The Association of Self-esteem and Depression in Adolescence: How does Gender Mediate? Jolien van der Scheer (10677763)
Bachelor thesis University of Amsterdam
January 2018 4591 words
Table of Contents
Abstract ... 3
The Association of Self-esteem and Depression in Adolescence: How does Gender Mediate? 4 The scar model in adolescence ... 6
The vulnerability model in adolescence ... 8
The moderating effect of gender ... 12
Conclusion and discussion ... 14
Abstract
This literature review examines the relationship between low self-esteem and depression. In doing so, two dominant models are discussed; the scar model (depression leads to low self-esteem) and the vulnerability model (low self-esteem leads to depression). Next, gender was considered as a moderator for the relationship between low self-esteem and depression. The main finding of this review is that both models seem to be of value in different age groups, with depression leading to low self-esteem in early adolescence and low self-esteem leading to depression in mid- and late adolescence. However, it cannot be excluded that both models have a reciprocal effect or that third variables play a role in the relationship between low self-esteem and depression. Gender as a moderator had mixed results, without a clear conclusion whether or not gender made a difference in either of the two models. Therefore, it is
recommended that age, instead of gender, should be considered a more important moderator than is the case in the discussed studies.
Keywords: low self-esteem, depression, scar model, vulnerability model, gender differences
The Association of Self-esteem and Depression in Adolescence: How does Gender Mediate? While only approximately 2% of children in early adolescence have experience with depression, this rises to roughly 18% in early adulthood (Hankin et al., 1998; Oldehinkel & Ormel, 2015). This increase is mainly accounted for by a rise in depression among girls, since females are twice as likely as males to become depressed by the age of 18 (Kessler,
McGonagle, Swartz, Blazer, & Nelson, 1993). In childhood boys and girls have comparable depression rates (Cohen et al., 1993). When a difference in depression rates in childhood is found, it seems that boys are more often depressed than girls are (Anderson, Williams, McGee, & Silva, 1987). The turning point seems to be around ages 13 to 15 (Twenge & Nolen-Hoeksema, 2002); from that age on girls are more likely to become depressed than boys. Depression as a term can be used for the clinical diagnoses, which is described as the presence of sad, empty or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function (American Psychiatric Association, 2013). These symptoms must last at least two weeks in order to get a diagnosis. However, the term depression can also be used sub clinically, to describe elevated scores of depressive symptoms on a symptom scale that does not meet the criteria for a depressive disorder yet. This subclinical understanding could be the precursor or the aftermath of a depression disorder (Cuijpers & Smit, 2008). Depressive symptoms, just as a depression disorder, are associated with diminished psychosocial functioning (Lewinsohn, Solomon, Seeley, & Zeiss, 2000). Therefore, in this study, depression captures both clinical and subclinical depression.
Depression has been linked with many problems, one of which being low levels of self-esteem (e.g. Brown, Andrews, Harris, Adler, & Bridge, 1986; Hedberg, 2010; Sharma & Agarwala, 2013). The concept of self-esteem has been thoroughly investigated and refers to the overall affective evaluation of one’s worth, value or importance (Blascovich & Tomaka, 1991). According to Rosenberg (1989), high self-esteem “expresses the feeling that one is
‘good enough.’. The individual simply feels that he is a person of worth. . . . He does not necessarily consider himself superior to others” (p. 31). A person with low self-esteem conversely does not consider himself as worthy or of importance.
Low self-esteem and depressive symptoms often cooccur among adolescents, as numerous research shows (e.g., Carbonell, Reinherz, & Giaconia, 1998; Lee & Hankin, 2009; Overholser, Adams, Lehnert, & Brinkman, 1995; Sowislo & Orth, 2013). To explain this occurrence, two dominant models are proposed; the vulnerability model and the scar model. The vulnerability model states that low self-esteem is a causal risk factor for the development of depression (e.g. Beck, 1967). The scar model explains low self-esteem as a consequence of depression, with experiences of depression leaving permanent scars in the self-concept of the individual (e.g. Rohde, Lewinsohn, & Seeley, 1990). It also might be a combination of both processes operating simultaneously (Orth, Robins, & Roberts, 2008). It should be noted that the vulnerability effect of low self-esteem leading to depression is found to be twice as large as the scarring effect of depression leading to low self-esteem (Sowislo & Orth, 2013; Steiger, Fend, & Allemand, 2015).
