The Link Between Self-esteem and Adolescent Depression

Rose was 15 when her parents informed her that they would need to move for her father’s work. Rose was dealing with the change alright until the first day of school in the new school. There she was full of anxiety and fear with how to make new friends. Unfortunately, very few friends appeared over the next three years, and Rose also began to gain a lot of weight. What resulted was very low self-esteem. When Rose went to college, she faced very similar fears as she experienced during the change to high school. Shortly after this transition, she was diagnosed with MDD.

Rose’s situation is not unique. While the specifics of the story may be different than other adolescents struggling with depression, many adolescents struggle with low self-esteem all throughout high school only to learn later in life that they struggle with depression. Today, 5.5% of all eighteen year olds are diagnosed with major depressive disorder (MDD) (van Tuijl, de Jong, Sportel, de Hullu, & Nauta, 2014), but probably 20-40% of adolescents have MDD and are just not diagnosed (Hu & Ai, 2016). Specifically, depressive symptoms begin to increase from ages fourteen to seventeen, and are even greater for females (Rawana & Morgan, 2014). This depression has been seen to be a result of low self-esteem, but the depression is also seen to lower self-esteem even further (Steiger, Fend, & Allemand, 2015). Even if adolescents are not diagnosed with depression, most adolescents are seen to have quite low self-esteem, especially when compared to their self-esteem in childhood (van Tuijl et al., 2014). Although it appears that depression leads to low self-esteem, through investigating the research, it becomes clear that the opposite is true in that low self-esteem leads to depression especially in adolescence. This is specifically seen in longitudinal studies that show adolescents with low self-esteem over time developing depression, especially when they have negative relationships with their parents and low attachment with their peers.

Adolescent Depression

Adolescence is a time of a lot of changes in all aspects of an individual’s life. Not only are there drastic changes, but these changes are happening at different rates. For example, most adolescents hit physical maturity during this time of life, but all lack psychological maturity until their mid-twenties (Hu & Ai, 2016). Another change is the immense socialization with peers that adolescents begin to participate in (Steiger et al, 2015). These changes may be the reason we see such a spike in depressive symptoms during adolescence (Hu & Ai, 2016). However, depression may not be diagnosed in some adolescents because people brush off the symptoms as just a “phase”.

Ignoring depressive symptoms in adolescents because it is assumed the symptoms will pass is extremely dangerous because depression is a serious harm to an individual’s well-being. Someone who is depressed normally develops helplessness is social settings, achievement settings, and physical settings (Steiger et al., 2015). Depressed patients are also seen to have a shorter life expectancy and a less physical lifestyle overall (Bruce, Seeman, Merrill, & Blazer, 1994). There is also significant evidence that suggests that when depression appears in young adolescents, their normal development is seriously affected making them lead very different lives than those who do not have psychopathology (Nolen-Hoeksema, Girgus, & Seligman, 1992). Looking at all of the negative side effects of depression, it becomes clear that depression should be caught as early as possible in order to buffer against some of these consequences.

Once adolescent depression is identified, the next step is treating it. Adolescent depression is hard to treat and understand as it is aetiologically and neurologically different than that of adult depression. Some even argue that it should not be considered the same disorder. Along with that, even self-esteem and the understanding of the construct may differ between adolescents and adults (van Tuijl et al., 2014). However, as most of the treatment available for depression is made for adults, that same treatment is often applied to adolescents. Throughout time as this has been done, the differences in reactions to this same treatment has enlightened researchers on a few of the differences between adolescent and adult depression. Specifically, it has shown that adolescents with depression are more likely to be pessimistic, have poor social skills, and be worse in school. These findings are more significant for depressed adolescents than depressed adults. One reason these are believed to change is due to the natural development that occurs from adolescence to adulthood (Nolen-Hoeksema et al., 1992). As more of these differences are identified, a more effective treatment for adolescent depression can be developed.

Self-Esteem

Self-esteem is largely involved in a person’s life. A person’s self-esteem affects their mental health, cognition, motivation, emotional behaviors, social behaviors and personality. It appears that self-esteem may be more important, however, in people with depression. If self-esteem is high, people are able to adapt easily to different situations, avoid depressive symptoms, and lead healthier lifestyles (Hu & Ai, 2016; Krug, Wittchen, Lieb, Beesdo-Baum, & Knappe, 2016). If self-esteem is low, research has shown, individuals are more likely to be involved in delinquent behaviors and suffer from poverty. People with low self-esteem also focus more on their failures rather than successes and are extremely sensitive to rejection, and this gets even worse if the adolescent feels any rejection from their parents. If someone develops low self-esteem in the adolescent years, and by consequence these negative associations with low self-esteem, it is harder for them to raise their self-esteem as they get older (Steiger et al., 2015). This idea leads to the thought process that low self-esteem leads to depression and not vice versa.

