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Self-esteem in a broad-spectrum approach for mental Health promotion

  • Adler University


Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.
Self-esteem in a broad-spectrum approach for
mental health promotion
Michal (Michelle) Mann
, Clemens M. H. Hosman
, Herman P. Schaalma
and Nanne K. de Vries
Self-evaluation is crucial to mental and social
well-being. It influences aspirations, personal
goals and interaction with others. This paper
stresses the importance of self-esteem as a pro-
tective factor and a non-specific risk factor in
physical and mental health. Evidence is pre-
sented illustrating that self-esteem can lead to
better health and social behavior, and that poor
self-esteem is associated with a broad range of
mental disorders and social problems, both
internalizing problems (e.g. depression, suicidal
tendencies, eating disorders and anxiety) and
externalizing problems (e.g. violence and sub-
stance abuse). We discuss the dynamics of self-
esteem in these relations. It is argued that
an understanding of the development of self-
esteem, its outcomes, and its active protection
and promotion are critical to the improvement
of both mental and physical health . The
consequences for theory development, program
development and health education research are
addressed. Focusing on self-esteem is consid-
ered a core element of mental health promotion
and a fruitful basis for a broad-spectrum
The most basic task for one’s mental, emotional
and social health, which begins in infancy and con-
tinues until one dies, is the construction of his/her
positive self-esteem. [(Macdonald, 1994), p. 19]
The beliefs and evaluations people hold about
themselves determine who they are, what they can
do and what they can become (Burns, 1982). These
powerful, inner influences provide an internal
guiding mechanism, steering and nurturing indi-
viduals through life, and governing their behavior.
People’s concepts and feelings about themselves
are generally labeled as their self-concept and
self-esteem. These, together with their ability to
deal with life’s challenges and to control what
happens to them, are widely documented in liter-
ature (Seligman, 1975; Bandura, 1977; Bowlby,
1980; Rutter, 1992; Harter, 1999).
Self-concept is defined as the sum of an
individual’s beliefs and knowledge about his/her
personal attributes and qualities. It is classed as
a cognitive schema that organizes abstract and
concrete views about the self, and controls the
processing of self-relevant information (Markus,
1977; Kihlstrom and Cantor, 1983). Other concepts,
such as self-image and self-perception, are equiv-
alents to self-concept. Self-esteem is the evaluative
and affective dimension of the self-concept, and
is considered as equivalent to self-regard, self-
estimation and self-worth (Harter, 1999). It refers to
a person’s global appraisal of his/her positive or
negative value, based on the scores a person gives
him/herself in different roles and domains of life
(Rogers, 1981; Markus and Nurius, 1986). Positive
Department of Health Education and Promotion,
Maastricht University, Maastricht and
Research Center on Program Development and Effect
Management, The Netherlands
Correspondence to: M. Mann, Department of Health
Education and Promotion (GVO), PO Box 616,
6200 MD Maastricht, The Netherlands;
Theory & Practice Pages 357–372
Health Education Research Vol.19 no.4, Ó Oxford University Press 2004; All rights reserved DOI: 10.1093/her/cyg041
self-esteem is not only seen as a basic feature of
mental health, but also as a protective factor that
contributes to better health and positive social
behavior through its role as a buffer against the
impact of negative influences. It is seen to actively
promote healthy functioning as reflected in life
aspects such as achievements, success, satisfaction,
and the ability to cope with diseases like cancer and
heart disease. Conversely, an unstable self-concept
and poor self-esteem can play a critical role in
the development of an array of mental disorders
and social problems, such as depression, anorexia
nervosa, bulimia, anxiety, violence, substance abuse
and high-risk behaviors. These conditions not only
result in a high degree of personal suffering, but also
impose a considerable burden on society. As will be
shown, prospective studies have highlighted low
self-esteem as a risk factor and positive self-esteem
as a protective factor. To summarize, self-esteem is
considered as an influential factor both in physical
and mental health, and therefore should be an
important focus in health promotion; in particular,
mental health promotion.
