vulnerabilities to Social Anxiety Severity in Iranian Context

doi:10.21203/rs.3.rs-3130663/v1

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Adverse Childhood Experience, Parental Bonding, and Fatherhood as Parenting Vulnerabilities to Social Anxiety Severity in Iranian Context

https://doi.org/10.21203/rs.3.rs-3130663/v1

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published 17 Jul, 2024

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The present study aimed to examine the association between adverse childhood experiences, parental bonding, fatherhood, and social anxiety symptoms among emerging adults in an Iranian context. In a cross-sectional study, self-reports measuring fatherhood, parental bonding, anxious thoughts, and childhood trauma were administered to 242 university students with social anxiety symptoms. The data were analyzed using multiple linear regression. Individuals with adverse childhood experiences displayed more social anxiety symptoms (R2 = .32) than others. Moreover, fatherhood (R2 = .28), paternal bonding (R2 = .26), and maternal bonding (R2 = .26) were all significantly and equally associated with variance in social anxiety symptoms. Our findings revealed that adverse childhood experiences, fatherhood, and both maternal and paternal bonding significantly correlated to social anxiety symptoms later in adulthood. Accordingly, it is vital to assess the significance of each factor that contributes to social anxiety in order to develop community-based prevention packages and reduce the prevalence of social anxiety in society.

social anxiety

adverse childhood experience

parental bonding

fatherhood

anxious thought

trauma

Research indicates that adverse childhood experiences, fatherhood quality, and parental bonding are associated with social interaction difficulties and the severity of social anxiety symptoms.
The correlation between symptoms of social anxiety disorder and parental bonding, fatherhood, and adverse childhood experiences was examined in a sample of Iranian emerging adults between the ages of 18-29.
Adverse childhood experiences have the largest contribution to explaining the prevalence of social anxiety in emerging adults. Afterward, fatherhood and parental bonding are important predictors of social anxiety.

Community health setting specialists must consider the role of parental factors, particularly fathers, in the prevention of social anxiety symptoms.

Social anxiety disorder (SAD) is a common experience triggered by heightened fear or anxiety in social situations in which an individual is exposed to the scrutiny of others; such as being observed or performing in front of strangers (American Psychiatric Association, 2013). Evidence indicated the 30-day, 12-month, and lifetime prevalence rates of social anxiety within various nations to be 1.3%, 2.4%, and 4.0%, respectively (D. J. Stein et al., 2017). Based on epidemiologic research, 36% of adults, especially youth fulfilled the threshold criteria for SAD (Jefferies & Ungar, 2020). Moreover, roughly one in ten students reported a severe level of SAD (Reta et al., 2020) predisposing them to a variety of negative outcomes like poor academic performance (Hood et al., 2021), low level of social interactions (Briot et al., 2020), susceptibility to depression (Habibi et al., 2014), and suicidality (Buckner et al., 2017). The severity of SAD as a public psychological concern has prompted a substantial increase in research into it. Effective prevention requires precise prediction. Therefore, a primary focus is on the underlying mechanisms and risk factors of SAD.

A great surge of research identified associated factors leading to SAD such as negative coping styles (Hofmann, 2007), substandard family function (Shao et al., 2020), poor life quality (Wu et al., 2016), cognitive emotion dysregulation (Zsido et al., 2021), insufficient of social support (Singh et al., 2020), as well as adverse childhood experiences (ACEs) (Lee et al., 2020). ACEs are characterized by child maltreatment (e.g., physical, sexual, emotional abuse, emotional and physical neglect) and family dysfunction (e.g., divorce or separation of parents, incarceration, violence, mental illness, and substance abuse) (Wang et al., 2021). Based on research into developmental psychopathology, ACEs are reported by 28.9% of individuals with psychiatric problems (Kessler et al., 2010). Specifically, ACEs are one of the most significant indicators of social anxiety symptoms (Crandall et al., 2020; Fitzgerald & Gallus, 2020; Wang et al., 2021). The findings of a meta-analysis indicated that exposure to any form of childhood maltreatment may more than double the risk of anxiety symptoms in adulthood (Li et al., 2016). Notably, those who encountered three or more times mentioned traumas displayed higher susceptibility (Meng et al., 2021; Watt et al., 2020). To date, numerous hypotheses explained the relationships between ACEs and social anxiety; relevant to this study, the stress sensitization theory postulated that individuals exposed to childhood adversity may be more susceptible to psychological disorders produced by proximate stressors (Bandoli et al., 2017). Additionally, cognitive theories place maladaptive emotion regulations at the core of depression and anxiety disorders. Emotion regulation abilities form in childhood and any adversities in this period are followed by failures in effectively regulating emotions. Also, based on evidence, emotion regulation mediates the association between ACEs and social anxiety (Cisler et al., 2010). Thus, children who experienced traumas are prone to subsequent social anxiety symptoms (Buhle et al., 2014; Burns et al., 2010). Moreover, the cognitive-behavioral model of SAD posits that the onset of SAD is the consequence of biological susceptibility and negative social learning experiences in combination (Heimberg et al., 2014). Based on Bowlby’s theory (1973), children develop coping mechanisms based on the influences of their parents and family environment to deal with stress, but ACEs during a formative period like childhood can disturb the development of a healthy self-concept, low self-esteem resulting in social withdrawal (Liu et al., 2015). A substantial rise in international research has proved the correlation between ACEs and social anxiety symptoms in various cultural contexts (Essau et al., 2012; Ho et al., 2020; Vaughn et al., 2017; Westermair et al., 2018). For instance, a study in Korea evaluated childhood financial struggles as significant early adversities. Considering that financial struggles may contribute to mental health issues like social anxiety in adulthood. Also, Korean culture has considered traumas to be shameful experiences that individuals must suffer and endure in solitude leading to social anxiety (Kim et al., 2023). Overall, childhood trauma as a strong predictor of SAD should not be overlooked; however, positive childhood experiences, such as strong parental bonding, have been identified as a protector against vulnerabilities to SAD (Spence & Rapee, 2016).