While the effects of both models are explored, the underlying mechanisms are not and neither is the effect of gender within these mechanisms. In general, girls tend to have poorer levels of self-esteem than boys do and self-esteem has more influence on the level of
depressive mood in girls than in boys (Bolognini, Plancherel, Bettschart, & Halfon, 1996). Therefore the hypothesis of the current study is that one of the two models and its underlying mechanism might be more fitting for one gender than for the other. For example, seeking reassurance and negative feedback are theoretically linked to low self-esteem and depression, as is rumination (Evraire & Dozois, 2011; Joiner, Katz, & Lew, 1999; Kuster, Orth, & Meier, 2012). These processes differ for boys and girls (Jose & Brown, 2008; Nesi & Prinstein, 2015; Prinstein, Borelli, Cheah, Simon, & Aikins, 2005). Therefore, boys and girls might
differ in levels of low self-esteem and depression. In this study the scar and vulnerability model are reviewed in order to answer the question ‘How are self-esteem and depression associated in adolescence?’. Next, a distinction will be made between boys and girls, since it is expected that gender may have a mediating role.
The scar model in adolescence
Is low self-esteem a consequence of depression? The scar model suggests it is, explaining that episodes of depression can leave permanent scars in the self-concept of the individual (e.g. Rohde et al., 1990). There are a few possible explanations for this
relationship, with both intra- and interpersonal pathways (Orth et al., 2008). One of the possible intrapersonal pathways is that depression might alter the way in which an individual processes self-relevant information. That way, a chronic negative mood may lead to more negative self-evaluations (Orth et al., 2008). One of the possible interpersonal pathways is that the depression can change certain relationships between people, with the depressive person being viewed and treated differently by their community (Joiner, 2000). This can happen even if the depression has already decreased. These pathways could explain the decrease in self-esteem for the (former) depressive person, although they are not yet thoroughly researched. With regards to the scar model, it should be noted that this model divides the research field by gaining supporters as well as opponents, as there is support in favour and against the scar model.
One of the studies in favour of the scar model is that of Shahar and Henrich (2010). They researched whether or not the associations depression and self-esteem differ for early-, mid- and late adolescence. Their participants were 4,520 high school students (52.1% female), who were divided into three groups; early adolescents (13-14 years old), middle adolescents (15-16 years old) and late adolescents (17 and older). Self-esteem was measured with the Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965) and depression was measured with the
Center for Epidemiological Studies Depression Scale (CES–D; Radloff, 1977). The results showed that the only significant effect of depressive symptoms on self-esteem could be found for early-adolescence. This is a remarkable outcome, with the age of participants as an
important factor. The fact that depressive symptoms could lead to low self-esteem is in line with the expectations of the scar model.
Also supportive of the scar model is the meta-analysis with 77 samples of information on the relations between self-esteem and depression Sowislo and Orth (2013) conducted to the nature of the relationship between low self-esteem and depression. The studies used in this meta-analysis were mostly non-clinical, only three of them used clinical patients. The studies included in the meta-analysis used a variety of measurements for self-esteem and depression. For depression the most frequently used questionnaires were the CES-D and the Beck
Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), though 27 studies used another questionnaire. For self-esteem a wider variety of questionnaires was used, with different questionnaires for measuring global and domain-specific self-esteem. The large majority used the RSE, which measures global self-esteem. The mean cross-lagged effect of depression on self-esteem Sowislo and Orth (2013) found was β = -.08 (p < .05). This means that depression does lead to low self-esteem. With this effect being significant, it can be concluded that the scar model is evident, although the impact of the effect is small.
