Cultural differences in social anxiety: A meta-analysis of Asian and European heritage samples

By: Sheila R. Woody
Department of Psychology, University of British Columbia;
Sheena Miao
Department of Psychology, University of British Columbia
Kirstie Kellman-McFarlane
Department of Psychology, University of British Columbia

Acknowledgement: Sheena Miao is now at the Department of Psychology, University of Victoria.
Sheena Miao and Kirstie Kellman-McFarlane contributed equally to this work.

Cultures vary in the norms and values that guide social behavior and upon which social evaluation is based (Triandis, 1989). It is not surprising that the prevalence and expression of social anxiety, defined as fear of negative social evaluation, also differs depending on cultural context. Factors hypothesized to contribute to cultural differences in social anxiety include individualism, collectivism, perception of social norms, independent and interdependent self-construal, and gender roles (Hofmann, Asnaani, & Hinton, 2010). Because of the contrasts in social norms and values across East Asian and Western European countries, many researchers have compared social anxiety across these broad cultural groups. Most studies examining this question have found that East Asian participants report higher social anxiety than do Western Europeans, but effect sizes have ranged widely, and studies are difficult to compare because of the use of different measures of social anxiety and different sample characteristics.

The study presented here was conducted to aggregate the results of these studies through meta-analysis to provide an estimate of the magnitude of cultural group differences and identify, if possible, robust moderators of this difference. A confident statement about the magnitude of cultural group differences in social anxiety is necessary before proceeding with research to understand the mechanisms underlying this cross-cultural difference. Understanding this difference can ultimately lead to modification of theories and treatment of social anxiety to incorporate cross-cultural factors, such as a collectivistic orientation.

Compared with individuals of European heritage, Asian heritage individuals more often display behaviors such as verbal reticence (Chen, 1995), emotional restraint (Kao, Nagata, & Peterson, 1997), social introversion (Sue & Sue, 1974), and shyness (Paulhus, Duncan, & Yik, 2002)—behaviors that are reflected in the Western construct of social anxiety disorder (SAD). Consistent with this observation, numerous studies have documented higher self-reported social anxiety among Asian research participants than among people of European heritage (Okazaki, 1997, 2000; Norasakkunkit & Kalick, 2002; Sue, Ino, & Sue, 1983). However, the story is not simple, because as SAD is less common among Asian Americans than among Caucasian Americans (Asnaani, Richey, Dimaite, Hinton, & Hofmann, 2010), and SAD appears to be less prevalent in East Asian than in Western countries (Hofmann et al., 2010).

If East Asians do experience more social anxiety than do Western Europeans, then what are the reasons? Cultural frame could be one explanation. For example, East Asian cultures may foster social behaviors that fit well in a more collectivist environment—one that places a premium on social obligations and group harmony. These same behaviors may not be as highly valued within a more individualistic context that prioritizes personal autonomy and achievement. To the degree that East Asian or collectivistic social values are in some ways consistent with Western notions of social anxiety, cultural group differences would be expected to be maximized in studies that use samples that are maximally distinct. Consistent with this idea, Okazaki (2000) found that Asians who had been born abroad reported less social anxiety than did Asians born in the United States. Moreover, Okazaki, Liu, Longworth, and Minn (2002) reported that Western acculturation was negatively correlated with self-reported social anxiety, although this finding was not statistically significant after adjusting for multiple comparisons.

Meta-analyses are dependent on the measures included in the primary studies from which data are drawn. Unfortunately, direct measures of acculturation have rarely been reported in studies of cultural differences in social anxiety. To gain some insight into this question, we examined other acculturation-relevant predictors that were available in the relevant studies. The most directly relevant available variables were based on residence (number of years that Asian participants had resided in a Western country, age when Asian participants first moved to a Western country, and location of the Asian sample) and language of assessment.

For example, some studies of cultural differences in social anxiety have used samples of Asian individuals recruited from Western countries, mostly frequently the United States and Canada, whereas other studies involved samples of Asians living in their native country (e.g., Japanese participants residing in Japan). Given different cultural contexts, it is likely that Asians who live in their heritage cultural environment and those immersed in Western culture have different socialization experiences relevant to endorsement of Western notions of social anxiety. We examined these variables as potential moderators of the magnitude of the social anxiety difference between European and Asian heritage individuals, with the expectation that studies in which the Asian sample had more experience living in a Western country would show smaller cultural group differences than would studies using Asians residing in Asia.