Parental bonding refers to an emotional attachment, commitment, and social relationship with parents/caregivers (Tichelman et al., 2019). Robust evidence showed poor parental bonding such as changes in parents' role, parenting style, and overprotection moderated the effect of ACEs on the child's anxiety (Field et al., 2011; Nanda et al., 2016). In a nutshell, the parent-child relationship, rather than curing and returning a person to an optimal level of well-being, would exacerbate the conditions as a traumatic experience, leading to extreme symptoms on the anxiety spectrum (Breidenstine et al., 2011; Mak et al., 2018). The significance of parental bonding in the etiology of SAD and its mediating role in relations between ACEs and social anxiety symptoms emphasizes the necessitates of studying it. A child’s ability to form this essential bond largely relies on the quality of care and protection offered by a parent. Abnormal parental bonding is defined as suboptimal levels of care, excessive levels of protection, and heightened criticism increasing susceptibility to social anxiety or other psychiatric disorders (Bowlby, 1973; Morris & Oosterhoff, 2016; Spence & Rapee, 2016). Kidd et al. (2022) in a systematic review of 57 studies reaffirmed that individuals with anxiety symptoms reported poor quality parental bonding with lower parental care and higher overprotection than those without psychiatric symptoms. Additionally, A meta-analysis of 53 studies in China (n = 26024) revealed that positive parenting is associated with a decline in social anxiety, while negative parenting is associated with increased social anxiety (Dong et al., 2022). Based on Bowlby’s attachment theory (1973), the years between infancy and emerging adulthood are crucial for psychological development. Thus, inadequate parental input in this period not only hinders psychological development but also renders the child susceptible to psychiatric disorders (Bowlby, 1973). Also, a child with secure emotional bonds finds her/himself worthy of affection, as well as having positive interactions with others. In contrast, a child with an insecure bond may have troubles with self-regulation, low self-esteem, or view him/herself as unworthy (Lee & Shin, 2021); which is followed by social anxiety symptoms (Dixon et al., 2020). Previous literature has converged on the idea that there is a strong association between traumatic events and insufficient parental care (Breidenstine et al., 2011). For instance, the frequency of ACEs is significantly higher in individuals experiencing separation from parents, having violent relatives, or any plausible deficits in parental bonding (Arditti, 2012). Therefore, parental bonding is an essential psychological process for a child's optimal development, as well as a crucial foundation for parents' positive behaviors, particularly in the context of fatherhood (Burns et al., 2022).

Several reviews indicated a possibly differing influence between fathers and mothers on the development of child anxiety (Majdandžić et al., 2016); nonetheless, most research has concentrated on the roles of mothers, with few considering the fatherhood (Bögels et al., 2008). According to Dick (2004), fatherhood is an individual's view of the father's emotional response and the roles fathers engage in based on the child's experiences growing up. Evidence showed that memories of the lack of father’s responsiveness in early childhood are associated with depression (Kullberg et al., 2020) and social anxiety (Bögels & Phares, 2008). Generally, Fathers play a challenging role in fostering a child's active, competitive, independent, and inquisitive nature, as well as the transition of these traits into the social world, particularly when young adults move away from home (Bögels & Phares, 2008); which varies from the mother-child attachment relationship that is to console and soothe offspring (Paquette, 2004). Existing theories proposed that the effective dynamic relationship between child and father, referred to as the father-child activation relationship, has the function to push the child’s limits and in this way can buffer against early separation, strangers, and novelty of the development of anxiety (Bögels & Perotti, 2011). Regarding the emotion regulation process, the father’s unfavorable behaviors in the child-parent relationship influence the child’s cognition toward life; as a result, a large obstacle poses to the emotion regulation process which plays an essential role in the emergence of social anxiety (Gómez-Ortiz et al., 2019). Moreover, based on the emotional security theory (EST), fathers are essential sources of emotional security (Suh et al., 2016). Hence, children who are rejected by their fathers experience a lack of affection and security, leading to inferiority, rage, and a lack of self-confidence (Van Zalk et al., 2018). In contrast, children of accepting fathers showed a strong ability for innovation and emotional security which is a supporting factor in confronting social anxiety (Bögels & Perotti, 2011). Data from a meta-analysis suggested the relationship between parental control and child social anxiety was strong in research that included fathers and moderate in studies that only involved mothers (Van Der Bruggen et al., 2008). Furthermore, a recent study conducted over 3000 families in the UK found that mental health problems in fathers or the father's absence from the child may affect the child's cognition, emotions, the social ability, in addition to affecting the father (Gutierrez-Galve et al., 2019).