Furthermore, Steiger and colleagues (2015) tested the long-term longitudinal and intergenerational validity of the scar and vulnerability model. Participants were followed between the ages 12-16 and were tested again twice in adulthood, once in 2002 when they were on average 35.5 years old and once in 2012, with an average age of 45.7 years. With this last follow-up, the children of the participants were also included in the study. They used six items representing a sense of self-acceptance and self-worth (with two items identical and two items similar to the RSE) to measure self-esteem. Depression was measured with the BDI.
The intergenerational effect of the scar model was not found. Conversely, the longitudinal effect was significant, showing that the scar effect of depression is valid and can be measured even three decades later.
However, there are also studies that failed to find support for the scar model. Orth and colleagues (2008) conducted two longitudinal sub-studies to test the scar and vulnerability model, and their prospective effects on each other. The first sub-study used data from the National Longitudinal Survey of Youth (NLSY79), the participants were high school students. The second from the Berkeley Longitudinal Study, with the participants being college
students. Both sub-studies concluded that the scar model was not significantly valid. Subsequent to these findings are a few studies (Ormel, Oldehinkel, & Vollebergh, 2004; Rhode, Lewinsohn, & Seeley, 1990), who used adults as participants to assess the scar model. Their findings do not support the scar model either. In spite of this, these results will not be discussed in the current study, given that there is too much of an age difference between adolescents and adults. This age difference might play an important role to why certain studies have found support for the scar model, while others have not. As mentioned in Shahar and Henrich (2010), it seems that the scar model is valid in early adolescence, with the effects fading away in mid- and late adolescence. It than seems rather logical that studies with adults as participants will not find support for the scar model.
In summary, most research done on depression as a consequence for low self-esteem is conflicting. A few studies support the scar model, while others do not or find very small effects. With the findings of Shahar and Henrich (2010) it can be concluded that the theory of the scar model is probably only valid in early adolescence.
The vulnerability model in adolescence
Can we state that low self-esteem is causing depression in adolescence? The
are a causal risk factor of depression. (e.g. Beck, 1967). The vulnerability model offers multiple possible explanations why low self-esteem leads to depression, again through both interpersonal and intrapersonal pathways (Orth et al., 2008). One of the possible intrapersonal pathways for the vulnerability model is the explanation of rumination (Orth et al., 2008). The tendency to ruminate about negative aspects of the self is closely linked to depression
(Spasojevic & Alloy, 2001). When looking at a possible interpersonal pathway, reassurance plays a big role. Individuals with low self-esteem can seek too much reassurance about their personal worth from people who are close to them (Joiner, 2000). This reassurance can be answered positively, with the individual getting the confirmation they need. Though, asking for reassurance can also be answered negatively with a rejection for the individual. This rejection increases the risk of depression (Joiner, 2000).
Most of the studies done on the vulnerability model have supportive findings. Southall and Roberts (2002) viewed whether the combined interactions between self-esteem,
attributional style and life-stress lead to changes in depressive symptoms. According to their hypothesis, low self-esteem would be one of the factors leading to depression. They
conducted a study with 115 high school students (50.4% female), with an age range between 14-19 years old. They used the RSE to measure self-esteem and the BDI for depressive symptoms. Their results show that low self-esteem predicts an increase in depression 3 months later.
Yet, not only short-term effects have been found, low self-esteem also has long-term effects on depressive symptoms. Trzesniewski and colleagues (2006) looked at low self-esteem as a risk factor for important life outcomes. They found that self-self-esteem scores in early adolescence (ages 11 to 15) predicted depression at age 26. This result held both for a clinical and a subclinical measurement of depression. They measured self-esteem with the RSE, and depression was clinically assessed by a psychologist at three points in adolescence
with the Diagnostic Interview Schedule for Children. Adolescents with low self-esteem were twice more likely to be depressed as supposed to adolescents without low self-esteem
(Trzesniewski et al., 2006).
