Received: 16 June 2016 Revised: 28 October 2016 Accepted: 23 December 2016 DOI: 10.1111/jspn.12172 ORIGINAL ARTICLE Social anxiety levels and associated factors among adolescents with type 1 diabetes compared with healthy peers Cigdem Ceylan Naime Altay Nursing Department, Gazi University Health Sciences Faculty, Ankara, Turkey Correspondence Cigdem Ceylan Email: cigdemceylan@gazi.edu.tr, with a copy to the Editor: ryan-wenger.10@osu.edu Abstract Purpose: The purpose of this study was to examine adolescent social anxiety and related factors among youth aged 12-15 years with type 1 diabetes mellitus (T1DM) compared to healthy peers. Design and Methods: The study used a descriptive correlational design. The data were collected with The Social Anxiety Scale for Adolescents (SAS-A) and a youth descriptive information form. Results: The overall SAS-A mean score was statistically significantly higher for adolescents with T1DM (40.14 ± 11.44) compared to their healthy peers (33.33 ± 9.34) p = 0.000. The list of factors was related to increased SAS-A scores. Practice Implications: The early identification of social anxiety in adolescents by nurses may reduce possible complications of diabetes. KEYWORDS adolescent, social anxiety, social anxiety scale for adolescents, type 1 diabetes 1 INTRODUCTION Type 1 diabetes is the most common chronic disease in chil- dren in developed countries (Sarnblad, Berg, Detlofsson, Jönsson, & Forsander, 2014). It is one of the most common chronic endocrine diseases in children and adolescents (Pate, Klemenˇ ciˇ c, Battelino, & Bratina, 2016). Approximately 151,000 children and adolescents under 20 years of age with a diagnosis of diabetes are monitored, and each year, more than 13,000 adolescents are diagnosed with diabetes (Centers for Disease Control and Prevention [CDC], 2012). Adolescent and childhood diabetes constitute more than 90% of type 1 diabetes mellitus (T1DM) cases (Craig et al., 2014). Type 1 diabetes mellitus is a lifelong disease with physical, psy- chological, and social effects. Shortly after a diagnosis of T1DM, chil- dren and families may experience an initial shock of the disease (Rankin et al., 2014; Reynolds, & Helgeson, 2011). During the period of adaptation after the diabetes diagnosis, children and parents may experience emotions and conditions such as sadness, bereavement, frustration, guilt, blame, insecurity, depression, anxiety, psychologi- cal distress, and eating disorders (Delamater, Wit, McDarby, Malik, & Acerini, 2014; Haugstvedt, Wentzel-Larsen, Rokne, & Grauce, 2011). Peer support is important for adolescents in terms of helping them cope with their chronic disease (Cavusoglu, 2008a). Adolescents with chronic disease avoid communicating with friends and participating in social activities, which consequently lead to introversion (Cavusoglu, 2011). Peer attributions have the strongest effect and are associated with anticipated adherence difficulties, stress, and glycemic control (Berlin, Hains, Kamody, Kichler, & Davies, 2015). Peer relationships play a critical role in the emotional development of adolescents. There is a negative relationship between high friend support and social anx- iety (La Greca, & Harrison, 2005), and there is a positive relationship between low friend support and social anxiety and rejection sensitiv- ity (McDonald, Bowker, Rubin, Laursen, & Duchene, 2010). Social anx- iety is characterized by a negative evaluation by others or subjection to embarrassment, a phenomenon also known as social phobia, and specific and continuous fear and/or avoidance of social environments (Herbert et al., 2009). Social anxiety disorder is a common condition seen in children and adolescents (Wagner et al., 2004). The estimated prevalence of social anxiety is 4–9% in adolescents (Warner, Fisher, Shrout, Rathor, & Klein, 2007). The study uses a descriptive correlational design to determine social anxiety levels and the factors that affect these levels in adoles- cents with T1DM aged 12–15 years and their healthy peers. 2 METHODS 2.1 Study population The study included 140 adolescents (70 study and 70 control group). Adolescents with T1DM constituted the study group. The inclusion J Spec Pediatr Nurs 2017; 22: e12172 c  2017 Wiley Periodicals, Inc. 1 of 9 wileyonlinelibrary.com/journal/jspn