Health promotion refers to the process of enabling
people to increase control over and improve their
own health (WHO, 1986). Subjective control as well
as subjective health, each aspects of the self, are
considered as significant elements of the health
concept. Recognizing the existence of different views
on the concept of mental health promotion, Sartorius
(Sartorius, 1998), the former WHO Director of
Mental Health, preferred to define it as a means by
which individuals, groups or large populations can
enhance their competence, self-esteem and sense of
well-being. This view is supported by Tudor (Tudor,
1996) in his monograph on mental health promotion,
where he presents self-concept and self-esteem as two
of the core elements of mental health, and therefore as
an important focus of mental health promotion.
This article aims to clarify how self-esteem is
related to physical and mental health, both empiri-
cally and theoretically, and to offer arguments for
enhancing self-esteem and self-concept as a major
aspect of health promotion, mental health pro-
motion and a ‘Broad-Spectrum Approach’ (BSA) in
The first section presents a review of the empirical
evidence on the consequences of high and low self-
esteem in the domains of mental health, health and
social outcomes. The section also addresses the
bi-directional nature of the relationship between
self-esteem and mental health. The second section
discusses the role of self-esteem in health promotion
from a theoretical perspective. How are differ-
entiations within the self-concept related to self-
esteem and mental health? How does self-esteem
relate to the currently prevailing theories in the field
of health promotion and prevention? What are the
mechanisms that link self-esteem to health and
social outcomes? Several theories used in health
promotion or prevention offer insight into such
mechanisms. We discuss the role of positive
self-esteem as a protective factor in the context of
stressors, the developmental role of negative self-
esteem in mental and social problems, and the role of
self-esteem in models of health behavior. Finally,
implications for designing a health-promotion
strategy that could generate broad-spectrum out-
comes through addressing common risk factors such
as self-esteem are discussed. In this context, schools
are considered an ideal setting for such broad-
spectrum interventions. Some examples are offered
of school programs that have successfully contrib-
uted to the enhancement of self-esteem, and the
prevention of mental and social problems.
Self-esteem and mental well-being
Empirical studies over the last 15 years indicate that
self-esteem is an important psychological factor
contributing to health and quality of life (Evans,
1997). Recently, several studies have shown that
subjective well-being significantly correlates with
high self-esteem, and that self-esteem shares
significant variance in both mental well-being and
happiness (Zimmerman, 2000). Self-esteem has
been found to be the most dominant and powerful
predictor of happiness (Furnham and Cheng, 2000).
Indeed, while low self-esteem leads to maladjust-
ment, positive self-esteem, internal standards and
aspirations actively seem to contribute to ‘well-
being’ (Garmezy, 1984; Glick and Zigler, 1992).
According to Tudor (Tudor, 1996), self-concept,
M. Mann et al.
identity and self-esteem are among the key
elements of mental health.
Self-esteem, academic achievements
and job satisfaction
The relationship between self-esteem and academic
achievement is reported in a large number of studies
(Marsh and Yeung, 1997; Filozof et al., 1998; Hay
et al., 1998). In the critical childhood years, positive
feelings of self-esteem have been shown to increase
children’s confidence and success at school (Coop-
ersmith, 1967), with positive self-esteem being a
predicting factor for academic success, e.g. reading
ability (Markus and Nurius, 1986). Results of a
longitudinal study among elementary school chil-
dren indicate that children with high self-esteem
have higher cognitive aptitudes (Adams, 1996).
Furthermore, research has revealed that core self-
evaluations measured in childhood and in early
adulthood are linked to job satisfaction in middle
age (Judge et al., 2000).
