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Abstract

Social physique anxiety is characterized by feelings of distress experienced when individuals believe they are negatively evaluated on their physique. It could be a risk factor for the development of depressive symptoms. In a sample of 1,724 undergraduate students (average age = 19.96 ± 1.29 years, 59.51% women), this study tested a model exploring whether psychological resilience could mediate the association between social physique anxiety and depressive symptoms, and examined gender’s moderating role in the tested model. Results indicated that social physique anxiety was positively associated with depressive symptoms (r = .359, p < .001) and negatively associated with psychological resilience (r = –.355, p < .001). Psychological resilience was inversely related to depressive symptoms (r = –.508, p < .001). Mediation analysis revealed a positive indirect effect of social physique anxiety on depressive symptoms through psychological resilience (indirect effect = 0.155, SE = 0.014, 95% CI [0.128, 0.182]). Furthermore, a first stage conditional effect of gender was observed that social physique anxiety had a stronger negative effect on psychological resilience in men than in women (moderated mediation index = −0.057, SE = 0.029, 95% CI = [−0.115, −0.001]. This study provides insight into the relationships among social physique anxiety, psychological resilience, and depressive symptoms. It holds promise to inform the development of treatment aiming to reduce depressive symptoms in individuals at risk of social physique anxiety.

Keywords

social evaluation physique psychological resilience depressive symptoms mediation moderation

Introduction

Social physique anxiety is an emotional distress experienced when individuals believe that their physique may be negatively evaluated by others (Hart et al., 1989; Herring et al., 2021). It is a common psychological issue among young people, as several studies have reported mild to moderate levels of social physique anxiety in their respective samples (Rothberger et al., 2015; Tsartsapakis & Zafeiroudi, 2025; Tsartsapakis et al., 2023). The phenomenon of social physique anxiety is largely attributable to the pervasive emphasis on an “ideal” appearance (Grogan, 2010). In Western cultures, this “ideal” appearance is characterized by a slender and toned physique for women (Markula, 2001; McComb & Mills, 2022), and a muscular and toned build for men (Grogan & Richards, 2002; Hargreaves & Tiggemann, 2009). It is worth noting that, with the increasing influence of Western culture and media in the contemporary world, the pursuit of such socially desirable body ideals has become more common among individuals from non-Western cultures (Jill Thompson et al., 2020; Madanat et al., 2007). This includes those from Confucian cultural backgrounds, which have traditionally placed greater emphasis on intellectual achievement than on physical fitness or appearance (Tan et al., 2013). Indeed, an emerging body of research confirms the relevance of social physique anxiety within Confucian cultural contexts. For instance, research has reported a link between media internalized pressure and social physique anxiety in a sample of Chinese university students (Fu et al., 2022). Adding to this, a study in the media-saturated context of Taiwan identified a correlation between social physique anxiety and clothing-related decisions (Liao & Huang, 2024).

While concerns over one’s physique could in some cases serve as a motivating factor for people to improve how they look and leave a desirable impression on others, it oftentimes links to an unhealthy relationship with one’s body and the development of anxiety about one’s physique (Brudzynski & Ebben, 2010). As indicated by a meta-analytic study (Paterna et al., 2021), there is a positive correlation between internalization of the body shape ideals and body dissatisfaction (average effect size r = .43, 95% CI [0.40, 0.46], k = 57 studies). In addition, another meta-analysis (Barnes et al., 2020) has demonstrated a positive association between body dissatisfaction and anxiety symptoms (pooled correlation r = .40, 95% CI [0.28, 0.51], k = 12).

For individuals with social physique anxiety, their perceived negative evaluation by others could be disproportionate to what may be reasonably expected (Kroon et al., 2023). Negative consequences could therefore arise, such as perception of social incompetence, attempts to reduce and minimize social interactions, and avoidance of social circumstances where physique evaluation could take place (La Rocque & Cioe, 2011; Thompson et al., 2003). Furthermore, social physique anxiety may be associated with an array of adverse mental health results (Alcaraz-Ibáñez et al., 2017), such as the development of depressive symptoms (Pimenta et al., 2009; Sabiston et al., 2014). As a mental health burden, depression is characterized by a range of symptoms, such as a reduced interest and enthusiasm in activities that a person used to enjoy, a loss of positive mood and feelings, a decreased motivation to do things, a feeling of hopelessness and self-worthlessness, and a heightened rate of suicidal thoughts and attempts (American Psychiatric Association, 2022). Thus, people with depressive symptoms could be negatively affected in their everyday functioning and have a reduced productivity in their study or work (Lerner & Henke, 2008; Simon et al., 2001). Moreover, if left unattended, depressive symptoms, or the sub-clinical level of depression, may further develop into an advanced stage, namely clinically diagnosed depression (Mitchell et al., 2009; Williams et al., 2002).

The association between social physique anxiety and depressive symptoms seems plausible theoretically. According to the body dissatisfaction–driven hypothesis (Patalay et al., 2015; Paxton et al., 2006), when individuals perceive a gap between their actual and ideal bodies, this dissatisfaction becomes a potent risk factor for depressive symptoms. Rooted in sociocultural and vulnerability–stress frameworks, the hypothesis holds that persistent negative self-evaluations of one’s physique foster affective and emotional vulnerabilities, which conspire to the development of depressive symptoms. Despite the paucity of empirical studies in this area, preliminary findings suggest a link between social physique anxiety and depressive symptoms (Alcaraz-Ibáñez & Sicilia, 2020; Sabiston et al., 2014).

To mitigate the association between social physique anxiety and depressive symptoms, an important factor to consider is psychological resilience. It is conceptualized as the ability to cope with mental stress without long term negative consequences (Nuttman-Shwartz & Green, 2021; Schetter & Dolbier, 2011), and could allow people to adapt positively when experiencing stressful situations (Herrman et al., 2011). Initially developed in developmental literature to study childhood adversity (Werner, 1989, 1993), the concept of psychological resilience has since been applied to other areas. These include addressing bullying in education (Andreou et al., 2020; Lin et al., 2020) and managing physical illnesses like cancer and heart disease in clinical settings (Toukhsati et al., 2017).

