SELF ESTEEM AND DEPRESSION IN ADOLESCENTS

 A Conceptual Research Paper

Author: Wajiha Kiran (Clinical Psychology)

laureatefolks@gmail.com

1.      Introduction

Over the past few decades, the world has seen a surge in psychological disorders especially depression. Depression has been declared as a major leading cause of disability and death in adolescents and young adults (The Lancet, 2018). Since teenage is a highly stressful period in life, due to ongoing physical and psychosocial transitions, adolescents are at high risk of developing depression and other psychological issues. According to DSM 5, Depression is manifested in form of sadness, irritability, changes in sleep and appetite, weight loss/gain, fatigue or loss of energy, difficulty in concentrating on tasks, and feelings of guilt or worthlessness. Most severely it leads to the development of suicidal ideation or even suicide. Moreover, clinical depression in adolescence has been linked to the onset of various psychological disorders in adulthood such as anxiety, bipolar disorder, and substance use disorders (APA, 2013).

Depression can lead to impairments in educational, social, personal, and occupational domains of life, which stresses the importance of identifying risk and protective factors contributing to this disorder. Many personal factors have been highlighted in this context, but an impressive amount of research has shown the significance of self-esteem in predicting depression in people (Ju, & Lee, 2018; Nguyen et al., 2019). Self-esteem has been defined as a person’s perceived evaluation of self-based on one’s attributes and shortcomings which further determines positive or negative attitude towards self. It is a factor of self-concept and is related to self-respect or self-importance. Self-esteem is considered to be an important component of personality that defines a person’s perceived worthiness and influences a variety of aspects of his life (Minev et al., 2018).

The the present paper is focused to explore the relationship between depression and self-esteem based on previous studies conducted on these variables. It is aimed to highlight the importance of self-esteem in predicting depression in adolescents and how protective measures can help in managing depression on preventive levels. 

1.1. Research Questions

The present research is aimed to explore the following research questions

·         What is the relationship between self-esteem and depression in adolescents?

·         What is the pathway of self-esteem in predicting depression in adolescents?

·         How self-esteem can contribute to preventing depression in adolescents?

1.2. Objectives of the Study

The present research study is aimed to follow the following objectives

·         To understand the manifestation of depression in adolescents and differentiate it from major depressive disorder in adulthood.

·         To determine the relationship between self-esteem and depression in adolescents.

·         To explore the pathway through which self-esteem is linked with depression.

·         To understand the causal role of self-esteem in predicting depression.

·         To identify the role of esteem as a protective factor against depression.

1.3.The Rationale of the Study

The present research study is aimed to increase the conceptual understanding of depression in adolescents and its relationship with self-esteem. Depression has become a leading cause of disability in people. Especially in adolescents, it has been considered as a leading cause of death. In such unprecedented circumstances, it has become the need of time to explore various contributing factors in depression especially self-esteem (Ju, & Lee, 2018; Nguyen et al., 2019).

Despite the substantial amount of researches on these variables, the actual importance of this relationship is still undermined. This emphasizes the implications of the present study in expanding the knowledge in this area which will ultimately help in the management of depression in adolescents.

2.      Moreover, the present study will elucidate the role of psychologists, counselors, and policymakers to incorporate certain necessary changes in curriculum, therapy plans, and counseling services which can help in dealing with this issue in long run. Background and Literature Review

The following section contains a literature review of both these variables i.e. depression and self-esteem.

Adolescence is a critical period of transition from childhood into adulthood and it brings a  variety of disturbances with it out of which depression is quite significant. Usually, adolescents have to deal with their need to develop autonomy as well as a constant demand to maintain healthy interpersonal relationships. They often find themselves oscillating between the two, as being autonomous might be perceived as disobedience by parents. This results in an enormous amount of stress in them (Joiner, 2000).

The history of the relationship between self-esteem and depression can be traced back to Beck’s (1967) cognitive model of depression in which he explained that core beliefs in depression mainly revolved around themes of worthlessness, inferiority, self-loathing, and pessimism. According to this model, people holding such rigid and dysfunctional core beliefs usually interpret and encode information through these cognitive filters. Therefore, they tend to perceive events in a dysfunctional and disabling way (Beck, 1967; 1987). Therefore, poor self-esteem, which can be characterized by a negative view of self and feelings of worthlessness, has been found related to depressive symptoms (Coopersmith, 1967).