Likewise, in many of the studies included in this meta-analysis, measures were administered in English for all participants, but some studies provided questionnaires in participants’ native language. Language of measurement may moderate the magnitude of cultural differences in social anxiety in a couple of ways. First, translation may result in subtle differences in the meaning and presentation of questions, which would potentially introduce measurement bias. For example, the Asian concept of “face,” although similar to how it is used in the English phrase “saving face,” is complex and difficult to concisely render in English. Second, the language of measurement may prime cultural norms in a way that influences questionnaire responses, especially if the language of measurement does not match the mainstream culture where the study is taking place. Previous research has shown that measures administered in English influence Asian students’ ratings of independent self-construal, a view of self that reflects individualistic values (Dixon, 2007; Kemmelmeier & Cheng, 2004). Moreover, in another study, Chinese-born students reported more collective self-statements and expressed more approval of Chinese cultural views when completing measures administered in Chinese than when completing measures administered in English (Ross, Xun, & Wilson, 2002). Given these findings, we expected questionnaire language to moderate cultural differences in social anxiety, such that studies in which Asian samples completed measures in their native language would show stronger differences between Asian- and Euro-heritage samples.

To summarize, we conducted a meta-analysis of studies that reported data on multiple cultural groups to determine whether East Asian samples report higher social anxiety than do participants of European heritage and, if so, to estimate the size of this effect. We also examined the potential moderating role of several acculturation-related variables commonly reported in these studies: average number of years members of the Asian sample had lived in a Western country, average age of moving to a Western country, location of the Asian participants (i.e., Asia or North America), and language of questionnaire administration.

Method
Literature Search and Study Selection

Relevant studies were identified through a literature search on PsycINFO, which covers more than 2,500 journals and dissertations. The most recent literature search for this study was conducted in July 2012. Searches combined terms indicative of Asian heritage (Asian, Chinese, Korean, Japanese, or Indian), Caucasian heritage (Caucasian, European, White, or Westerner), and social anxiety (social anxiety, social phobia, shyness). To be included, studies must have been (a) peer-reviewed journal articles or doctoral dissertations, (b) written in English, and (c) quantitative, and they must have (d) compared at least one sample of participants with Asian heritage to at least one sample of participants with European heritage on an established measure of social anxiety. Two studies met these criteria, but they did not report relevant data on social anxiety (Hsu & Alden, 2007; Heinrichs et al., 2006); the authors provided supplemental information upon our request.

Data Extraction

On the basis of a structured coding scheme developed for this study, two researchers independently extracted data from studies that met the inclusion criteria. Variables in the data extraction scheme included sample characteristics (i.e., sample size, age, Asian or European heritage), data necessary to calculate effect size for social anxiety measures (mean and standard deviation), indicators of Western acculturation for the Asian samples (i.e., country of residence, average number of years participants in the sample had lived in North America, average age participants had moved to North America), language of questionnaire administration, and publication status (dissertation or published article). To maximize reliability of data extraction, after the researchers independently extracted data from all studies, the datasets were compared, and any discrepancies were reconciled through consensus upon reexamination of the original articles.

Data Synthesis

For each study, Cohen’s d and the 95% confidence interval (CI) for between-group differences on social anxiety were computed. To compute Cohen’s d, differences in mean scores obtained by Asian and European samples on social anxiety measures were divided by their pooled standard deviation. Effect sizes were calculated so that positive values indicate higher scores for Asian than for European heritage samples. Separate effect sizes were computed for each comparison between an Asian sample and a European sample. Several studies compared multiple Asian and European heritage samples, distinguishing among subgroups. One study (Heinrichs et al., 2006) recruited six subgroups of participants with European heritage differentiated by their country of origin (Australia, Canada, United States, Netherlands, Spain, and Germany) and two Asian subgroups (Japanese and Korean). Given these subgroups, 12 individual effect sizes were calculated to capture all possible Asian-Euro comparisons. Moreover, when a study used more than one social anxiety scale for each comparison, data obtained from different social anxiety scales were statistically combined following standard meta-analytic convention (Horvath & Symonds, 1991).