Psychological resilience may act as a buffer against depression. In the face of stress, a resilient person might use positive coping strategies (Han et al., 2021; Rahman et al., 2021; Steinhardt & Dolbier, 2008), building and maintaining a supportive social network (Dorrance Hall & Scharp, 2021; Sippel et al., 2015), thereby reducing the risk of slipping into depression. Conversely, someone with lower resilience might struggle more, leading to feelings of hopelessness and other depressive symptoms (Canale et al., 2019). Indeed, there is empirical evidence showing that higher resilience correlates with lower depression rates. A meta-analytic review shows a significant negative association between psychological resilience and depression, such that higher reports of resilience are associated with decreased reports of depression. The overall weighted average correlation between resilience and depression was −.39 (SE = 0.03, z = −13.26, p < .001), with a 95% CI from −0.45 to −0.33 (Watters et al., 2023). A prospective study further indicates that resilience measured at baseline predicts lower depression scores 3 months later, even after controlling for initial symptom levels (Loh et al., 2014). Besides, while no study to date has examined the association between social physique anxiety and psychological resilience, there is circumstantial evidence indicating a negative link between generalized anxiety and psychological resilience (Peñacoba et al., 2021; Petzold et al., 2020). Social physique anxiety is a specific type of anxiety that involves fear of negative body evaluation by others and the pressure to meet idealized body standards. The experience of social physique anxiety has the potential to erode an individual’s psychological resilience through increased negative self-evaluation, social withdrawal, and chronic pressure if left unmanaged. Therefore, it is hypothesized in the present study that psychological resilience may be associated with both social physique anxiety and depressive symptoms. Also, as personal adaptive resources, psychological resilience may serve as a mediator in the relationship between social physique anxiety and depressive symptoms.

Moreover, previous research has documented gender differences in social physique anxiety and depressive symptoms. Some studies report that women are more likely to score higher than do men in social physique anxiety (McLester et al., 2018; Miller & Fry, 2018; Portman et al., 2018; Rothberger et al., 2015), and are more prone to depressive symptoms (Hyde & Mezulis, 2020; Piccinelli & Wilkinson, 2000; Salk et al., 2017). As to psychological resilience, results to date are mixed. While some show that men may have a higher level of psychological resilience (Erdogan et al., 2015), others did not find a significant difference between men and women (Afek et al., 2021). Moreover, other than potential mean difference, little is known whether the potential mediating effect of psychological resilience in the relationship between social physique anxiety and depressive symptoms would differ for men and women. As researchers point out, it is important to move beyond mere mean-level comparisons to the examination of differential relations among variables of interest, which could help gain better insight into the phenomenon and design gender-tailored interventions (Cunningham & Xiang, 2008). Exploring psychological resilience as a potential mediator between social physique anxiety and depressive symptoms could provide a modifiable protective mechanism that can be bolstered through prevention programs. Also, examining gender as a moderator could uncover whether men and women differ in these pathways, allowing for gender-sensitive approaches. Overall, this research holds promise to guide more effective strategies to reduce depressive symptoms by enhancing psychological resilience and addressing social physique anxiety in young populations.

The current research evaluated three hypotheses. First, it was hypothesized that there would be a positive association between social physique anxiety and depressive symptoms (H1). Second, it was hypothesized that psychological resilience would show a mediating role in the association between social physique anxiety and depressive symptoms, where higher reported social physique anxiety would correlate with lower psychological resilience, and lower resilience in turn would correlate with higher depressive symptoms (H2). Third, it was hypothesized that gender would moderate the indirect effect of social physique anxiety on depressive symptoms via psychological resilience. Specifically, it was hypothesized that gender would moderate both stages of the mediation pathway, including the effect of social physique anxiety on psychological resilience (H3a, a-path), and the effect of psychological resilience on depressive symptoms (H3b, b-path). Given the exploratory nature of gender’s moderating effects and the absence of prior empirical evidence, no directional predictions were made regarding how gender might influence these pathways.

Methods

Participants

Participants were recruited from a large public university located in Xinxiang, Henan Province, China. As a comprehensive university and one of the country’s largest higher education institutions, it offers a broad range of study programs for undergraduate students in natural sciences, engineering, social sciences, and humanities. The inclusion criteria were as follows: being current students between the ages of 18 and 29 years (i.e., young adults); being able to read, write, and comprehend Chinese to ensure the validity of the self-report. Individuals who had used psychotropic medication within the previous month, which could alter anxiety, resilience, or depressive symptom levels, were excluded from participation.

Procedure

An online survey was created first at Wen Juan Xing, a professional survey platform widely used in China. A training session was conducted for six undergraduate research assistants to ensure effective data collection and minimize bias. Subsequently, the author acquired a class schedule from the University’s Academic Registry and developed a comprehensive plan for assigning research assistants to specific college classes for data collection. After the initial preparations, research assistants went to classrooms, either before the start of the class or during breaks, to conduct data collection. They sought permission and assistance from class tutors to facilitate this process. Research assistants then distributed survey invitations, allowing interested participants to complete the online survey via a QR code. The cover page of the online survey presented the study’s information and highlighted the voluntary, confidential, and anonymous nature of the participants’ involvement. Participants indicated their informed consent by clicking on an opt-in button displayed on the online survey. Ethical approval was sought and granted from the ethics committee of the author’s affiliation. Participants completed the online survey voluntarily without monetary or non-monetary compensation. The survey was designed to be completed within approximately 7 to 9 min based on pilot testing.

Measurements

General information questionnaire. It aimed to collect basic information of participants, such as age, gender, and the colleges with which they were affiliated. Of note, the wording of the gender question was “What is your gender identity?” to focus on identity rather than biological assignment.

Social physique anxiety. It was measured by the Chinese Social Physique Anxiety Scale (CSPAS, Wen et al., 2021; Xu & Ji, 2008). The CSPAS employs a five-point Likert type scale, ranging from 1 (Not at all characteristic of me) to 5 (Extremely characteristic of me). It contains fifteen items, with nine positively worded items and six negatively worded items. The items assess anxiety and discomfort experiences associated with perceived evaluation of one’s physique. Specifically, the items are categorized into three dimensions (Xu & Ji, 2008), namely concerns about negative judgment of others (items 1, 4, 6, 9, 12, and 14); discomfort in having to show one’s own physique (items 2, 7, 10, 11, 13, and 15); and anxiety about physical and social comparisons with others (items 3, 5, and 8). Scoring is to reversely code negatively worded items and then calculate the sum of items. A sample item reads: “When in the presence of a person important to me, I worry about receiving a negative evaluation about my physique.” A higher score reflects a higher level of social physique anxiety.