The study context

In traditional Eastern societies such as Iran, an authoritarian parenting style is prevalent, resulting in cultural influences which lead fathers to adopt a less engaging and more authoritarian role in the father-child relationship (Rahkar Farshi et al., 2018). Fathers' ability to form relationships with children may also be constrained by time limitations caused by employment obligations; thus primary responsibility for the direct upbringing of children is usually attributed to mothers (Salami & Ghajarieh, 2016). In addition, it is the responsibility of mothers to facilitate relationships between fathers and children which contributes to a variety of positive outcomes, including enhanced well-being and self-efficacy. Accordingly, cultural structures reinforce gender roles and restrict the involvement of fathers in the Iranian context (Valizadeh et al., 2018). Evidence showed a majority of Iranian adolescents reported that their mothers were more familiar with them, provided more guidance, and was more involved in their lives than their fathers, highlighting the crucial role of mothers in Iranian childrearing, while fathers' roles appeared to be weaker (Rahkar Farshi et al., 2018). Furthermore, since Iran has been undergoing a long period of modernization recently, the location of this study is significant to reflect on. Iranian society witnessed substantial social changes such as an increase in education and personal self-efficacy, especially among young females. As a result, young adult participation in societal activities and education has expanded dramatically (Hajebi et al., 2018). Unlike in the past, parents increasingly encourage children to pursue higher education in order to raise their social standings (Abbasi et al., 2002). Being a member of a society emphasizes the need for researching social concerns and other undesirable symptoms that may impair an individual's societal presence (Heerey & Kring, 2007). Based on a national mental health survey, anxiety disorders were the most common type of psychiatric disorder in Iran demanding special dedicated attention (Noorbala et al., 2004) which may stem from parent-child interactions (Bernstein et al., 2019). Thus, in light of shifting social norms and family structure in Iranian society, we investigated the etiology of social anxiety, focusing on factors related to primary family relationships, which may make it difficult for an individual to function successfully in society as a confident person later in adulthood. A closer examination of these factors could aid in disease prevention and prognosis.

The present study aimed to evaluate the associations between ACEs, social anxiety symptoms, parental bonding, and fatherhood. In light of the broader research on social anxiety, several specific hypotheses were formulated: (i) It was postulated that social anxiety symptoms would exhibit a negative correlation with fatherhood. (ii) A negative association between parental bonding and social anxiety symptoms was expected. (iii) A positive association was anticipated between adverse childhood experiences and social anxiety symptoms.

Participants

A total of 980 students were recruited from various faculties at the University of Tabriz. 270 students fulfilled the symptoms of social anxiety and among them, twenty-eight (10.3%) respondents filled out the questionnaires incompletely. Thus, the final sample included 242 participants. The inclusion criteria were: a) attending university, b) having social anxiety symptoms based on self-reports, and c) being at the age of 18-29 (emerging adults). The exclusion criteria were: a) undergoing psychotropic psychotherapy or medications at present. 181 (74.8%) of respondents were boys and 61 (25.2%) were girls between the ages of 18-29 (M = 23.74, SD = 2.06). Around 65% of the participants were pursuing bachelor's degrees, while 35% were masters. A majority of them (84.3%) were of middle-class socioeconomic status, 6.6% of low, and 9.1% were of high income. Also, in terms of marital status, around 73.2% reported being single, 25.6% married, and 1.2% divorced.

Measurements

The Anxious Thought Inventory (AnTI). One of the most commonly used measures to assess anxiety thoughts is AnTI (Wells, 1994). In the current study, we used the social worry component of AnTI to measure social anxiety. The AnTI consists of 21 items with several empirically derived components that separately measure social worry (eight items), health worry (six items), and meta worry (seven items). A sample item reads “I worry about not being able to cope in life as adequately as others seem to” and responses were scored on a four-point Likert scale (1 = almost never to 4 = almost always). Moloodi et al (2020) have confirmed the psychometric properties of the AnTI in an Iranian sample. Moreover, Cronbach’s alpha for social worry, physical health, and meta-worry was .85, .81, and .75, respectively.

Childhood Trauma Questionnaire (CTQ). The CTQ was developed by Bernstein (1997) and consists of 28 items that assess the severity of different types of childhood trauma. The CTQ has five subscales including emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Participants respond to each item in the context of “when you were growing up” and answer according to a five-point Likert-type scale ranging from (0 = never true to 5 = very often true). For example, one of the items reads “People in my family said hurtful or insulting things to me”. Higher scores indicate higher childhood traumas. Chegeni et al. (2020) also confirmed the psychometric properties of the Iranian version of CTQ. Cronbach’s alpha of total scale, physical, emotional, and sexual abuse, and physical and emotional neglect was .89, .80, .86, .91, .84, and .78, respectively.