Self-esteem and coping with stress
in combi nation with coping with
physical disease
The protective nature of self-esteem is particularly
evident in studies examining stress and/or physical
disease in which self-esteem is shown to safeguard
the individual from fear and uncertainty. This is
reflected in observations of chronically ill individ-
uals. It has been found that a greater feeling of
mastery, efficacy and high self-esteem, in combi-
nation with having a partner and many close
relationships, all have direct protective effects on
the development of depressive symptoms in the
chronically ill (Penninx et al., 1998). Self-esteem
has also been shown to enhance an individual’s
ability to cope with disease and post-operative
survival. Research on pre-transplant psychological
variables and survival after bone marrow trans-
plantation (Broers et al., 1998) indicates that high
self-esteem prior to surgery is related to longer
survival. Chang and Mackenzie (Chang and Mack-
enzie, 1998) found that the level of self-esteem was
a consistent factor in the prediction of the functional
outcome of a patient after a stroke.
To conclude, positive self-esteem is associated
with mental well-being, adjustment, happiness,
success and satisfaction. It is also associated with
recovery after severe diseases.
Identity development and the
sources of negative self-esteem
The evolving nature of self-esteem was conceptu-
alized by Erikson (Erikson, 1968) in his theory on
the stages of psychosocial development in children,
adolescents and adults. According to Erikson,
individuals are occupied with their self-esteem
and self-concept as long as the process of crystal-
lization of identity continues. If this process is not
negotiated successfully, the individual remains
confused, not knowing who (s)he really is. Identity
problems, such as unclear identity, diffused identity
and foreclosure (an identity status based on whether
or not adolescents made firm commitments in
life. Persons classified as ‘foreclosed’ have made
future commitments without ever experiencing the
‘crises’ of deciding what really suits them best),
together with low self-esteem, can be the cause
and the core of many mental and social problems
(Marcia et al., 1993).
The development of self-esteem during child-
hood and adolescence depends on a wide variety of
intra-individual and social factors. Approval and
support, especially from parents and peers, and self-
perceived competence in domains of importance
are the main determinants of self-esteem [for
a review, see (Harter, 1999)]. Attachment and un-
conditional parental support are critical during the
phases of self-development. This is a reciprocal
process, as individuals with positive self-esteem
can better internalize the positive view of signifi-
cant others. For instance, in their prospective study
among young adolescents, Garber and Flynn
(Garber and Flynn, 2001) found that negative
self-worth develops as an outcome of low maternal
acceptance, a maternal history of depression and
exposure to negative interpersonal contexts, such as
negative parenting practices, early history of child
maltreatment, negative feedback from significant
Self-esteem in a BSA for mental health promotion
others on one’s competence, and family discord and
Other sources of negative self-esteem are
discrepancies between competing aspects of the
self, such as between the ideal and the real self,
especially in domains of importance. The larger the
discrepancy between the value a child assigns to
a certain competence area and the perceived self-
competence in that area, the lower the feeling of
self-esteem (Harter, 1999). Furthermore, discrep-
ancies can exist between the self as seen by oneself
and the self as seen by significant others. As implied
by Harter (Harter, 1999), this could refer to con-
trasts that might exist between self-perceived com-
petencies and the lack of approval or support by
parents or peers.
Finally, negative and positive feelings of self-
worth could be the result of a cognitive, inferential
process, in which children observe and evaluate
their own behaviors and competencies in specific
domains (self-efficacy). The poorer they evaluate
their competencies, especially in comparison to
those of their peers or to the standards of significant
others, the more negative their self-esteem. Such
self-monitoring processes can be negatively or
positively biased by a learned tendency to negative
or positive thinking (Seligman et al., 1995).
Outcomes of poor self-esteem
The outcomes of negative self-esteem can be
manifold. Poor self-esteem can result in a cascade
of diminishing self-appreciation, creating self-
defeating attitudes, psychiatric vulnerability, social
problems or risk behaviors. The empirical literature
highlights the negative outcomes of low self-
esteem. However, in several studies there is a lack
of clarity regarding causal relations between
self-esteem and problems or disorders (Flay and
Ordway, 2001). This is an important observation,
as there is reason to believe that self-esteem should
be examined not only as a cause, but also as a
consequence of problem behavior. For example,
on the one hand, children could have a negative
view about themselves and that might lead to
depressive feelings. On the other hand, depression
or lack of efficient functioning could lead to feeling
bad, which might decrease self-esteem. Although
the directionality can work both ways, this article
concentrates on the evidence for self-esteem as a
potential risk factor for mental and social outcomes.