Psychological resilience. Participants’ psychological resilience was assessed by the Brief Resilience Scale (BRS, Smith et al., 2008). It has been validated and widely used in people from different countries (Chmitorz et al., 2018; de Holanda Coelho et al., 2016; Konaszewski et al., 2020; Rodríguez-Rey et al., 2016), including in Chinese individuals (Lai & Yue, 2014). The scale encompasses six items, representing how resilient an individual is in the face of adversity. Participants answered the items on a five-point Likert type scale (1 = strongly disagree to 5 = strongly agree). A sample item reads: “I usually come through difficult times with little trouble.” Scoring is by reversely coding items 2, 4, and 6, and summing item scores, with a total score ranging from 6 to 36. The higher a score is, the greater an individual possesses the ability to be resilient.

Depressive symptoms. Participants’ symptoms of depression were measured with the depression subscale of the Depression Anxiety Stress scale-21 (DAS-21). The DAS-21 was developed from its long 42-item version (Lovibond & Lovibond, 1995), and has shown adequate validity and reliability across diverse samples from various countries (Daza et al., 2002; Lee et al., 2019; Oei et al., 2013; Yıldırım et al., 2018), including in China (Wang et al., 2016). The depression subscale contains seven items representing various depressive symptoms a person may experience over the past week. Responses are anchored along a four-point Likert type scale (0 = did not apply to me at all to 3 = applied to me very much or most of the time), yielding a total score range between 0 and 21. Scoring is by totaling item scores, and a higher score indicates a greater level of depressive symptoms. A sample item reads: “I was unable to become enthusiastic about anything.”

Data Analysis

Statistical analysis was conducted with IBM SPSS Statistical software version 26.0. Descriptive data, such as mean values and standard deviations were computed for the variables. Due to the difference in measurement scale of study variables, scores of variable measures were standardized prior to analyses. The internal consistency of the measures was assessed using Cronbach’s alpha. Zero-order correlations were computed for each of the following variable pairs: social physique anxiety and depressive symptoms, social physique anxiety and psychological resilience, and psychological resilience and depressive symptoms. T-tests were used to analyze the significance of differences in social physique anxiety, psychological resilience, and depressive symptoms across gender. Furthermore, mediation analysis was carried out with Hayes’s PROCESS Macro for SPSS (Version 3.5), to address the potential mediating role of psychological resilience between social physique anxiety and depressive symptoms (Model 4). In addition, Model 59 in PROCESS Macro was used to evaluate the hypothesized moderated mediation model. The significance of the effects was examined using a bootstrapping method with 5,000 resamples (Bland & Altman, 2015). It can produce robust standard errors for parameter estimation, and 95% confidence intervals of the effects not crossing zero indicate the examined effects are significant (Hayes, 2015; Mallinckrodt et al., 2006).

Results

In total, 1,724 willing participants (mean age = 19.96 years, SD = 1.29, range = 18–29) took part in this study and completed the online survey. Women participants consisted of 59.51% of the sample, with a total number of 1,026. In addition, 819 participants reported studying in a program in natural sciences or engineering, and 879 reported studying in a program in social sciences or humanities; 26 participants did not provide this information.

The internal consistency reliability analysis showed acceptable reliability for the first dimension of the social physique anxiety measure (α = .753, 95% CI [0.735, 0.771]). The remaining two dimensions demonstrated poor reliability (α = .404 and .592) and were therefore excluded from subsequent analysis. In addition, the Cronbach’s alpha values of the measures for psychological resilience and depressive symptoms were .706 (95% CI = [0.685, 0.728]) and .886 (95% CI = [0.878, 0.894]), respectively. These values indicate an acceptable level of reliability.

The mean score of social physique anxiety was slightly higher for women participants (M = 17.25, SD = 4.39) than for men participants (M = 16.92, SD = 4.24), but it did not reach statistical significance, t (1722) = −1.527, p = .127. No statistically significant difference was observed in the average score of psychological resilience across gender (M = 20.46, SD = 4.00 for men vs. M = 20.60, SD = 3.80 for women; t (1722) = −0.744, p = .457). However, men participants scored significantly higher in depressive symptoms than did women participants (M = 4.18, SD = 4.06 vs. M = 3.75, SD = 3.71; t (1403.493) = 2.215, p < .05). Correlation analysis showed that a higher level of social physique anxiety was associated with a reduced level of psychological resilience (r = −.355, p < .001), and an increased level of being depressive (r = .359, p < .001). Besides, a higher level of psychological resilience was related with a lower level of depressive symptoms (r = −.508, p < .001).

Regarding the mediation model analysis, results showed the expected positive association between social physique anxiety and depressive symptoms (β = .205, p < .001), and a negative association with psychological resilience (β = −.355, p < .001). Additionally, psychological resilience was negatively associated with depressive symptoms, after controlling for the effect of social physique anxiety (β = −.435, p < .001). Finally, there was a positive indirect effect of social physique anxiety on depressive symptoms through psychological resilience, where β = .155, SE = 0.014, 95% CI = [0.128, 0.182]. In other words, people high in social physique anxiety may have a reduced level of psychological resilience, which in turn was associated with a heightened level of depressive symptoms. Therefore, a partial mediation was supported, with an indirect effect accounting for 43.01% of the total effect.