Parental Bonding Instrument (PBI). The PBI (Parker, 1990) measures perceived parental behavior during the first 16 years of life (Wilhelm et al., 2005). It consists of two separate forms for the mother and the father. In the present study, only the mother form was used and the parental relationship was only evaluated from the mothers' perspective. The PBI has been compiled by Parker based on Bowlby’s attachment theory and asks respondents to recall how their mothers treated them in the first 16 years of their life, by answering multiple choices rated on a four-point Likert scale from (0 = almost like that to 3 = almost not like that at all). PBI has 24 items and four factors including (care, overprotection, indifference, and encouragement of autonomy). As an example, one of the items states “My mother spoke to me in a warm and friendly voice”. Behzadi and Parker (2015) evaluated the validity and reliability of the Iranian version of the PBI. In their research, Cronbach’s alpha of care, overprotection, indifference, and encouragement of autonomy in the mother’s form was .83, .88, .79, and .80, respectively.

Fatherhood Scale (FS). The FS scale was developed by Dick (2004) and consists of 64 items in the form of descriptive statements, to measure the type of relationship adults had with their fathers while growing up. The participants should answer based on their perceptions about the quality of the emotional relationship with their fathers during the developmental period. For instance, a sample item reads “My father comforted me when I was feeling bad”. The responses are rated on a five-point Likert scale from (0 = never to 4 = always). The FS measures the father’s engagement on nine subscales including positive engagement, positive emotional responsiveness, negative engagement, moral father role, good provider role, gender role model, androgynous role, responsible father, and accessible father. Esmaeelpanah Amlashi et al. (2021a) evaluated the psychometric properties of FS in an Iranian sample. Cronbach’s alpha for the total scale, positive emotional responsiveness, moral father role, father’s positive engagement, good provider role, negative engagement, gender role, androgynous role, responsible father, and accessible father was .96, .96, .85, .67, .79, .78, .82, .89, and .84, respectively. (See Table 1 for descriptive and Cronbach's alpha of the tools for the original and current study).

Table 1

Studies validating the psychometric properties of the AnTI, CTQ, PBI, and FS in different populations.

Tool

Author

Country

Participants

Reliability

mean

SD ^a

Reliability^c

Mean^c

SD^c

The Anxious Thought Inventory (AnTI)

Wells (1994)

England

n₁= 98 (41% male)

M (SD)_age = 21.22 (5.41)

n₂ = 141 (59% female)

M (SD)_age = 17.84 (2.37)

SW (n_1, n₂) = .84

SW (n_1, n₂) = 17.16, 19.12

SW (n1, n2) = 4.09, 4.95

SW (n) = .87

SW (n) = 16.98

SW (n) = 5.33

Childhood Trauma Questionnaire (CTQ)

Bernstein et al., (1997)

United states

n₁= 227 (57% female)

n₂= 171 (43% male)

M (SD)_age = 14.9 (1.4)

EA (n_1, n₂) = .95

EN (n_1, n₂) = .94

SA (n_1, n₂) = .91

PA (n_1, n₂) = .90

PN (n_1, n₂) = .81

TS (n_1, n₂) = .97

EA (n_1, n₂) = 42.1

EN (n_1, n₂) = 52.8

SA (n_1, n₂) = 11.3

PA (n_1, n₂) = 13.4

PN (n_1, n₂) = 16.8

TS (n_1, n₂) = 136.5

EA (n_1, n₂) = 17.2

EN (n_1, n₂) = 19.5

SA (n_1, n₂) = 7.3

PA (n_1, n₂) = 7.1

PN (n_1, n₂) = 6.9

TS (n_1, n₂) = 47.0

EA (n) = .73

EN (n) = .83

SA (n) = .78

PA (n) = .81

PN (n) = .45

TS (n) = .57

EA (n) = 7.23

EN (n) = 9.68

SA (n) = 5.69

PA (n) = 5.72

PN (n) = 6.42

TS (n) = 34.76

EA (n) = 3.14

EN (n) = 4.32

SA (n) = 1.75

PA (n) = 1.87

PN (n) = 2.02

TS (n) = 9.81

Parental Bonding Instrument (PBI)

Parker (1990)

Australia

n₁= 79 (52.6% female)

n₂= 71 (47.3% male)

M age = 25

C (n_1, n₂) =

.76

O (n_1, n₂) =

.63

TPBS (n_1, n₂) =

.70

C (n_1, n₂) =

24.9

O (n_1, n₂) =

13.3

C (n) = .79

O (n) = .73

C (n) = 20.87

O (n) = 20.61

C (n) = 3.72

O (n) = 4.52

Fatherhood Scale (FS)

Dick (2004)

United states

n= 311 (male)

M (SD)age = 34 (10.5)