The overall mean effect size was computed by combining the individual effect sizes from each comparison between an Asian and European heritage sample. A random effects model was used, which assumes that each observed effect size differs from the population mean by subject-level sampling error and randomly distributed between-study variance (Hedges & Vevea, 1998; Lipsey & Wilson, 2001). These calculations were performed in the software program Comprehensive Meta-Analysis (CMA), Version 2, using the following formula (Borenstein, Hedges, Higgins, & Rothstein, 2005):

In this formula, Wi is the weight of each study (computed as the inverse of the sum of the within study variance for each study and between studies variance), and Yi is the effect size of each study. By weighting each effect size according to its inverse variance, studies with smaller CIs around the estimated effect size (i.e., more measurement precision) are given more weight. CMA corrects for the dependency of multiple outcomes or contrasts within a given study by calculating the mean effect size and associated combined variance (Borenstein, Hedges, Higgins, & Rothstein, 2009).

Heterogeneity of individual effect sizes within the overall effect size was examined using Q statistics. A significant Q test indicates the variability among individual effect sizes is greater than would be expected from subject-level sampling error alone, suggesting potential utility in searching for moderators to explain the variability. To examine continuous moderators, separate metaregression analyses were conducted for each variable (i.e., average number of years lived in North America and average age when moved to North America), with social anxiety difference effect sizes as the dependent variable and the continuous moderator as the covariate. Categorical moderators (i.e., country of residence and language of questionnaire administration) were examined by repeating the main analysis described above and using Q statistics to compare subgroups of studies that differed on the categorical variable.

Publication bias is the tendency for studies with statistically significant findings to be published while studies with smaller effect sizes (without significant findings) remain unpublished, a phenomenon that obviously can lead to a biased estimate of true effect size. To counter this potential bias, we included doctoral dissertations in our literature search and examined publication bias using a funnel plot and fail-safe N calculation.

Results
Study Selection

Thirty-six studies were initially identified. Two of these (Choy, Schneier, Heimberg, Oh, & Liebowitz, 2008; Horng, 2007) were excluded because participants were specifically recruited on the basis of having high social anxiety; thus, they were not comparable to the other studies that examined social anxiety in unselected samples. A third article by Koff and Benavage (1998) was excluded because social anxiety was measured using the Self-Consciousness Scale (Fenigstein, Scheier, & Buss, 1975), which assesses a related construct rather than social anxiety per se. Finally, two articles reported on the same dataset as other articles included in the meta-analysis (Hsu & Alden, 2007; Xie, Leong, & Feng, 2008). The final set of 31 studies included three doctoral dissertations and 28 published journal articles (see Table 1). These studies included samples from China, Korea, Japan, the United States, Canada, and Australia and involved sample sizes ranging from 55 to 2,718. Most studies involved undergraduate samples, although three used community samples (Hong & Woody, 2007; Leung, Heimberg, Holt, & Bruch, 1994; Swift, 2001).

Effect Sizes

A total of 57 individual effect sizes were computed (see Table 2). The effect sizes ranged from −0.01 ≤ d ≤ 1.13, with positive values of d indicating higher social anxiety scores for participants with Asian heritage than for those with European heritage. The weighted mean of the 57 individual effect sizes calculated using the random effects model was d = 0.47, 95% CI [0.40, 0.55], a medium-sized effect according to Cohen’s (1988) conventions for effect size.

Heterogeneity and Moderator Analyses

Analyses suggested considerable heterogeneity in the effect sizes obtained across studies, Q = 299.40, p < .001, I2 = 80.96. This result justified the exploration of potential moderators of some of this heterogeneity using metaregression and subgroups analysis. The aim of these analyses was to examine preliminary evidence that culturally relevant variables would predict strength of the observed difference between cultural groups. Of primary interest were variables related to the degree of Western acculturation of the Asian samples, including years lived in a Western country, age of moving to a Western country, country of residence, and language of questionnaire administration. Sufficient data were not available in the published studies to use other variables, such as generational status, as a factor in the meta-analysis.

Eight studies provided information on the mean number of years participants in their Asian sample(s) had lived in a Western country; the values ranged from 9.47 to 18.98 years. This variable was not a significant predictor of effect size for cultural differences in social anxiety, QB = 1.47, p = .23, k = 9. Just four studies provided information about the mean age of participants in their Asian sample when they had first moved to a Western country (range 8.2–17.7 years). This variable also was not a significant predictor of the magnitude of cultural differences observed, QB = 1.23, p = .27, although the number of comparisons available for this analysis was small, k = 4.

All available studies provided information on Asian sample country of residence and language of questionnaire administration. Effect sizes were somewhat larger for comparisons between European-heritage participants and Asians living in Asia, d = 0.52, 95% CI [0.41, 0.64], k = 32, than for comparisons between Euro-heritage participants and Asians living in Western countries, d = 0.39, 95% CI [0.30, 0.47], k = 25, although the CIs do overlap, QB = 3.54, p = .06.