Moderated mediation existed if either or both patterns could be established: first, the path between social physique anxiety and psychological resilience was moderated by participants’ gender (first-stage moderation); and second, the path between psychological resilience and depressive symptoms was moderated by participants’ gender (second-stage moderation). Results of the moderated mediation model are displayed in Figure 1. The tested model showed that there was a positive effect of social physique anxiety on depressive symptoms (β = .199, p < .01), but this effect was not moderated by gender (β = .005, p > .05). Additionally, the effect of social physique anxiety on psychological resilience was negative (β = −.580, p < .001), and this effect was moderated by gender (β = .139, p < .01). Finally, the effect of psychological resilience on depressive symptoms was negative (β = −.422, p < .001), but this effect was not moderated by gender (β = −.008, p > .05). As such, a first-stage moderation was found. The percentile bootstrap analysis further indicated that the indirect effect of social physique anxiety on depressive symptoms through psychological resilience was moderated by gender, with a significant index of moderated mediation (i.e., the difference between conditional indirect effects across gender) of −0.057 (SE = 0.029, 95% CI [−0.115, −0.001]). Specifically, the conditional indirect effect was β = 0.189 (SE = 0.023, 95% CI [0.147, 0.234]) for men and β = 0.132 (SE = 0.018, 95% CI [0.099, 0.169]) for women. To illustrate the gendered effect in the mediation analysis, this study plotted predicted psychological resilience against social physique anxiety, for both men and women participants (See Figure 2). The simple slope tests showed that social physique anxiety had a greater effect on psychological resilience in men participants than in women participants. The hypothesis testing results of the present study are summarized in Table 1.

Figure 1.

Results of the tested moderated mediation model (N = 1,724).

Figure 2.

Psychological resilience as a function of social physique anxiety across gender (N = 1,724).

Table 1.

Hypothesis Testing Results.

Hypothesis	Statistical test	Effect size (Estimate)	Results
H1: SPA ↔ Depressive symptoms	Zero-order correlation	r = .359, p < .001	Supported
H2: Indirect effect (SPA → Psychological resilience → Depressive symptoms)	Mediation analysis	β = .155, p < .001	Supported
H3a: Gender × SPA → Resilience (a-path moderation)	Moderated mediation analysis	β = .139, p < .01	Partially supported
H3b: Gender × Resilience → Depression (b-path moderation)	Moderated mediation analysis	β = −.008, p > .05	Partially supported

Note. SPA = Social Physique Anxiety.

Discussion

People are oftentimes concerned about how their physical appearance looks to others. Indeed, some people may become anxious that they are unable to present their physique in a socially desirable manner, and be overwhelmed with feelings of worry, nervousness and fear associated with potential negative evaluations of their physique (Sabiston et al., 2014). Individuals affected by social physique anxiety could be troubled by a series of adverse consequences, such as low self-esteem and depression. Psychological resilience, as the ability to cope mentally and emotionally in the face of stress and difficulties, may help individuals overcome and protect their mental health. This study explored the role of psychological resilience in social physique anxiety and depressive symptoms and clarified their relations among undergraduate students in China. Importantly, social physique anxiety had both direct and indirect effects on depressive symptoms, and psychological resilience emerged as a mediator in the above relation. Meanwhile, moderated mediation showed there was a first-stage moderation that participants’ gender moderated the path between social physique anxiety and psychological resilience.

Social physique anxiety highlights the interpersonal aspect of body esteem, as it concerns a person’s feelings about how others perceive their physique (Sabiston et al., 2014). With a socially desirable physique in mind, when people believe they are unable to attain a socially favorable physique, they might be unsatisfied and likely experience social physique anxiety (Leary & Jongman-Sereno, 2014). While social physique anxiety is an important psychosocial issue in contemporary society, extant literature appears scant, especially compared with existing research on some other mental health conditions, such as panic disorder and phobia disorder (Domhardt et al., 2020). Given its possible negative psychosocial consequences, it should not be overlooked, and more scholarly attention is warranted. This study revealed that social physique anxiety had a direct and positive link with depressive symptoms, which is in agreement with past findings (Alcaraz-Ibáñez & Sicilia, 2020; Dickerson & Kemeny, 2004), A body-dissatisfaction-driven hypothesis has been proposed to account for such an effect (Patalay et al., 2015), suggesting that depressive symptoms could emanate from failed attempts to bring one’s body back in line with pursued ideal and may in turn facilitate the emergence of depressive symptoms (Sharpe et al., 2018).

In addition, psychological resilience mediated the effect between social physique anxiety and depressive symptoms. Psychological resilience involves the necessary mental resources to adapt well in the face of challenges, adversity, and stress, and could enable individuals to stay positive and protect their mental health when coming across stressful events and experiences (Kalisch et al., 2017; Windle, 2011). Thus, it could be a potential modifiable target in future intervention studies aiming to reduce depressive symptoms among individuals with social physique anxiety. Evidence-based approaches to bolster psychological resilience could include cognitive-behavioural therapy (Hatice et al., 2021), mindfulness-based interventions (Oh et al., 2022), and programs focused on building social support networks (Dorrance Hall & Scharp, 2021).

It has been shown in earlier research that levels of social physique anxiety and depressive symptoms would vary between women and men (Hyde & Mezulis, 2020; McLester et al., 2018). Indeed, some gender differences were observed in this study. Scholars have put forwarded several factors that may account for such difference, including biological, affective, cognitive, and sociocultural factors (Hyde & Mezulis, 2020; Zhao et al., 2020). As to the social physique anxiety score, no significant gender difference was observed. Traditionally, social physique anxiety is considered more of a problem for women (Kowalski et al., 2006); but based on the findings, it seems that social physique anxiety could affect both genders. Moreover, to the best of the author’s knowledge, this is the first study to move beyond mean differences of the variables across genders, and further explore the potential gendered effect in the associations among social physique anxiety, psychological resilience, and depressive symptoms. The moderated mediation analysis suggests that the negative effect of social physique anxiety on psychological resilience could be stronger for men. Conventionally, research on social physique anxiety indicates that women may be at a higher risk (Mülazimoğlu-Balli et al., 2010; Sabiston et al., 2014); however, it seems that social physique anxiety is also very relevant to men, as our contemporary society is putting increasing pressure on an idealized masculine physique (Ouyang et al., 2021). Hence, scholarly attention should be given to men as well. Nonetheless, given research on the moderated effect of gender is still in the initial stage, future studies to confirm the findings are warranted.