Self-esteem has many definitions, and therefore can sometimes be hard to study and understand. In adolescence, it most commonly boils down to physical attractiveness, academic competence, self-acceptance, and self-respect (Krug et al., 2016; Steiger, Allemand, Robins, & Fend, 2014). There are two types of self-esteem: implicit and explicit. Implicit self-esteem is the automatic self-evaluation experienced in a given situation. Explicit self-esteem is adopted through motivation, and is more stable than implicit self-esteem, especially during the adolescent years. People with implicit self-esteem have a harder time adjusting to negative situations, therefore those with depression are more likely to be found with implicit self-esteem. However, those with low explicit self-esteem are seen to develop high depressive symptomatology as well. Specifically, low implicit self-esteem is seen to immediately affect depression, while low explicit self-esteem affects it slowly over long periods of time (van Tuijl et al., 2014). Therefore, both types of low self-esteem are linked to depression symptoms, they just show up along different timelines.

The relationship between these types of self-esteem lead to different labels for self-esteem. Discrepant self-esteem occurs when implicit and explicit self-esteem are inversely related. Fragile self-esteem is specifically high explicit self-esteem with low implicit self-esteem and is seen within narcissistic behaviors. Damaged self-esteem is high implicit self-esteem with low explicit self-esteem and is seen within depressive behaviors (van Tuijl et al., 2014). Therefore, understand these different types of self-esteem can help clinicians identify what kind of self-esteem a patient has and therefore see if they are likely to have depression or not.

There are two theories within the relationship between self-esteem and depression. One is the vulnerability model which suggests that low self-esteem leads to depression. The other is the scar hypothesis which suggests that depression leads to low self-esteem by all the “scars” that depressive episodes leave on the individual. These scars typically have to do with social relationships, as depressive individuals put a lot of strain on the people they are in any type of relationship with. These scars may also be the result of being unable to think positively of themselves as they have been thinking negatively for so long (Steiger et al., 2015). Most research supports the vulnerability model, however the two are actually seen most often working together. It is also suggested that the scar hypothesis can only truly be seen in adults and not adolescents. The scar hypothesis is also most often seen in individuals with an unusually high amount of MDD episodes (van Tuijl et al., 2014). Distinguishing between these two theories can help researchers understand their patients better, especially if those patients are adolescents with depression.

Self-esteem is correlated with depression, but has also been seen to change over time. Therefore, it can be assumed that depression also changes over time. For example, when individuals are seen to enter adolescence with low self-esteem, that self-esteem is seen to decrease over time and those individuals are more likely to be diagnosed with depression later in life (Steiger et al., 2014). For adolescents who are already diagnosed with depression, their depression is seen to transform into severe depression and suicidal behaviors appear when they are adults (van Tuijl et al., 2014). This supports the vulnerability hypothesis that depression gets worse as self-esteem gets worse.

Parents

One aspect of adolescent’s lives that may impact their depression and self-esteem is their relationship with their parents. In order to adjust to all the changes going on at this time, adolescent’s need a strong support system at home. Adolescent’s are quite aware of the changes they are going through, and therefore assume that everyone else is completely aware of them too (Hu & Ai, 2016). This makes self-esteem a big part of adolescent’s lives. Parents need to support adolescent’s self-esteem, as everything else around them tends to lower their self-esteem. The way they can raise their child’s self-esteem is by being warm and understanding, or in other words, being emotionally supportive (Hu & Ai, 2016). When parents treat their children with their warmth and understanding, the adolescents are better able to learn how to cope with difficult situations which then serves as a barrier to low self-esteem (Steiger et al. 2015). With most depressed adolescents, research has been able to find a lack of emotional support from the parents.

Depression has many factors involved in it, such as, personality, heredity, and negative life events. However, the most telling sign of depression, especially in adolescents, is dysfunctional attitudes such as being a perfectionist or expecting consistent praise from those around them. The job of parents is to catch these dysfunctional attitudes before they turn into depression and help educate their children on how to think healthily (Hu & Ai, 2016).

While parents do have the ability to help their children suffering with depressive symptoms, an issue arises where most adolescents with depression have at least one parent also suffering from the disorder, most likely the mother (Krug et al., 2016). This may have to do genetic factors of depression but adolescents also learn how to respond to situations the same way their parents do, so if the parents are responding in ways due to their depression, adolescents are most likely to respond in a similar way, which will over time lead them to develop depressive symptoms and eventually MDD (Steiger et al., 2015). This is specifically true with the construct of self-criticism. If a parent is very likely to be self-critical of themselves, they are also more likely to be extremely critical of others. If the parent is consistently critical towards their child, their child will start to become self-critical which then lowers self-esteem and raises depressive symptoms. Another aspect of this is that parents with depression are more likely to be insecure simply interacting with their children, therefore causing strain on the parent-adolescent relationship (Steiger et al., 2015). Parents with depression are more likely to be focused on the self, and therefore less likely to be available to give warmth and understanding to their children, who need that relationship with their parents in order to have higher self-esteem.