A significant number of researchers have reported that self-esteem is quite malleable during adolescence years as it’s the critical time of identity formation after which it becomes comparatively stable over the life span (Longmore et al. 2004). Therefore, a person’s self-esteem during this time could be a major contributing factor in determining depression in adolescence. Furthermore, it is also noticeable that girls tend to have lower levels of self-esteem during their adolescence as compared to boys who report more satisfaction from self in terms of physical appearance, athletic abilities, and global self-esteem  (Kearney-Cooke,1998; Kling et al., 1999).

Initially, self-esteem was considered as a component of depression and both of these concepts were thought to be a single construct, but many types of research have proved that these are separate constructs and a low level of self-esteem is not only linked to depression, but is also significantly related to psychological distress and other disorders such as anxiety and anti-social disorder (Sowislo, & Orth, 2013).

Currently, many kinds of research have been conducted to explore this relationship. Reza and colleagues (2020) studied the interconnectedness of depression and self-esteem in adolescents and college students. According to the result, feeling like a failure was the prominent symptom that established a link between depression and self-esteem. Moreover, another study was conducted to explain the different factors involved in depression and self-esteem. 349 Chinese students were recruited in the research study. According to the result, the effect of interpersonal relationships on depressive symptoms is directly regulated by self-esteem which implies that if a person evaluates oneself based on one’s relationship, he is more likely to experience distress and thus depressive symptoms (Li et al., 2021).

The present study is aimed to highlight the importance of the relationship between self-esteem and depression in the context of adolescents and how this understanding can help taking preventive measures.

3.      Theoretical Models on the relationship between self-esteem and depression

Although numerous researches have shown a correlation between self-esteem and depression, yet the direction and causal link of this relationship remain ambivalent owing to the presence of significant evidence supporting both theories. Researches suggest that low self-esteem predicts distress and depressive symptoms (Longmore et al. 2004; Sowislo, & Orth, 2013). While low self-esteem/feelings of worthlessness have been added as a symptom of depression in DSM-5 (APA, 2013).

So, according to this, people with low self-esteem perceive themselves as worthless or inferior and as result end up being sad and depressed, and depressed people consider themselves as incompetent and worthless in comparison to others. Several theoretical models have been proposed to understand this relationship which is given below.

3.1. Vulnerability Model

According to the Vulnerability model of self-esteem, low self-esteem significantly predicts depression and therefore it is to be considered as a risk factor in depression. (Beck, 1967; Zeigler-Hill, 2011). As discussed above, Beck (1967) proposed that a negative view of oneself is one of the major etiological factors in depression as it is embedded deeply in form of core belief which has been shaped since childhood. Numerous studies have supported the vulnerability model of low self-esteem and depression in the context of minority groups, genders, and majority populations (Orth et al., 2008; Orth, Robins, Trzesniewski, et al., 2009). Furthermore, this model has also been found applicable across the life span in various age groups (Orth, Maes, & Schmitt, 2015). According to this, the relationship between self-esteem and depression can be depicted as below.

Figure 1.

Vulnerability Model of Low Self Esteem And Depression

 

 

 

Note: Adapted from Orth and Robbins (2013)

3.2. Scar Model

Contrary to the vulnerability model, which suggests low self-esteem as an etiological factor for depression, the Scar model posits the concept of self-esteem as consequence. The word scar denotes the idea that depression deteriorates a person’s self-esteem which gets scarred. This low self-esteem remains persistent even after recovering from depression (Shahar, & Davidson, 2003). 

Figure 2.

The Scar Model of Low Self Esteem and Depression

 

 

 

Note: Adapted from Orth and Robbins (2013)

3.3.Reciprocal Model

The two-way relationship between self-esteem and depression led to the development of a reciprocal model which considers this relationship as proceeding in both ways. Self-esteem and depression both influence each other and contribute to reciprocally predicting each other.

Figure 3.

The Reciprocal Model of Low Self Esteem and Depression

 

 

 

 Note: Adapted from Orth and Robbins (2013)

3.4.Stress Diathesis Model

Human beings are complex organisms and so is the environmental factor they live in. Every day a person experiences numerous biopsychosocial factors which affect his functioning in one way or the other. In such circumstances, any relationship couldn’t be linear, as they're bound to be other contributing factors that tend to mediate or moderate this relationship. Recent studies have suggested Diathesis stress model could also be implicated in understanding this relationship between self-esteem and depression. According to this, self-esteem is considered as a predisposing factor that is innate and various stressful circumstances in a person’s life led to this low self-esteem in developing into depression (Hemmen, 2005).