Some limitations associated with the study and future directions need to be discussed. The cross-sectional nature of the study precludes the possibility of inferring causal relations of the variables. It would be desirable to investigate the temporal connections of the variables in the future. Besides, while participants were recruited from diverse undergraduate programs in various disciplines, they were still limited to one university. Therefore, future study could consider having a more representative undergraduate sample by involving students from different institutions. Furthermore, the use of a binary gender measure is a limitation, as it does not capture the full gender spectrum. Future research should employ multi-category measures to facilitate a more comprehensive understanding of these relationships.

Notwithstanding the limitations, there were several strengths associated with the current study. First, this study has attempted to recruit a large sample size, which could provide more statistical power to the analyses, and offer increased precision in model testing. Second, although the psychometric properties of the measurements were supported by past research, this study also tested their reliability prior to analysis to ensure robust results. This methodological caution strengthened the credibility of the results. Third, another strength was the novel integration of social physique anxiety and depressive symptoms in a model for testing. This study addressed a research gap by examining the role of psychological resilience in the relationship between them. This offers a potential intervention target for counselors and practitioners helping individuals susceptible to social physique anxiety.

Conclusion

This study demonstrated the mediating role of psychological resilience in the relationship between social physique anxiety and depressive symptoms. Social physique anxiety was associated with increased depressive symptoms, both directly and indirectly, through reduced psychological resilience. A first-stage moderating effect of gender was also observed in the pathway between social physique anxiety and resilience. These findings suggest that enhancing psychological resilience may be a beneficial strategy for mitigating depressive symptoms among individuals susceptible to social physique anxiety.

Footnotes

Acknowledgements

The author wishes to thank all the participants in the study.

ORCID iD

Tao Zhong

Ethical Considerations

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of College of Sport and Health, Henan Normal University (protocol code HNSD-21-16).

Consent to Participate

Informed consent was obtained from the participants involved in the study.

Author Contributions

The author confirms sole responsibility for the study’s conception, data analysis, and manuscript preparation.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are available via the following URL. .

References

Afek

Ben-Avraham

Davidov

Berezin Cohen

Ben Yehuda

Gilboa

Nahum

(2021). Psychological resilience, mental health, and inhibitory control among youth and young adults under stress. Frontiers in Psychiatry, 11, Article 608588. https://doi.org/10.3389/fpsyt.2020.608588

Alcaraz-Ibáñez

Sicilia

(2020). Analysis of the dynamic relationship between social physique anxiety and depressive symptoms in young adults. Journal of Applied Developmental Psychology, 66, Article 101085. https://doi.org/10.1016/j.appdev.2019.101085

Alcaraz-Ibáñez

Sicilia

Á.

Burgueño

(2017). Social physique anxiety, mental health, and exercise: Analyzing the role of basic psychological needs and psychological inflexibility. The Spanish Journal of Psychology, 20, Article E16. https://doi.org/10.1017/sjp.2017.13

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., Text Revision). American Psychiatric Publishing.

Andreou

Roussi-Vergou

Didaskalou

Skrzypiec

(2020). School bullying, subjective well-being, and resilience. Psychology in the Schools, 57(8), 1193–1207. https://doi.org/10.1002/pits.22409

Barnes

Abhyankar

Dimova

Best

(2020). Associations between body dissatisfaction and self-reported anxiety and depression in otherwise healthy men: A systematic review and meta-analysis. PLOS ONE, 15(2), Article e0229268. https://doi.org/10.1371/journal.pone.0229268

Bland

J. M.

Altman

D. G.

(2015). Statistics notes: Bootstrap resampling methods. BMJ, 350, Article 2622. https://doi.org/10.1136/bmj.h2622

Brudzynski

L. R.

Ebben

(2010). Body image as a motivator and barrier to exercise participation. International Journal of Exercise Science, 3(1), 14–24.

Canale

Marino

Griffiths

M. D.

Scacchi

Monaci

M. G.

Vieno

(2019). The association between problematic online gaming and perceived stress: The moderating effect of psychological resilience. Journal of Behavioral Addictions, 8(1), 174–180. https://doi.org/10.1556/2006.8.2019.01

10.

Chmitorz

Wenzel

Stieglitz

R.-D.

Kunzler

Bagusat

Helmreich

Gerlicher

Kampa

Kubiak

Kalisch

(2018). Population-based validation of a German version of the Brief Resilience Scale. PLOS ONE, 13(2), Article e0192761. https://doi.org/10.1371/journal.pone.0192761

11.

Cunningham

G. B.

Xiang

(2008). Testing the mediating role of perceived motivational climate in the relationship between achievement goals and satisfaction: Are these relationships invariant across sex? Journal of Teaching in Physical Education, 27(2), 192–204. https://doi.org/10.1007/s10956-008-9091-9

12.

Daza

Novy

D. M.

Stanley

M. A.

Averill

(2002). The depression anxiety stress scale-21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology and Behavioral Assessment, 24, 195–205. https://doi.org/10.1023/A:1016014818163

13.

de Holanda Coelho

G. L.

Hanel

P. H. P.

Medeiros Cavalcanti

Teixeira Rezende

Veloso Gouveia

. (2016). Brief Resilience Scale: Testing its factorial structure and invariance in Brazil. Universitas Psychologica, 15(2), 397–408. http://doi.org/10.11144/Javeriana.upsyl5-2.brst

14.

Dickerson

S. S.

Kemeny

M. E.

(2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130(3), 355–391. https://doi.org/10.1037/0033-2909.130.3.355

15.

Domhardt

Letsch

Kybelka

Koenigbauer

Doebler

Baumeister

(2020). Are Internet-and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis. Journal of Affective Disorders, 276(1), 169–182. https://doi.org/10.1016/j.jad.2020.06.059

16.

Dorrance Hall

Scharp

K. M

. (2021). Communicative predictors of social network resilience skills during the transition to college. Journal of Social and Personal Relationships, 38(4), 1238–1258. https://doi.org/10.1177/0265407520983467

17.

Erdogan

Ozdogan

Erdogan

(2015). University students’ resilience level: The effect of gender and faculty. Procedia-Social and Behavioral Sciences, 186, 1262–1267. https://doi.org/10.1016/j.sbspro.2015.04.047

18.