Language of questionnaire administration for the Asian sample is nearly redundant with the above analysis because most of the studies that provided native language translations for social anxiety measures collected Asian sample data in Asian countries. Three comparisons involved studies conducted in Western countries that nevertheless provided Asian-language questionnaires for Asian participants (another indication of the degree of acculturation of those samples). Comparisons that involved English language questionnaires for Asian samples, d = 0.39, 95% CI [0.29, 0.49], k = 22, did not show significantly larger Asian-Euro group differences than did those comparisons involving native language questionnaires for Asian samples, d = 0.51, 95% CI [0.40, 0.62], k = 35, QB = 2.62, p = .10, although the direction is similar to the analysis for country of residence.

Publication Bias

A funnel plot was generated to examine evidence of systematic publication bias. Funnel plots are based on the assumption that studies with large effect sizes will be published even if they involved small samples, which are known to produce more variable results. Figure 1 shows the funnel plot with study size indexed on the y-axis by standard error of d. The shape of the distribution in Figure 1 is symmetrical and does not suggest that smaller, less precise studies included in this meta-analysis have larger effect sizes. Fail-safe N (Rosenthal, 1979) is another indicator of potential publication bias because it estimates the number of studies with null results that would have to be added to the dataset to reduce the estimated effect size to not significantly different from zero (i.e., p > .05). The fail-safe N for this meta-analysis was 10,262 studies.

Discussion

Synthesizing data from 31 studies involving 57 comparisons, we found that participants of Asian heritage score about a half standard deviation higher than do European-heritage participants on self-report measures of social anxiety. This finding consolidates previous studies on this question and provides a quantitative estimate of the size and direction of this cultural difference. We observed no evidence of a publication bias that might erroneously inflate the estimated effect size. However, the analysis indicated substantial heterogeneity (not due to chance) in effect sizes across studies, suggesting that there would be value in future research to understand this variability.

Consistent with the idea that cultural factors may be responsible for ethnic group differences in self-reported social anxiety, we examined several culturally relevant variables as potential moderators of the effect size. Only country of residence (of the Asian sample) appeared promising as a potential predictor of cross-sample heterogeneity in effect size. Other culturally relevant variables about the Asian samples, including duration of residence in a Western country, average age of moving to a Western country, and language of questionnaire administration, were not significant predictors of the size of the Asian-European difference in social anxiety.

Regarding the country of residence variable, it is worth noting that our analysis did not permit a direct comparison of Asian-heritage participants in Asian versus Western countries. The comparison was of the magnitude of the Asian-heritage versus European-heritage difference between studies that recruited Asian participants living in North America and those that recruited Asian participants living in Asian countries. Although the analysis of this variable did not quite reach the conventional standard for statistical significance, it is fairly common to set α = .10 for tests involving Q statistics to offset the low power of these tests (Hedges & Pigott, 2004; Jackson, 2006). The small overlap in CIs (p = .06) for comparisons of studies involving Asians residing in North America versus those residing in Asia suggests that this variable is deserving of further study.

Country of residence is superior in several ways from the other culturally relevant variables analyzed. First, this variable is measured with a high degree of accuracy in comparison to other personal information reported by participants, such as age of immigration. Second, the country of residence was the same for every participant in a given sample, whereas other indicators in the analysis were average values across participants, which introduces a great deal of additional error because most participants deviate from the average. As a result, the other culturally relevant predictors examined in this analysis, although representing the best available data, are crude indicators.

Country of residence may predict degree of cultural group differences in self-reported social anxiety for cultural reasons, such as degree of immersion in Western social values. As described in the introduction to this paper, valued social behaviors in East Asian contexts bear some similarities to the Western construct of social anxiety, leading to the hypothesis that cultural values may account for group differences in social anxiety. However, specifying the nature of this effect is not straightforward. For example, Asians in Asia may indeed be less acculturated to Western social values, or they may be more acculturated to East Asian social values compared with Asians recruited in Western countries, who in turn vary in the degree to which they have retained the Eastern culture. To the degree that acculturation to Asian or Western social values is related to experience of social anxiety, these different types of acculturation would conceivably operate differently.