Three clusters of outcomes can be differentiated.
The first are mental disorders with internalizing
characteristics, such as depression, eating disorders
and anxiety. The second are poor social outcomes
with externalizing characteristics including aggres-
sive behavior, violence and educational exclusion.
The third is risky health behavior such as drug
abuse and not using condoms.
Self-esteem and internalizing mental
Self-esteem plays a significant role in the develop-
ment of a variety of mental disorders. According to
the Diagnostic and Statistical Manual of Mental
Disorders (DSM IV), negative or unstable self-
perceptions are a key component in the diagnostic
criteria of major depressive disorders, manic and
hypomanic episodes, dysthymic disorders, dissocia-
tive disorders, anorexia nervosa, bulimia nervosa, and
in personality disorders, such as borderline, narcis-
sistic and avoidant behavior. Negative self-esteem is
also found to be a risk factor, leading to maladjust-
ment and even escapism. Lacking trust in themselves,
individuals become unable to handle daily problems
which, in turn, reduces the ability to achieve
maximum potential. This could lead to an alarming
deterioration in physical and mental well-being. A
decline in mental health could result in internalizing
problem behavior such as depression, anxiety and
eating disorders. The outcomes of low self-esteem for
these disorders are elaborated below.
Depressed m oods, depression and suicidal
The clinical literature suggests that low self-esteem
is related to depressed moods (Patterson and
Capaldi, 1992), depressive disorders (Rice et al.,
1998; Dori and Overholser, 1999), hopeless-
ness, suicidal tendencies and attempted suicide
M. Mann et al.
(Overholser et al., 1995). Correlational studies
have consistently shown a significant negative
relationship between self-esteem and depression
(Beck et al., 1990; Patton, 1991). Campbell et al.
(Campbell et al., 1991) found individual appraisal
of events to be clearly related to their self-esteem.
Low self-esteem subjects rated their daily events as
less positive and negative life events as being more
personally important than high self-esteem sub-
jects. Individuals with high self-esteem made more
stable and global internal attributions for positive
events than for negative events, leading to the
reinforcement of their positive self-image. Subjects
low in self-esteem, however, were more likely to
associate negative events to stable and global
internal attributions, and positive events to external
factors and luck (Campbell et al., 1991). There is
a growing body of evidence that individuals with
low self-esteem more often report a depressed state,
and that there is a link between dimensions of
attributional style, self-esteem and depression
(Abramson et al., 1989; Hammen and Goodman-
Brown, 1990).
Some indications of the causal role of self-esteem
result from prospective studies. In longitudinal
studies, low self-esteem during childhood (Rein-
herz et al., 1993), adolescence (Teri, 1982) and
early adulthood (Wilhelm et al., 1999) was
identified as a crucial predictor of depression later
in life. Shin (Shin, 1993) found that when
cumulative stress, social support and self-esteem
were introduced subsequently in regression analy-
sis, of the latter two, only self-esteem accounted for
significant additional variance in depression. In
addition, Brown et al. (Brown et al., 1990) showed
that positive self-esteem, although closely associ-
ated with inadequate social support, plays a role as
a buffer factor. There appears to be a pathway from
not living up to personal standards, to low self-
esteem and to being depressed (Harter, 1986, 1990;
Higgins, 1987, 1989; Baumeister, 1990). Alterna-
tively, another study indicated that when examining
the role of life events and difficulties, it was found
that total level of stress interacted with low self-
esteem in predicting depression, whereas self-
esteem alone made no direct contribution (Miller
et al., 1989). To conclude, results of cross-sectional
and longitudinal studies have shown that low
self-esteem is predictive of depression.