Peers

Besides parents, another telling factor of adolescents self-esteem, and therefore their depressive symptoms, is their popularity among their peers. This is especially true in male adolescents (Steiger et al, 2015). Specifically, the construct of school connectedness, which is how much a student feels accepted at school, has been linked to depression and low self-esteem in adolescents. School connectedness has even been suggested to be a specific form of self-esteem in high school students. High self-esteem is actually the largest predictor with high school connectedness, along with gender, socioeconomic status, and academic achievement. School connectedness also appears to be highly influenced by how safe an adolescent feels in the home. If they are highly attached to their parents, they will also experience high school connectedness and vice versa. Peers may even be a more important influence on school connectedness since the peers are actually at school when the parents are not (Millings, Buck, Montgomery, Spears, & Stallard, 2012). The research on this topic has shown that as a student has more school connectedness, they are less likely to experience low self-esteem, which therefore leads to a decrease in depressive symptoms for the adolescent. While the research on this topic is convincing, it still needs more evidence in order to the construct to truly be understood in regards of the relationship between school connectedness and adolescent depression (Millings et al., 2012). Once this is understood more, however, it will give researchers another variable to examine when trying to find adolescents suffering with depression early on.

A huge part of school connectedness is how attached the adolescents feel to their peers. While relationships with peers are always important in a person’s life, during adolescence, these relationships seems to become more important as it is more integrally a part of the adolescent’s life and the interaction between the adolescent and their peers becomes more complex (Millings et al., 2012). As adolescents become more attached to the peers around them, they can form either a secure or insecure attachment. An insecure attachment leads to relationships that are avoidant and dependent, where the individual is constantly concerned that the friend will avoid them and therefore the individual avoids their friends in fear, and ultimately these relationships do not lead to a lasting attachment (Millings et al., 2012). When an attachment falls through, it may lower an adolescent’s self-esteem and therefore make them more predisposed to depressive symptoms. Secure attachments, on the other hand, are seen to raise confidence, provide support, and ultimately lead to a lasting, fulfilling, relationship. Secure attachments also seem to come to light naturally, while insecure attachments seem more forced (Millings et al., 2012). Overall, high attachment with peers tends to show high self-esteem as well, and vice versa.

Limitations

While the research that has been done on adolescent depression is very well done and informative pertaining to this topic, unfortunately there are very few researchers who are looking into this issue. Part of this comes from the fact that both self-esteem and depression are huge constructs and can therefore be studied and measured in millions of different ways. This leads a variety in the research rather than multiple focused research studies on a specific topic. Another issue that arises with this subject is that most self-esteem studies are done with self-report measures as they have not yet found a way to physiologically measure self-esteem like they can with neurotransmitters in depression (van Tuijl et al., 2014). Self-report measures are often bias, as the participant may not be totally honest in their responses in order to look a certain way. Also, people’s feelings can change day to day, making self-report responses inconsistent over time which also biases the data. This is best avoided when the self-report measures have been shown to have high reliability and validity through psychometrics (Millings et al., 2012). Most of the studies on this subject also are not longitudinal, therefore making it very difficult to be sure whether the vulnerability or scar hypothesis will best explain depression in adolescents in relation to self-esteem (Millings et al., 2012). Overall, while the research available is very helpful in understanding this issue, much more needs to be done in order to outweigh these limitations.

Solution

From the research above it becomes clear that self-esteem in adolescence is very important in regards to depression. It is imperative that positive self-esteem is encouraged in adolescents at this critical age (Rawana & Morgan, 2014). If we are able to raise self-esteem in our adolescents, we will be able to lower depression rates in adults later in life (Steiger et al., 2014). Therefore, we should focus more on raising self-esteem in interventions than lowering depressive symptoms (Steiger et al, 2015). Self-esteem is more set in stone the older and individual is, therefore self-esteem needs to be the focus of those dealing with children and adolescents early on, in order to raise self-esteem before it becomes almost stagnant by the time they are young adults. Self-esteem is also easier to manipulate when the adolescents are more family oriented than social oriented with their peers. Therefore, raising self-esteem in the home early on is imperative as a protective factor against depressive symptoms in adolescence (Steiger et al., 2015). Millings et al. (2012) also highly suggest that along with increasing parental attachment, raising peer attachment will highly raise self-esteem and school connectedness which will offer as protective factors against self-esteem. Raising self-esteem in all aspects of an adolescent’s life will help, but at home it will be the most beneficial.

One therapy that has already been seen to raise self-esteem is cognitive behavioral therapy (CBT), however this therapy is rarely used in adolescents, especially as many adolescents with MDD are not diagnosed yet even though they have all the symptoms. Instead, it may be more effective to create interventions designed purely to raise self-esteem in adolescents (van Tuijl et al., 2014). Another intervention that may be useful is interventions for parent-adolescent relationships. These interventions help both the parent and adolescent to respect and trust each other, and specifically focuses on teaching the parents how to positively evaluate their children in order to raise self-esteem (Hu & Ai, 2016). An intervention that could also be beneficial for adolescent’s self-esteem would be one that focuses on school connectedness. While school connectedness is not a direct predictor of adolescent depression, it is a direct predictor of self-esteem which is a direct predictor of adolescent depression, and therefore if school connectedness was the focus of an intervention, it would eventually lead to the desired results of lowering depression in adolescents. This intervention should also focus on improving peer attachments as an aspect of school connectedness. An intervention like this should also take place in a school for best desired results. (Millings et al., 2012). If these interventions were put into place more frequently, we might see a decrease in adolescent depression rates.