Another longitudinal study was done by Orth and colleagues (2008), who used two data sets to test the scar and vulnerability model, and their prospective effects on each other. With the first data set, 2,403 participants (50% female) were studied. These participants were either 15 or 16 at the beginning of the study, with the mean age being 15.5 years. They used the RSE and CES-D to measure self-esteem and depression. The multiple cross-lagged paths from self-esteem to depression they checked were all significant (range: -.09 to -.10, all p < .01). According to this data, the effect of self-esteem on depression corresponds to r = .08, which is a small effect, but still supports the theory of the vulnerability model. With the second data set 359 participants (59% female) were studied. These participants were 18 or 19 years old at the beginning of the study, with a mean age of 18.3 years. Here they also used the RSE and CES-D to measure self-esteem and depressive symptoms. The same cross-lagged paths were conducted, showing the effect of self-esteem on depression to be significant, (range: -.20 to -.21; p < .01). In the sub-study conducted with the second data set, the effect of self-esteem on depression corresponds to r = .23, which indicates a medium effect and also suggests that low self-esteem is a risk factor for developing depressive symptoms.
Next, the meta-analysis Sowislo and Orth (2013) conducted to the nature of the relationship between low self-esteem and depression, as mentioned before, also reported on the vulnerability model. The mean crosslagged effect of selfesteem on depression was β = -.16 (p < .05). This suggests that the vulnerability model has twice as big of an effect as the scar model does. As also mentioned before, Steiger and colleagues (2015) tested the long-term longitudinal and intergenerational validity of the vulnerability model. Again, the
however, was. They confirmed the effect from adolescence up to adulthood by showing that low self-esteem in adolescence was related to adult depressive symptoms at age 45. In addition, they confirmed the findings of Sowislo and Orth (2013); having a low self-esteem lead twice as often to depression as supposed to depression leading to having a low self-esteem.
However, not all research finds support for the vulnerability model. Block, Gjerde, and Block (1991) evaluated depressive tendencies at age 18 using high school data from 88
adolescents (52.3% female). Depression was measured with the CES-D. Self-esteem was measured with two separate measurements of a 43-item adjective Q sort (Block & Block, 1980). According to Block and colleagues (1991) having low self-esteem at age 14 did not predict depression at age 18. Adjecent, Butler, Hokanson and Flynn (1994) failed to support the vulnerability model as well. Butler and colleagues (1994) conducted two sub-studies, with the second being a follow-up for the first. The first part of the study controlled whether levels of trait self-esteem and self-esteem lability differed for currently depressed, previously depressed and never depressed adolescents. The second part of the study checked whether self-esteem predicted future depressions. In this second sub-study, 73 participants (76.7% female) took part. Butler and colleagues (1994) had to conclude that self-esteem was not longitudinally related to depression. And, although their participants were adults and will therefore not be concluded in this study, the results of Shahar and Davidson (2003) were not significant for the vulnerability model either. In spite of this, given that the scar model they tested was significant, this study is worth mentioning.
In summary, most of the research done on the causal risk factor of low self-esteem leading to depression have significant findings. Yet, a few studies fail to support the
vulnerability model or find small effects. Therefore, the theory of the vulnerability model; low self-esteem leading to depression, can be confirmed, albeit with caution.
The moderating effect of gender
Since boys and girls have comparable depression rates in childhood (Cohen et al., 1993), while girls tend to have lower self-esteem rates (Bolognini et al., 1996), it is believed that the effects of self-esteem on depression or the effects of depression on self-esteem can be different for both boys and girls. Most of the studies conducting research on the vulnerability and scar model therefore controlled for the moderating effect of gender. However, Butler and colleagues (1994) did not. These effects, or the absence of a gender difference, will be
discussed here.
Multiple studies had to conclude that there was no significant gender difference on the relationship of self-esteem and depression, after they controlled for a gender moderator (Orth et al., 2008; Rohde et al., 1990; Shahar & Davidson, 2003; Trzesniewski, et al., 2006) .This was also the case with Sowislo and Orth (2013), though they only conducted a moderator analyses for the vulnerability model, and not for the scar model. They concluded that both boys and girls have a bigger risk on depression, if they have a low self-esteem. However, whether this risk is the same with depression leading to low self-esteem, is unknown. A satisfactory explanation for the absence of a gender difference is not given in these studies. Neither is it known why the following researches did find a gender difference.