PER (n) = .96

PE (n) = .93

NE (n) = .85

MFR (n) = .86

GPR (n) = .90

GRM (n) =

.80

AR (n) = .83

PA (n) = .87

PR (n) =

.90

TFS (n) =

.98

PER (n) = 57.0

PE (n) = 36.9

NE (n) = 48.2

MFR (n) = 14.6

GPR (n) = 19.4

GRM (n) =

16.1

AR (n) = 19.9

PA (n) = 10.2

PR (n) =

27.8

TFS (n) =

232.9

PER (n) = 18.3

PE (n) = 13.6

NE (n) = 8.09

MFR (n) = 5.68

GPR (n) = 5.54

GRM (n) =

5.29

AR (n) = 5.51

PA (n) = 3.95

PR (n) =

10.0

TFS (n) =

54.3

PER (n) = .94

PE (n) = .89

NE (n) = .87

MFR (n) = .69

GPR (n) = .71

GRM (n) = 0.71

AR (n) = .72

PA (n) = .81

PR (n) = .73

PER (n) = 36.73

PE (n)= 12.92

NE (n) = 15.9

MFR (n) = 11.80

GPR (n) = 13.7

GRM (n) = 14.35

AR (n) = 16.39

PA (n) = 10.07

PR (n) = 17.56

PER (n) = 9.61

PE (n) = 3.9

NE (n) = 4.72

MFR (n) = 2.98

GPR (n) = 2.26

GRM (n) = 3.54

AR (n) = 3.54

PA (n) = 2.90

PR (n) = 4.34

Note. n = sample size. SW = social worry; HW = health worry; MW = meta-worry; TW = total worry; EA = emotional abuse; EN = emotional neglect; SA = sexual abuse; PA = physical abuse; PN = physical neglect; PER = positive emotion responsiveness; PE = positive engagement; NE = negative engagement; MFR= moral father role; GPR = good provider roll; GRM = gender role model; AR = androgynous role; PA = paternal accessibility; PR = paternal responsibility; TFS = total fatherhood scale; C = care; O = overprotection. = Chronbach’s alpha and descriptive statistics of original study. Not reported in the original study. = Chronbach’s alpha and descriptive statistics of current study.

Procedure

A university-based ethics committee approved the data collection and study. Ethical considerations were clarified (such as voluntary participation, privacy, anonymity, and confidentiality). Before participating, each respondent received information about the study and signed an informed consent form. They were informed that participation was voluntary and that they could withdraw at any time. The questionnaires were anonymous, and no participant responses were discussed individually in this study. Before completing the AnTI, CTQ, PBI, and FS, participants were asked to respond to demographic questions regarding their age, gender, level of education, and socioeconomic status; no compensation was offered.

Statistical Analysis

Descriptive statistics of variables were calculated using SPSS version 24. Prior to running the analyses, the assumptions of multiple regressions were checked on data. Less than 3% of data were missing. Regression estimation was used to replace these missing data. The outliers were assessed using squared Malahanobis distance (D2). Twenty-eight individuals showed D² values that would recommend their removal; therefore, they were excluded from the study (N = 242). The normality was evacuated by the coefficients of skewness (Sk) and kurtosis (Ku). All the variables indicated sufficient normality. Dependent and independent variables were linearly correlated, residual terms were uncorrelated, no heteroscedasticity was present, the error distribution was normal, and no multi-collinearity was present. A p-value of less than or equal to .05 was used to determine statistical significance. To examine whether adverse childhood experiences, parental bonding, and fatherhood were associated with social anxiety levels, a series of multiple regression analyses were administered.

As shown in Table 2, generally, maternal bonding, paternal bonding, fatherhood, and adverse childhood experiences can explain 39% of changes in social anxiety (F = 37.41, P < .05). The results related to regression coefficients indicate that maternal bonding (t = -3.13, β = -.20 P < .05), paternal bonding (t = -5.01, β = -.30, P < .05) and fatherhood (t = -2.35, = - .12, P < .05) negatively predicted social anxiety. That means by increasing one unit in variables like maternal and paternal bonding and fatherhood the amount of social anxiety decreases by .20, .29, and .30; respectively. Moreover, adverse childhood experiences (t = 3.48, β = .22, P < .05) positively predicted social anxiety. In other words, by an increase of one unit in adverse childhood experiences, the number of social anxieties increases by .22 units. (Insert Table 2 here)

Table 2.

Results of simultaneous multiple regressions for predicting social anxiety via total scores of maternal and paternal bonding, fatherhood, and adverse childhood experiences.

Variable	B	SE	β	T	Sig.	R	R²	F
Maternal model	-.12	.04	-.20	-3.13	.001	.62	.39	37.4
Paternal model	-.15	.03	-.30	-5.01	.001
Fatherhood	-.03	.01	-.12	-2.35	.02
Adverse childhood experience	.13	.04	.22	3.48	.001

Based on Table 3, components of maternal bonding generally were able to explain 27% of changes in social anxiety (F = 21.52, P < .05). The results of regression coefficients showed that components of care (t = -5.01, β = -.24, P < .05), overprotecting (t = -2.77, β = -.18 P < .05) and encouragement of autonomy (t = -5.09, β = -.48, P < .05) negatively predicted social anxiety which means that by increasing one unit in care, overprotecting and encouragement of autonomy, the severity of social anxiety increases by .34, .19 and .34; respectively, but indifference wasn’t a significant predictor of social anxiety (p > .05). (Insert Table 3 here)

Table 3.