Wang

Sun

(2022). Media internalized pressure and restrained eating behavior in college students: The multiple mediating effects of body esteem and social physique anxiety. Frontiers in Psychology, 13, Article 887124. https://doi.org/10.3389/fpsyg.2022.887124

19.

Grogan

(2010). Promoting positive body image in males and females: Contemporary issues and future directions. Sex Roles, 63(9–10), 757–765. https://doi.org/10.1007/s11199-010-9894-z

20.

Grogan

Richards

(2002). Body image: Focus groups with boys and men. Men and Masculinities, 4(3), 219–232. https://doi.org/10.1177/1097184X02004003001

21.

Han

Wang

(2021). Cyberbullying involvement, resilient coping, and loneliness of adolescents during COVID-19 in rural China. Frontiers in Psychology, 12, Article 664612. https://doi.org/10.3389/fpsyg.2021.664612

22.

Hargreaves

D. A.

Tiggemann

(2009). Muscular ideal media images and men’s body image: Social comparison processing and individual vulnerability. Psychology of Men & Masculinity, 10(2), 109–119. https://doi.org/10.1037/a0014691

23.

Hart

E. A.

Leary

M. R.

Rejeski

W. J.

(1989). The measurement of social physique anxiety. Journal of Sport and Exercise Psychology, 11(1), 94–104. https://doi.org/10.1123/jsep.11.1.94

24.

Hatice

Ş.

Şahin

Türk

. (2021). The impact of cognitive-behavioral group psycho-education program on psychological resilience, irrational beliefs, and well-being. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 39(4), 672–694. https://doi.org/10.1007/s10942-021-00392-5

25.

Hayes

A. F.

(2015). An index and test of linear moderated mediation. Multivariate Behavioral Research, 50(1), 1–22. https://doi.org/10.1080/00273171.2014.962683

26.

Herring

M. P.

Gordon

B. R.

McDowell

C. P.

Quinn

L. M.

Lyons

(2021). Physical activity and analogue anxiety disorder symptoms and status: Mediating influence of social physique anxiety. Journal of Affective Disorders, 282, 511–516. https://doi.org/10.1016/j.jad.2020.12.163

27.

Herrman

Stewart

D. E.

Diaz-Granados

Berger

E. L.

Jackson

Yuen

(2011). What is resilience? The Canadian Journal of Psychiatry, 56(5), 258–265. https://doi.org/10.1177/070674371105600504

28.

Hyde

J. S.

Mezulis

A. H.

(2020). Gender differences in depression: Biological, affective, cognitive, and sociocultural factors. Harvard Review of Psychiatry, 28(1), 4–13. https://doi.org/10.1097/HRP.0000000000000230

29.

Jill Thompson

Poyrazli

Miller

. (2020). Western media and body image dissatisfaction in young women in developing nations. Eurasian Journal of Educational Research, 90, 45–66.

30.

Kalisch

Baker

D. G.

Basten

Boks

M. P.

Bonanno

G. A.

Brummelman

Chmitorz

Fernàndez

Fiebach

C. J.

Galatzer-Levy

(2017). The resilience framework as a strategy to combat stress-related disorders. Nature Human Behaviour, 1(11), 784–790. https://doi.org/10.1038/s41562-017-0200-8

31.

Konaszewski

Niesiobędzka

Surzykiewicz

(2020). Validation of the Polish version of the Brief Resilience Scale (BRS). PLOS ONE, 15(8), Article e0237038. https://doi.org/10.1371/journal.pone.0237038

32.

Kowalski

K. C.

Mack

D. E.

Crocker

P. R. E.

Niefer

C. B.

Fleming

T.-L.

(2006). Coping with social physique anxiety in adolescence. Journal of Adolescent Health, 39(2), 9–16. https://doi.org/10.1016/j.jadohealth.2005.12.015

33.

Kroon

Neumann

D. L.

Piatkowski

T. M.

Moffitt

R. L.

(2023). How the physical appearance of companions affects females with high or low social physique anxiety: A virtual reality exercise study. Virtual Reality, 27, 541–551. https://doi.org/10.1007/s10055-022-00676-w

34.

La Rocque

C. L.

Cioe

. (2011). An evaluation of the relationship between body image and sexual avoidance. Journal of Sex Research, 48(4), 397–408.

35.

Lai

J. C. L.

Yue

(2014). Using the Brief Resilience Scale to assess Chinese people’s ability to bounce back from stress. Sage Open, 4(4), 1–9. https://doi.org/10.1177/2158244014554386

36.

Leary

M. R.

Jongman-Sereno

K. P.

(2014). Social anxiety as an early warning system: A refinement and extension of the self-presentation theory of social anxiety. In Hofmann

DiBartolo

(Eds.), Social anxiety: Clinical, developmental, and social perspectives (3rd ed., pp. 579–597). Elsevier. https://doi.org/10.1016/B978-0-12-394427-6.00020-0

37.

Lee

E.-H.

Moon

S. H.

(2019). Systematic review of the measurement properties of the Depression Anxiety Stress Scales–21 by applying updated COSMIN methodology. Quality of Life Research, 28, 2325–2339. https://doi.org/10.1007/s11136-019-02177-x

38.

Lerner

Henke

R. M.

(2008). What does research tell us about depression, job performance, and work productivity? Journal of Occupational and Environmental Medicine, 50(4), 401–410. https://doi.org/10.1097/JOM.0b013e31816bae50

39.

Liao

Y.-M.

Huang

J.-W.

(2024). The impact of social physique anxiety on clothing choices among female university students. Fashion, Style & Popular Culture. Advance online publication. https://doi.org/10.1386/fspc_00283_1

40.

Lin

Wolke

Schneider

Margraf

(2020). Bullying history and mental health in university students: The mediator roles of social support, personal resilience, and self-efficacy. Frontiers in Psychiatry, 10, Article 960. https://doi.org/10.3389/fpsyt.2019.00960

41.

Loh

J. M. I.

Schutte

N. S.

Thorsteinsson

E. B.

(2014). Be happy: The role of resilience between characteristic affect and symptoms of depression. Journal of Happiness Studies, 15, 1125–1138. https://doi.org/10.1007/s10902-013-9467-2

42.

