Global prevalence and associated factors of social anxiety disorder among medical students: a systematic review and meta-analysis

Social anxiety disorder (SAD) is common and can seriously affect daily functioning. Medical students face high academic pressure and frequent social evaluation, but how common SAD is in this group globally remains unclear. This review therefore aimed to estimate the worldwide prevalence of SAD among medical students and summarized what factors are linked to it. We followed PRISMA guidelines and searched 13 databases from inception to September–October 2025, with no language restrictions. We included observational studies that reported SAD prevalence among undergraduate medical, nursing or allied health students using validated tools. Two reviewers independently extracted data and assessed study quality with the JBI checklist. A random-effects model was used to pool prevalence. Heterogeneity was examined with I² and prediction interval. We also did subgroup analyses and meta-regression. Associated factors were summarized narratively using a grading framework developed by the authors. Thirty-four studies from 18 countries were included, covering 25,914 students. The pooled prevalence of SAD was 45.8% (95% CI: 38.0%–53.8%), but heterogeneity was very high (I² = 99.01%). The 95% prediction interval ranged from 4.1% to 84.3%. Prevalence varied significantly by the screening tool used and increased with more recent publication year (β = 0.1341, p = 0.0033). Female proportion and sample size showed no significant association. Other subgroup analyses (Geographical region, study quality, sampling method, participant type) did not show significant differences. Factors consistently associated with SAD included female sex, early academic years, depression/anxiety symptoms, low self-efficacy, neuroticism, body dissatisfaction, family conflict, negative peer experiences, academic stress, low socioeconomic status, and tobacco use. Globally, SAD is very common among medical students, though estimates vary widely mainly because of differences in how it is measured. The factors identified point to a mix of personal vulnerability and stressful training conditions. Standardized screening and interventions that address both student resilience and the learning environment are urgently needed.