Variable	B	SE	β	T	Sig.	R	R²	F
Care	-.28	.12	-.24	-2.33	.02	.51	.26	20.70
Overprotection	-.26	.15	-.18	-1.75	.08
Indifference	.05	.08	.03	.43	.67
Encouragement of autonomy	-.52	.08	-.48	-6.41	.001

Results of simultaneous multiple regression for predicting social anxiety via dimensions of maternal Bonding.

Table 4 shows that components of paternal bonding were able to explain 27% of changes in social anxiety disorder (F = 21.52, P < .05). The results of regression coefficients show that components such as care (t = -5.01, β = -.35, P < .05), overprotecting (t = -2.77, β = -.19, P < .05) and encouragement of autonomy (t = -5.09, β = -.34, P < .05), negatively predicted social anxiety. This means that by increasing one unit in these variables the numbers of social anxiety increase by .34, .19, and .34; respectively. But indifference was not a significant predictor of social anxiety (p > .05). (Insert Table 4 here)

Table 4.

Results of simultaneous multiple regression for predicting social anxiety via dimensions of paternal Bonding.

Variable	B	SE	β	T	Sig.	R	R²	F
Care	-.46	.091	-.35	-5.01	.001	.52	.26	21.52
Overprotection	-.24	.08	-.19	-2.77	.006
Indifference	-.07	.08	-.06	-.88	.380
Encouragement of autonomy	-.43	.08	-.34	-5.09	.001

As shown in Table 5, general components of fatherhood would explain 28% of changes in social anxiety (F = 10.16, P < .05). The factors like moral father role (t = -3.03, β = -.21, P < .05), gender role model (t = -2.88, β = -.25, P < .05), good provider role (t = -2.20, β = -.15, P < .05), responsible father (t = -2.86, β = -.22, P <.05), and accessible father (t = -4.20, β = -.42, P < .05) negatively predicted social anxiety; Which means by increasing one unit in these subscales the number of social anxiety decreases by .21, .25, .15, .22 and .41; respectively. Furthermore, based on regression coefficients the negative engagement (t = 4.38, β = .30, P < .05) positively predicted social anxiety which means by increasing one unit in negative engagement, the number of social-anxiety increases by .30 units, but subscales like positive engagement, emotional responsiveness, and androgynous role weren’t significant predictors of social anxiety (p > .05). (Insert Table 5 here)

Table 5.

Results of simultaneous multiple regression for predicting social anxiety via dimensions of fatherhood.

Variable	B	SE	β	T	Sig.	R	R²	F
Positive engagement	-.13	.124	-.09	-1.07	.28	.53	.28	10.16
Emotional responsiveness	.01	.045	.02	.25	.80
Negative engagement	.25	.057	.30	4.38	.001
Moral father role	-.30	.097	-.21	-3.03	.001
Gender role model	-.31	.11	-.25	-2.88	.001
Good provider role	-.29	.13	-.15	-2.20	.03
Androgynous role	.005	.11	.004	.05	.96
Responsible father	-.28	.097	-.22	-2.86	.005
Accessible father	-.76	.18	.42	-4.20	.001

According to Table 6, components of adverse childhood experiences predicted 32% of changes in social anxiety (F = 22.01, P < .05). Based on the results of factors like experiences, components like physical abuse (t = 5,57, β = .32, P < .05), emotional abuse (t = 2.69, β = .18, p = .008), and sexual abuse (t = 4.43, β = .30, P < .05) positively predicted social anxiety. Therefore, by increasing one unit in these components, the number of social-anxiety increases by .32, .18, and .28; respectively. But the components of physical and emotional neglect weren’t significant predictors of social anxiety (p > .05). (Insert Table 6 here)

Table 6.

Results of simultaneous multiple regression for predicting social anxiety via dimensions of adverse childhood experiences.

variable	B	SE	β	T	Sig.	R	R²	F
Physical abuse	.80	.14	.32	5.57	.001	.564	.32	22.01
Emotional abuse	.33	.12	.18	2.70	.008
Sexual abuse	.82	.20	.30	4.32	.001
Physical neglect	.13	.12	.07	1.02	.30
Emotional neglect	.07	.07	.06	.90	.37