Shahar and Henrich (2010) had already split adolescence in three different groups, as they also made a difference between boys and girls. The effects of depression on low self-esteem were found for both genders in early adolescence. Yet they concluded that boys had a greater variability of self-esteem in early adolescence. For girls, this effect was weaker. As a possible explanation for this gender difference, they state that this variability might be the result of boys getting a bit later to puberty as girls do (Kail & Cauvaugh, 2010). Therefore, the boys in the study might experience more changes associated with puberty that influence their self-esteem, whereas the early adolescent girls might have experienced these changes
prior to the study, earlier in their lives. For mid- and late adolescence, no gender difference was found; boys and girls had comparable self-esteem stability rates.
The gender difference Shahar and Henrich (2010) found in early adolescence can be named remarkable. Even more so since earlier research found that depressive symptoms and self-criticism among early adolescent girls appeared to be involved in a vicious cycle (Shahar, Blatt, Zuroff, Kuperminc, & Leadbeater, 2004). Self-criticism and self-esteem are concepts that might or might not overlap. Since there is no clear answer on this, the study Shahar and colleagues (2004) conducted is not included in the current literature review, yet the difference of results, with either one naming the opposite gender as more prone to differences in self-esteem or self-criticism, should not go unmentioned.
Another gender difference is found in the study of Block and colleagues (1991). For girls, selfesteem at age 14 was negatively related to depressive symptoms 4 years later (r = -.20). For boys, a positive correlation was found (r = .17). The correlations itself were not significant, though the difference between the two was. This means, again, that there is a gender difference found in early adolescence. Next, Steiger and colleagues (2015) found that gender and esteem were moderately associated at age 16, with boys having higher self-esteem than girls when looked at the longitudinal study they conducted. In addition, they also found a significant association for gender and self-esteem in the intergenerational study, again with males having higher esteem than females. Not only did females have a lower self-esteem when compared to males, their depressive symptoms were also slightly more noticeable. Southall and Roberts (2002) have similar findings when they compare boys and girls. They find that girls tend to report higher levels of depressive symptoms than boys do. However, they do not remark whether or not this gender difference is significant when including the levels of self-esteem.
moderating effect of gender. Some studies found no relations between the vulnerability or scar model and gender. Yet, other studies show striking differences, with interactions between gender and depression or gender and self-esteem. It seems somewhat logical to assume the meta-analysis Sowislo and Orth (2013) conducted took so many studies in consideration, their findings of gender not being a moderator effect should be taken seriously. This assumption is hampered by the fact that they only controlled for gender with the vulnerability model, and not the scar model. A clear conclusion on whether or not gender plays an important role in the relationship of low self-esteem and depression can therefore not be drawn.
Conclusion and discussion
This literature review describes the most important findings with regards to the relation between low self-esteem, depression and the moderating effect of gender. Two questions were answered in order to give an overview of the possible relationship. First, in this review the scar model is discussed. The underlying theory assumes that depression leaves a scar in the self-concept of a person, making them more prone to low self-esteem. Therefore, according to this theory, low self-esteem is a consequence of depression. This model is not frequently researched, and the studies who did conduct research have contradicting findings. Most of the studies with older participants, that is to say adults, fail to support the scar model, whereas studies done to adolescents mostly support the scar model. This might be another indication that the low self-esteem as a consequence of depression might be true in
adolescence, but most likely not in adulthood. With the second question, the vulnerability model is discussed. Here, the underlying theory assumes that low self-esteem can cause depression, with negative self-evaluations being a causal risk factor. With this model being more frequently researched, there is also more support available for this model. Therefore, albeit with caution, it seems that the vulnerability model can be marked truthful. In addition, the vulnerability effect appeared to be twice as big as the scar model. This might be
influenced by the fact that the vulnerability model seems to connect with mid- and late
adolescence, while the scar model connects with early adolescence. Finally, both models were controlled for the moderating effect of gender. Once again, conflicting evidence was found. Where some studies had found gender differences, others had not. A clear conclusion to reject or approve the hypothesis of this review could therefore not be made, though it seems clear that self-esteem and depression are linked in adolescence.