Although all these models seem quite effective, yet, in scientific studies, only those theories which are backed up by heavy evidence are considered to be important. In the present case, researchers have provided significant evidence in favor of the vulnerability model. A meta-analysis of researches on self-esteem and depression suggested that both these models are statistically significant but the evidence in support of the vulnerability model is twofold more significant than that of the scar model (Swislo, & Ortho, 2013).

3.5.Self Esteem and Prevention against Depression in adolescents

            In the above discussion, various empirical studies have been discussed which provided evidence about the significant role of self-esteem in predicting depressive disorders in adolescents, through one way or the other. This significant association between self-esteem and depression urges us to think of all helpful ways through which self-esteem can contribute positively against depression. Human beings have a constant need to stay happy and optimistic. These pleasure-seeking urges are a great source of motivation for them and self-esteem acts as a motivational force to work towards goals. Moreover, studies have suggested that an improved sense of self-worth and positive self-evaluation is linked with better quality of life (Ikiz, & Cakar, 2010; Poudel et al., 2020).

Self-esteem also serves as a defense mechanism against stressful circumstances as people having high self-esteem tend to perceive an exaggerated sense of self-worth which is kept intact even after stressful circumstances. Therefore, they tend to be affected less by devastating conditions as compared to those who have low self-worth (Michal et al., 2014). Also, self-esteem has been linked positively with social support as researches suggests that adolescents having high self-esteem usually have strong social support from parents and friends which is further related to lower levels of depression (Fabes et al., 1999; Ikiz, & Cakar, 2010).

These pieces of evidence suggest the inclusion of such strategies and plans in students’ academic journey which could nurture self-esteem to prevent depressive disorders in long run. This approach should be based on improving the sense of self-esteem as a generic component which is both a risk and protective factor against mental health problems. (Hemmen, 2005; Orth, Maes, & Schmitt, 2015). By nurturing self-esteem as a protective factor the prevalence of various mental disorders could be reduced (Michal et al., 2004). 

Since school/college is a huge medium for personality development and personal growth, therefore incorporating self-esteem boosting activities in this medium would be very effective (Michal et al., 2004; Weare, 2000). It is also related to Gardener’s(1993) interpersonal intelligence for developing self-concept. According to this, the self-concept is a form of awareness about one’s self and constructing a cognitive depiction of one’s reality. Thus the practical implication of this concept can be fruitful in this context (Gardner, 1993). As discussed above that social support and family support are strong determinants of self-esteem therefore, goals should be devised in keeping these constructs in mind.

Harter (1999) suggested the following principles enhance the sense of self-esteem in adolescents

·         Efforts should be done to minimize the discrepancy between a person’s real self and his ideal self.

·         Adolescents’ real self should be encouraged and they should be helped in accepting their real self as their ideal thus reducing the discrepancy.

·         Catering the pessimistic view about self and fostering the belief that they can develop a positive sense of self-evaluation.

·         Psychoeducation about role and consequences of their negative self-evaluation onto the self-esteem and personal wellbeing.

·         Discussing the evolutionary view negative evaluations of the brain should be discussed to highlight these as survival instincts.

·         Helping them construct a more holistic and global sense of self-esteem while including all the contradictions too.

·         Promoting the role of social support in terms of peer groups and significant others in developing self-esteem.

·         Highlighting the importance of internalization of the positive view of others.

Many studies have analyzed the influences of fostering self-esteem in schools and college students and results showed a significant improvement in dealing with depression, eating disorders, and many other internalizing disorders (Flay & Ordway, 2000, Greenberg et al., 2000).

4.      Conclusion

The purpose of this conceptual study was to explore the relationship between self esteem and depression in adolescents. Moreover, this relationship has been discussed in the light of previous studies and theoretical models explaining the link between self esteem and depression. From previous studies most significant model in determining this relationship is vulnerability model (Swislo, & Ortho, 2013). But other models such reciprocal model, the scar model and diathesis stress model are also of significant importance in understanding the implications of this relationship. Furthermore, the role of self esteem as a preventive and protective factor has been highlighted and various steps for fostering self esteem as a part of curriculum goal has been discussed (Michal et al., 2004; Weare, 2000).

5.      Future Recommendation and Implications of the Study

Following are some important future recommendations and implications of the present study.

·         The concept of self esteem should be further explored to observe cultural variations especially in collectivistic societies.

·         An integrative model for explaining the causal relationship between self esteem and depression should be tested empirically.

·         This research elucidate the role of government officials and policy makers to introduce such curriculum goals which can help fostering self esteem of children and adolescents.

·         Both the Government and psychologists should work on raising awareness about the importance of this concept and how families and social institutions can play their part in it.

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