Lovibond

P. F.

Lovibond

S. H.

(1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U

43.

Madanat

H. N.

Brown

R. B.

Hawks

S. R.

(2007). The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women. Public Health Nutrition, 10(10), 1039–1046. https://doi.org/10.1017/S1368980007666713

44.

Mallinckrodt

Abraham

W. T.

Wei

Russell

D. W.

(2006). Advances in testing the statistical significance of mediation effects. Journal of Counseling Psychology, 53(3), 372–378. https://doi.org/10.1037/0022-0167.53.3.372

45.

Markula

(2001). Beyond the perfect body: Women’s body image distortion in fitness magazine discourse. Journal of Sport and Social Issues, 25(2), 158–179. https://doi.org/10.1177/0193723501252004

46.

McComb

S. E.

Mills

J. S.

(2022). The effect of physical appearance perfectionism and social comparison to thin-, slim-thick-, and fit-ideal Instagram imagery on young women’s body image. Body Image, 40, 165–175. https://doi.org/10.1016/j.bodyim.2021.12.003

47.

McLester

C. N.

Hicks

C. S.

Miller

McLester

J. R.

(2018). An investigation of the differences between perceived vs. measured body composition, social physique anxiety, and overall appearance satisfaction among college students. International Journal of Exercise Science, 11(5), 957–967.

48.

Miller

Fry

(2018). Relationship between motivational climate to body esteem and social physique anxiety within college physical activity classes. Journal of Clinical Sport Psychology, 12(4), 525–543. https://doi.org/10.1123/jcsp.2018-0005

49.

Mitchell

A. J.

Vaze

Rao

(2009). Clinical diagnosis of depression in primary care: A meta-analysis. The Lancet, 374(9690), 609–619. https://doi.org/10.1016/S0140-6736(09)60879-5

50.

Mülazimoğlu-Balli

Ö.

Koca

Aşçi

. (2010). An examination of social physique anxiety with regard to sex and level of sport involvement. Journal of Human Kinetics, 26, 115–122. https://doi.org/10.2478/v10078-010-0055-9

51.

Nuttman-Shwartz

Green

(2021). Resilience truths: Trauma resilience workers’ points of view toward resilience in continuous traumatic situations. International Journal of Stress Management, 28(1), 1–10. https://doi.org/10.1037/str0000223

52.

Oei

T. P. S.

Sawang

Goh

Y. W.

Mukhtar

(2013). Using the depression anxiety stress scale 21 (DASS-21) across cultures. International Journal of Psychology, 48(6), 1018–1029. https://doi.org/10.1080/00207594.2012.755535

53.

V. K. S.

Sarwar

Pervez

(2022). The study of mindfulness as an intervening factor for enhanced psychological well-being in building the level of resilience. Frontiers in Psychology, 13, Article 1056834. https://doi.org/10.3389/fpsyg.2022.1056834

54.

Ouyang

Luo

Teng

Zhang

Wang

(2021). Research on the influence of media internalized pressure on college students’ sports participation—Chained intermediary analysis of social physique anxiety and weight control self-efficacy. Frontiers in Psychology, 12, Article 654690. https://doi.org/10.3389/fpsyg.2021.654690

55.

Patalay

Sharpe

Wolpert

(2015). Internalising symptoms and body dissatisfaction: Untangling temporal precedence using cross-lagged models in two cohorts. Journal of Child Psychology and Psychiatry, 56(11), 1223–1230. https://doi.org/10.1111/jcpp.12415

56.

Paterna

Alcaraz-Ibáñez

Fuller-Tyszkiewicz

Sicilia

. (2021). Internalization of body shape ideals and body dissatisfaction: A systematic review and meta-analysis. International Journal of Eating Disorders, 54(9), 1575–1600. https://doi.org/10.1002/eat.23568

57.

Paxton

S. J.

Neumark-Sztainer

Hannan

P. J.

Eisenberg

M. E.

(2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child and Adolescent Psychology, 35(4), 539–549. https://doi.org/10.1207/s15374424jccp3504_5

58.

Peñacoba

Velasco

Catalá

Gil-Almagro

García-Hedrera

F. J.

Carmona-Monge

F. J.

(2021). Resilience and anxiety among intensive care unit professionals during the COVID-19 pandemic. Nursing in Critical Care, 26(6), 501–509. https://doi.org/10.1111/nicc.12694

59.

Petzold

M. B.

Bendau

Plag

Pyrkosch

Mascarell Maricic

Betzler

Rogoll

Große

Ströhle

(2020). Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany. Brain and Behavior, 10(9), Article e01745. https://doi.org/10.1002/brb3.1745

60.

Piccinelli

Wilkinson

(2000). Gender differences in depression: Critical review. The British Journal of Psychiatry, 177(6), 486–492. https://doi.org/10.1192/bjp.177.6.486

61.

Pimenta

A. M.

Sánchez-Villegas

Bes-Rastrollo

López

C. N.

Martínez-González

M. Á

. (2009). Relationship between body image disturbance and incidence of depression: The SUN prospective cohort. BMC Public Health, 9, 1–9. https://doi.org/10.1186/1471-2458-9-1

62.

Portman

R. M.

Bradbury

Lewis

(2018). Social physique anxiety and physical activity behaviour of male and female exercisers. European Journal of Sport Science, 18(2), 257–265. https://doi.org/10.1080/17461391.2017.1417485

63.

Rahman

M. A.

Islam

S. M. S.

Tungpunkom

Sultana

Alif

S. M.

Banik

Salehin

Joseph

Lam

Watts

M. C.

(2021). COVID-19: Factors associated with psychological distress, fear, and coping strategies among community members across 17 countries. Globalization and Health, 17(1), 1–19. https://doi.org/10.1186/s12992-021-00768-3

64.

Rodríguez-Rey

Alonso-Tapia

Hernansaiz-Garrido

(2016). Reliability and validity of the brief resilience scale (BRS) Spanish version. Psychological Assessment, 28(5), Article e101. https://doi.org/10.1037/pas0000191

65.

Rothberger

S. M.

Harris

B. S.

Czech

D. R.

Melton

(2015). The relationship of gender and self-efficacy on social physique anxiety among college students. International Journal of Exercise Science, 8(3), 234–242. https://doi.org/10.70252/VYNB1202

66.