The findings of this review are complementary to previous research. Almost all the studies included in this literature review, mention that the scar model has contradictory
evidence and a few studies mention that the scar model has too little empirical research for the much needed conclusions in this field. The current study shows some light on the possible explanations for the variable outcomes of previous research. As implicated by Shahar and Henrich (2010), age is an important factor in the scar model. In early adolescence, the scar model has more influence than in later life. As far as known, Shahar and Henrich are the first to notice this important influence of age. Unfortunately, the meta-analysis Sowislo and Orth (2013) conducted was not controlled for the moderating effect of age with regards to the scar model. In addition, Sowislo and Orth did not use an age restriction. The studies used in this meta-analysis include both adolescents and adults, with the average age of the participants at the time of the first assessment being 27.7 years (SD = 17.4; range: 8.2-79.3). They did conduct a moderator analysis with the vulnerability model, were age appeared to not
significantly influence the relationship between self-esteem and depression. However, given that Shahar and Henrich (2010) have shown that age is important for the scar model, this might be different for the scar model. Therefore, the small effect Sowislo and Orth (2013) found for the scar model, might be influenced by the relatively old mean age of participants that participated in the included studies.
depression and self-esteem are more often than not unclear. Not all studies used the same questionnaires or even specified what their view on depression or self-esteem was. Some used depressive feelings or thoughts for a short period of time, others were more strict and used depressive symptoms over a longer period or even a clinical definition of depression. With self-esteem, the definition can differ even more, since self-esteem can be seen as a global construct, but can also be viewed domain specifically. Not all studies are clear on whether they view self-esteem as a trait or state, which might influence the results as well. In future research, it should be more clear what view the researchers have on self-esteem and
depression. Furthermore, it is recommended that (early) adolescence is more researched, most definitely with regards to the scar model. Though, for correct reference, (early) adolescence in combination with the vulnerability model should not be forgotten. Ideally, further research also takes the reciprocal models in account, since it cannot be excluded that low self-esteem and depression are conducted in a vicious cycle. A meta-analysis with adolescents and adults separately is also recommended. This way, it is possible to check whether one of the models fits more in a certain age group as supposed to the other model.
Unfortunately, research conducted to the underlying mechanisms of the scar and vulnerability model do not show clear signs to whether constructs such as seeking
reassurance, rumination and seeking negative feedback can be marked as the reason for low self-esteem leading to depression or depression leading to low self-esteem. That is to say, there is hardly any research to the scar or vulnerability model that includes these underlying constructs. For instance, while it is known that rumination in girls is linked to depression (Prinstein et al., 2005), these researchers did not link this to self-esteem. Therefore, none of these possible pathways Orth and colleagues (2008) offered as explanations can be concluded to be the underlying mechanism of the relationship between depression and low
However, despite the limitations, this current literature review does contribute to the existing knowledge of the relation between low self-esteem and depression. It is now clear that age might play a different role in the scar model, than it does in the vulnerability model. This might have affected the results from the meta-analysis (Sowislo & Orth, 2013), given that the mean age was far beyond early adolescence, in adulthood. This should be taken in account with future research and interventions that address adolescence. In early adolescence, focusing on subsiding or dissolving the depression an adolescent has, might help prevent the adolescent from developing a low self-esteem. Caretakers of adolescents, as well as
researchers creating interventions for these adolescence, should take this in mind. In mid- and late adolescence, low self-esteem could be seen as a risk factor for depression. Therefore the development of low self-esteem in adolescence should be avoided as much as possible, and if low self-esteem does develop in adolescence, this should be monitored and diminished sooner rather than later. Caretakers and researchers should take this into account as well, in an effort to help adolescents as much as possible with containing their mental health.
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