SAD is a deliberative disorder affecting a person's social interactions throughout life (Heerey & Kring, 2007). It is crucial to investigate its etiology to prevent youth from developing symptoms as adults (Spence & Rapee, 2016). According to research, families are the fundamental setting of a person's existence, hence their crucial effect on the etiology of SAD must be studied (Merikangas et al., 2003). The purpose of this study was to examine the predictive value of adverse childhood experiences, parental bonding, and fatherhood concerning social anxiety symptoms. Findings showed that social anxiety was predicted negatively by maternal and paternal bonding and fatherhood, and positively by adverse childhood experiences. Also, among the components of adverse childhood experiences, physical, emotional, and sexual abuse significantly and positively predicted social anxiety levels. These findings are in line with research by Meng et al. (2021) and Myers and Llera (2020). Prior research centered on the effects of physical, sexual, and emotional abuse and viewed them as maltreatment, which can be an important risk factor for social anxiety (Fitzgerald & Gallus, 2020). Several plausible explanations exist for the observed relationships. Recent research indicates that physical, sexual, and particularly emotional abuse predict negative cognitions associated with anxiety disorders (Teicher et al., 2016). Moreover, among all forms of childhood maltreatment, emotional abuse significantly predicted difficulties with emotion regulation (Burns et al., 2010), which is highly related to social anxiety disorder (Fitzgerald & Gallus, 2020). Aside from this, physical abuse in childhood is correlated with the reduction of the frontal lobe and Amygdala-hippocampus complex volume (Salokangas et al., 2021). These abnormalities have also been reported in psychosis, schizophrenia (Bogerts et al., 1993), bipolar disorder (Chen et al., 2004), depression (Hastings et al., 2004), and, most notably, social anxiety disorder (Ludot et al., 2015).

Additionally, the current study found that maternal bonding, care, and encouragement of autonomy, as well as paternal bonding, care, overprotection, and encouragement of autonomy associated with social anxiety. These findings are in line with the findings of Rambau et al. (2018). To illustrate, an intimate relationship with parents is an important factor that influences people’s socio-emotional function (Thomas et al., 2017). Studies have demonstrated the significance of a relationship with one's parents in the development of behavioral problems (Nishida et al., 2016). A close relationship with parents can be a protective factor for children, helping to develop social skills and reducing social anxiety (Early et al., 2010). Also, high levels of mother-child closeness result in less social distress (Metin Aslan & Altinisik, 2022). It appears that a close relationship with parents improves a person's cognitive and emotional regulation skills (Bernier et al., 2010) and it enables adaptive coping with anxiety in a social context by creating a supportive environment and fostering social skills (Acar et al., 2019). On the other hand, parents’ behaviors like the encouragement of autonomy and overprotection might be related to some changes in the onset and maintenance of social anxiety (Spokas & Heimberg, 2009). These kinds of parental behaviors may become an impediment to normal development by preventing the child from engaging in age-appropriate activities, discouraging independence and autonomy, and encouraging dependency (McLeod et al., 2007). Such parents may unintentionally increase the risks of social anxiety by preventing their children from fully engaging in anxious situations, allowing them to develop an ineffective cognitive bias toward fearful stimuli (Cooper-Vince et al., 2014).

The current study indicated that components of fatherhood, moral father role, gender role model, good provider role, responsible father, accessible father, and negative engagement of father predicted social anxiety. The findings were in line with the results of M. Wang et al. (2021) and Van Zalk et al. (2018). Considering these findings, fathers have a different role than mothers in child socialization and protecting them from social anxiety (Spence & Rapee, 2016). A meta-analysis by Yap and Jorm (2015) supported the idea that fatherhood plays a vital role in predicting social anxiety. Studies in the field of developmental psychopathology revealed that if fathers had anxiety instead of intimacy, the child would be at risk of social anxiety. Also, negative parental behavior such as criticism or rejection, developing a threatening view of the world, and preventing children from learning emotional management on their own is regarded as one of the most important causes of social anxiety (Bögels & Phares, 2008). Thus, it is no surprise that fathers’ negative behaviors like physical punishment, hurting feelings, and shouting can influence the onset and maintenance of social anxiety. Generally, children consider their parents as clues to the external world (Bögels & Perotti, 2011), and also their formation of irrational beliefs is significantly influenced by the father's gender patterns (Craig, 2006). Morris and Oosterhoff (2016) asserted that femininity and preferring girls’ toys and activities have a positive correlation with fear and social anxiety; whereas, masculinity and preference for boys’ toys and activities have a negative relation with these feelings. Growing up with beliefs like “my father thought me to fight for my right”. “my father encouraged me to express my feelings”, and developing adaptive beliefs in children are critical protective factors for reducing social anxiety.

Furthermore, the responsible engagement of the father in behaviors like participation in academic and sports activities makes children have less threatening perceptions and worries about the surrounding environment by observing their parents' attitudes and behaviors (Lester et al., 2017). This may increase affective cognitions and coping strategies, and decrease avoidance strategies in society which lowers the level of social anxiety (Chorpita et al., 1996). Accessibility to the father is associated with lower levels of social anxiety (Lindhout et al., 2006).

Additionally, high levels of father accessibility promote secure attachments, which reduce social anxiety (Cavanaugh & Buehler, 2016). Father's accessibility may positively affect a person's perception, e.g., when individuals know they can share their personal problems with their father or rely on his support in a difficult time, they believe they can act better in stressful situations due to his acceptance and protection; subsequently, this increases positive self-assessments in social interactions and decreases social anxiety levels (Sarkadi et al., 2008).

