Exposure to trauma and social phobia among children attending mental health services in Riyadh, Saudi Arabia

Background: Experiencing traumatic events can lead to a range of mental health problems such as Post Traumatic Stress Disorder (PTSD), depression and anxiety. A range of risk factors have been found to mediate exposure to trauma. However, there is limited knowledge regarding the relationship between trauma and social phobia, and the underpinning mechanisms. Research aims: The aims of this study were to investigate the association between exposure to trauma and social phobia as well other emotional disorders; and to establish whether parenting factors mediated this relationship. Methods: A clinical sample of 89 children aged 9-16 years was recruited from consecutive attenders in three mental health services in Riyadh city, Saudi Arabia. Children were diagnosed with emotional disorder, following a clinical interview using the K-SADS. Measures were completed by parents and children on socio-demographic information, child psychopathology (Impact of Event Scale, Revised Children’s Manifest Anxiety Scale, Children’s Depression Inventory, Social Phobia Questionnaire and Strengths and Difficulties Questionnaire); exposure to trauma; and parenting factors (Parenting Rearing Style, Parenting Stress Index-Short Form and General Health Questionnaire). Results: Exposure to trauma was not directly associated with social phobia symptoms. However, when exposure was measured as a dichotomous variable (exposed to any or no traumatic events), children exposed to trauma exhibited higher scores of social phobia symptoms. Other predictors included the child’s increasing age, parental stress and reduced emotional warmth. Furthermore, there was a significant association between the degree of trauma and PTSD symptoms. Depressive symptoms were predicted by the child’s age, parental rearing style and parental mental health problems. In contrast, anxiety and general mental health problems were only predicted by the child’s age. Conclusions: The findings provide support for the role that trauma and parenting factors may play in the development and maintenance of social phobia. These findings are discussed in the context of previous evidence. Clinical and research implications as well as recommendations for future research are considered.