Sabiston

C. M.

Pila

Pinsonnault-Bilodeau

Cox

A. E.

(2014). Social physique anxiety experiences in physical activity: A comprehensive synthesis of research studies focused on measurement, theory, and predictors and outcomes. International Review of Sport and Exercise Psychology, 7(1), 158–183. https://doi.org/10.1080/1750984X.2014.904392

67.

Salk

R. H.

Hyde

J. S.

Abramson

L. Y.

(2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102

68.

Schetter

C. D.

Dolbier

(2011). Resilience in the context of chronic stress and health in adults. Social and Personality Psychology Compass, 5(9), 634–652. https://doi.org/10.1111/j.1751-9004.2011.00379.x

69.

Sharpe

Patalay

Choo

T.-H.

Wall

Mason

S. M.

Goldschmidt

A. B.

Neumark-Sztainer

(2018). Bidirectional associations between body dissatisfaction and depressive symptoms from adolescence through early adulthood. Development and Psychopathology, 30(4), 1447–1458. https://doi.org/10.1017/S0954579417001663

70.

Simon

G. E.

Barber

Birnbaum

H. G.

Frank

R. G.

Greenberg

P. E.

Rose

R. M.

Wang

P. S.

Kessler

R. C.

(2001). Depression and work productivity: The comparative costs of treatment versus nontreatment. Journal of Occupational and Environmental Medicine, 43(1), 2–9. https://doi.org/10.1097/00043764-200101000-00002

71.

Sippel

L. M.

Pietrzak

R. H.

Charney

D. S.

Mayes

L. C.

Southwick

S. M.

(2015). How does social support enhance resilience in the trauma-exposed individual? Ecology and Society, 20(4), 1–10. https://doi.org/10.5751/es-07832-200410

72.

Smith

B. W.

Dalen

Wiggins

Tooley

Christopher

Bernard

(2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15, 194–200. https://doi.org/10.1080/10705500802222972

73.

Steinhardt

Dolbier

(2008). Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. Journal of American College Health, 56(4), 445–453. https://doi.org/10.3200/JACH.56.44.445-454

74.

Tan

Shaw

Cheng

Kim

K. K.

(2013). The construction of masculinity: A cross-cultural analysis of men’s lifestyle magazine advertisements. Sex Roles, 69, 237–249.

75.

Thompson

Dinnel

D. L.

Dill

N. J.

(2003). Development and validation of a body image guilt and shame scale. Personality and Individual Differences, 34(1), 59–75. https://doi.org/10.1016/S0191-8869(02)00026-0

76.

Toukhsati

S. R.

Jovanovic

Dehghani

Tran

Hare

(2017). Low psychological resilience is associated with depression in patients with cardiovascular disease. European Journal of Cardiovascular Nursing, 16(1), 64–69. https://doi.org/10.1177/1474515116640412

77.

Tsartsapakis

Zafeiroudi

(2025). Social physique anxiety in college students: The role of study field, physical activity, physical self-perception, and self-esteem. Sports, 13(4), Article 119. https://doi.org/10.3390/sports13040119

78.

Tsartsapakis

Zafeiroudi

Vanna

Gerou

(2023). Relationships of body dissatisfaction and self-esteem with social physique anxiety among university students in different study programs. Trends in Psychology, 31(3), 1–14. https://doi.org/10.1007/s43076-023-00329-0

79.

Wang

Shi

H.-S.

Geng

F.-L.

Zou

L.-Q.

Tan

S.-P.

Wang

Neumann

D. L.

Shum

D. H. K.

Chan

R. C. K.

(2016). Cross-cultural validation of the depression anxiety stress scale–21 in China. Psychological Assessment, 28(5), 88–100. https://doi.org/10.1037/pas0000207

80.

Watters

E. R.

Aloe

A. M.

Wojciak

A. S.

(2023). Examining the associations between childhood trauma, resilience, and depression: A multivariate meta-analysis. Trauma, Violence, & Abuse, 24(1), 231–244. https://doi.org/10.1177/15248380211029397

81.

Wen

Zou

Cai

Xin

(2021). The influneces of body image and social physique anxiety on physical activity behavior of college students. Journal of Hang Zhou Normal University, 20(1), 102–107.

82.

Werner

E. E.

(1989). High-risk children in young adulthood: A longitudinal study from birth to 32 years. American Journal of Orthopsychiatry, 59(1), 72–81. https://doi.org/10.1111/j.1939-0025.1989.tb01636.x

83.

Werner

E. E.

(1993). Risk, resilience, and recovery: Perspectives from the Kauai Longitudinal Study. Development and Psychopathology, 5(4), 503–515. https://doi.org/10.1017/S095457940000612X

84.

Williams

J. W.

Jr. Noël

P. H.

Cordes

J. A.

Ramirez

Pignone

(2002). Is this patient clinically depressed? JAMA, 287(9), 1160–1170. https://doi.org/10.1001/jama.287.9.1160

85.

Windle

(2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21(2), 152–169. https://doi.org/10.1017/S0959259810000420

86.

(2008). Construction and validation of the conceptual model of social physique anxiety for young Chinese. International Journal of Sport and Exercise Psychology, 6(2), 245–247. https://doi.org/10.1080/1612197X.2008.9671864

87.

Yıldırım

Boysan

Kefeli

M. C.

(2018). Psychometric properties of the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21). British Journal of Guidance & Counselling, 46(5), 582–595. https://doi.org/10.1080/03069885.2018.1442558

88.

Zhao

Han

Zhao

Jin

Yang

Cui

(2020). Gender differences in depression: Evidence from genetics. Frontiers in Genetics, 11, Article 562316. https://doi.org/10.3389/fgene.2020.562316

The Association Between Social Physique Anxiety and Depressive Symptoms in Young Adults: The Mediating Effect of Psychological Resilience and the Moderating Effect of Gender

Abstract

Keywords

Introduction

Methods

Participants

Procedure

Measurements

Data Analysis

Results

Discussion

Conclusion

Footnotes

Acknowledgements

ORCID iD

Ethical Considerations

Consent to Participate

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

References