Limitations and future directions

This study presents valuable results concerning the etiology of social anxiety. However, some limitations must be acknowledged. First, the risk of experiencing trauma during childhood exists for every individual, and these traumas can manifest themselves in multiple adverse experiences during childhood. In other words, a person may simultaneously experience several traumatic events. Accordingly, participants may distort their memories either positively or negatively due to the passage of time or cognitive distortion, and the memories they have recalled during responses might not be exactly correct (Schacter et al., 1995). In the present study, participants between the ages of 18-29 had to recall adverse childhood experiences, parental bonding, and fatherhood during their middle childhood to early adolescence. Therefore, there is a possibility that the results may be affected by cognitive distortions rather than based on reality alone. Second, in this study, a retrospective self-report method was applied to assess the data rather than the multi-informant approach. The data were derived solely from participants’ self-reports. Self-report data are susceptible to response bias and the responses were not confirmed by their family members or relatives (McDonald, 2008). Third, it is also possible that other variables, such as social support and personality traits, can also contribute to the development of social anxiety; thus, future research should involve social support and personality qualities. Fourth, Sixth, according to the literature degree of genetic predisposition in social anxiety severity is quite substantial, hence it is conceivable that an individual may be genetically vulnerable to anxiety disorders (Stein et al., 2017). As a result, it is vital to acknowledge that disregarding this fact would result in an underestimating of heredity influences and an overestimation of the environment. This remains an important area for the future genetically informative study. since the study was conducted on college students, its findings cannot be generalized to social anxiety disorder patients. Fifth. Given that the majority of participants in this study were male, future studies with a majority of females could be conducted to determine whether the results would differ.

These findings suggest that adverse childhood experiences may be the most significant contributing factor to adult social anxiety. Following that, fatherhood and parental bonding are influential determinants of social anxiety in these individuals. According to the literature, there has been no research conducted on the role of fatherhood in social anxiety, and the present study would add a fresh perspective to the research literature. Furthermore, no research has been conducted in the context of Persian culture on the effects of adverse childhood experiences and parental bonds. According to studies of the etiology of social anxiety, adverse childhood experiences, parental bonding, and fatherhood may contribute to symptoms; therefore, these findings could be used by community health setting specialists to develop prevention packages, taking into account the studied variables and the family-based factors contributing to social anxiety disorder, to prevent the occurrence and spread of this disorder in society. Additionally, this report sheds light on community-based interventions such as public health programs in society or in academic settings to promote mental health.

Author Notes

Rasoul Heshmati: https://orcid.org/0000-0003-2418-8821

Parisa Haji Abbasoghli: https://orcid.org/0000-0003-0351-8473

Nazanin Seyed Yaghoubi Pour https://orcid.org/0000-0002-9218-4825

Mojtaba Habibi Asgarabad https://orcid.org/0000-0002-5011-2823

Author contribution

all authors have contributed to the conception and design of the study, drafted or were involved in revising this manuscript, reviewed the final version of this manuscript before submission, and agreed to be accountable for all aspects of the work. The specific contributions of each author are as follows: Conceptualization and design, R.H, N.S.Y.P and M.H.A.; Methodology, R.H and M.H.A.; Software, R.H and M.H.A; Formal analysis, R.H.; Investigation; N.S.Y.P.; Resources; P.H.A and N.S.Y.P; Data curation and acquisition; P.H.A; Writing-original draft preparation, N.S.Y.P; Writing, review and editing; R.H, M.H.A, N.S.Y.P; Visualization, R.H and MH.A; Supervision, MH.A.; Project administration, R.H; Project coordination, M.H.A, N.S.Y.P;

Conflict of Interest

The authors have no commercial or financial relationships that could be construed as a potential conflict of interest.

Data Availability Statement

The raw data supporting the conclusions of this article can be provided by the corresponding author upon reasonable request.

Acknowledgment

The researchers would like to offer appreciation to psychology faculty and mental health center of University of Tabriz and all of the students who participated in this study.

Ethics approval and consent to participate

All procedures performed in the study involved human participants following the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The University of Tabriz ethics board granted permission for the study to proceed. Affiliated Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran. All participants provided informed written consent at the beginning of survey and were informed that participation was voluntary and that they could withdraw at any time. Also, they were assured that the questions did not contain any personally identifiable information and that the data collected will be used for the stated research purposes only.

Consent for publication

Not applicable.

Funding Resources

Thanks to the Norwegian University of Science and Technology (NTNU) for providing financial support for the publication of this article as an open-access article. The funders played no role in the design of the study, the collection of data, the analysis, the decision to publish, or the preparation of the manuscript.

Competing interests

The authors report there are no competing interests to declare.

Author details

¹Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran. ²Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran. ³Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway. ⁴Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Psychiatric Institute), Iran University of Medical Sciences, Tehran, Iran. ⁵Positive Youth Development Lab, Human Development and Family Sciences, Texas Tech University, Texas, U.S.A. ⁶Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran.

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Adverse Childhood Experience, Parental Bonding, and Fatherhood as Parenting Vulnerabilities to Social Anxiety Severity in Iranian Context

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