As mentioned earlier, indicators of acculturation available in the published studies were far from perfect. For example, beyond simply time spent living in a country that is culturally distinct from one’s heritage, acculturation reflects cultural immersion and internalization of cultural values. Although each of the culturally relevant variables in the analysis captures some aspect of exposure to Western social values, exposure is conceptually unsatisfying. Mere exposure to specific cultural values is not the same as internalizing those values. Furthermore, culturally relevant methodological factors are also worthy of future study. For example, to the degree that social anxiety is culturally relevant, reference group effects may influence the magnitude of observed cultural group differences (Heine, Lehman, Peng, & Greenholtz, 2002). Reference group effects occur when participants compare themselves to others in their social network when rating their level of social anxiety or avoidance. Culturally relevant response biases may also be a factor because participants in cultures with high power distance tend to respond in a more acquiescent manner to Likert-type scales (Hofstede, 1980; Oishi et al., 2005; Schimmack, Oishi, & Diener, 2005).

Another limitation was the inability to examine regional and subgroup differences within the Asian population. Although several of the included studies specifically recruited Japanese, Korean, or Chinese participants, most studies recruited Asian participants as a superordinate category and did not report social anxiety data separately by ethnic subgroups. Moreover, most literature in this meta-analysis examined East Asians (i.e., Chinese, Japanese, and Korean) with less consistent sampling of South Asians (e.g., Indian) or Southeast Asians (e.g., Malaysian, Thai). This limited sampling of the Asian population suggests that the current understanding of cultural differences in social anxiety may be limited to only part of Asia, with insufficient literature available for generalizing across regional or subcultural groups.

All but two studies in the meta-analysis used postsecondary students as participants, which limits generalizability. Although this homogeneity enhances the internal validity of the findings as applied to young adults attending college, these findings may not generalize to other age groups or to less advantaged segments of the population. This is a common limitation for psychological research, but its negative effect on the external validity of our findings is notable. University students generally experience a particular set of social pressures, interactions, and lifestyles that may uniquely influence social anxiety. Moreover, samples composed entirely of postsecondary students are likely to be similar in age and to have had similar life experiences; thus, they may be susceptible to cohort effects. To determine whether differences between individuals of Asian and European heritage on social anxiety can be generalized to populations of varying ages and backgrounds, research using more diverse community samples is necessary.

Future research could take steps to resolve several important issues. A richer understanding of cultural differences in social anxiety would likely be obtained by examining participant-level data (rather than study-level data) on specific measures of acculturation, such as the Suinn-Lew Asian Self-Identity Acculturation Scale (Suinn, Rickard-Figueroa, Lew, & Virgil, 1987) or the Vancouver Index of Acculturation (Ryder, Alden, & Paulhus, 2000). Such an approach would potentially permit a more nuanced answer to the question of whether and how acculturation accounts for some of the heterogeneity in effect sizes for cultural differences in social anxiety. In addition, few studies have examined bicultural participants. Acculturative stress has been associated with social anxiety among Mexican American immigrants (Polo & Lopez, 2009). Hsu and colleagues (2012) reported that their sample of bicultural Asian-heritage participants living in Canada had higher social anxiety scores than did unicultural participants living either in Canada or one of two Asian countries. Cultural conflict as a potential source of elevated social anxiety (or more general distress) is in need of further study.

Finally, future research should explore more deeply what it means for the experience of an individual of Asian heritage to score higher on measures of social anxiety. Research specifically needs to clarify the degree to which Western-conceptualized social anxiety and avoidance are culturally accepted in Asian contexts in much the same way that Western social norms accept (without pathologizing) the idea that most people will feel anxious on a first date or when giving a formal speech. That is, to what degree do higher ratings on social anxiety scales reflect clinically or socially significant distress for Asian-heritage participants? Further, does the meaning of scores on a measure such as this change with increasing Western acculturation (or decreasing Asian acculturation)? That SAD appears less common in Asian than in Western countries but (mostly undergraduate) samples in Asian countries self-report higher social anxiety and avoidance is a paradox that may be resolved by achieving a deeper understanding of the meaning of “social anxiety” in Asian cultures.

Overall, results of this meta-analysis show that individuals with Asian heritage report moderately higher social anxiety than do individuals with European heritage, with this difference probably being magnified for Asian participants living in Asian countries. This line of research has implications for helping clinicians to consider the role of cultural frame for clients with social anxiety, but the parameters and mechanisms behind these cultural differences first need to be clarified through future research.

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Submitted: July 10, 2013 Revised: December 12, 2013 Accepted: February 17, 2014