The potentially detrimental impact of low self-
esteem in depressive disorders stresses the signif-
icance of Seligman’s recent work on ‘positive
psychology’. His research indicates that teaching
children to challenge their pessimistic thoughts
whilst increasing positive subjective thinking (and
bolstering self-esteem) can reduce the risk of
pathologies such as depression (Seligman, 1995;
Seligman et al., 1995; Seligman and Csikszentmi-
halyi, 2000).
Other internalizing disorders
Although low self-esteem is most frequently
associated with depression, a relationship has also
been found with other internalizing disorders, such
as anxiety and eating disorders. Research results
indicate that self-esteem is inversely correlated with
anxiety and other signs of psychological and
physical distress (Beck et al., 2001). For example,
Ginsburg et al. (Ginsburg et al., 1998) observed
a low level of self-esteem in highly socially anxious
children. Self-esteem was shown to serve the
fundamental psychological function of buffering
anxiety, with the pursuit of self-esteem as a de-
fensive avoidance tool against basic human fears.
This mechanism of defense has become evident in
research with primary (Ginsburg et al., 1998) and
secondary school children (Fickova, 1999). In
addition, empirical studies have shown that bol-
stering self-esteem in adults reduces anxiety
(Solomon et al., 2000).
The critical role of self-esteem during school
years is clearly reflected in studies on eating
disorders. At this stage in life, weight, body shape
and dieting behavior become intertwined with
identity. Researchers have reported low self-esteem
as a risk factor in the development of eating
disorders in female school children and adolescents
(Fisher et al., 1994; Smolak et al., 1996; Shisslak
et al., 1998), as did prospective studies (Vohs et al.,
2001). Low self-esteem also seems predictive of the
poor outcome of treatment in such disorders, as has
been found in a recent 4-year prospective follow-up
Self-esteem in a BSA for mental health promotion
study among adolescent in-patients with bulimic
characteristics (van der Ham et al., 1998). The
significant influence of self-esteem on body image
has led to programs in which the promotion of self-
esteem is used as a main preventive tool in eating
disorders (St Jeor, 1993; Vickers, 1993; Scarano
et al., 1994).
To sum up, there is a systematic relation between
self-esteem and internalizing problem behavior.
Moreover, there is enough prospective evidence to
suggest that poor self-esteem might contribute to
deterioration of internalizing problem behavior
while improvement of self-esteem could prevent
such deterioration.
Self-esteem, externalizing problems
and other poor social outcomes
For more than two decades, scientists have studied
the relationship between self-esteem and exter-
nalizing problem behaviors, such as aggression,
violence, youth delinquency and dropping out of
school. The outcomes of self-esteem for these
disorders are described below.
Violence and aggressive behavior
While the causes of such behaviors are multiple and
complex, many researchers have identified self-
esteem as a critical factor in crime prevention,
rehabilitation and behavioral change (Kressly,
1994; Gilbert, 1995). In a recent longitudinal
questionnaire study among high-school adoles-
cents, low self-esteem was one of the key risk
factors for problem behavior (Jessor et al., 1998).
Recent studies confirm that high self-esteem is
significantly associated with less violence (Fleming
et al., 1999; Horowitz, 1999), while a lack of self-
esteem significantly increases the risk of violence
and gang membership (Schoen, 1999). Results of
a nationwide study of bullying behavior in Ireland
show that children who were involved in bullying
as either bullies, victims or both had significantly
lower self-esteem than other children (Schoen,
1999). Adolescents with low self-esteem were
found to be more vulnerable to delinquent behavior.
Interestingly, delinquency was positively associ-
ated with inflated self-esteem among these ado-
lescents after performing delinquent behavior
(Schoen, 1999). According to Kaplan’s self-
derogation theory of delinquency (Kaplan, 1975),
involvement in delinquent behavior with delinquent
peers can increase children’s self-esteem and sense
of belonging. It was also found that individuals
with extremely high levels of self-esteem and narcis-
sism show high tendencies to express anger and
aggression (Baumeister et al., 2000). To conclude,
positive self-esteem is associated with less aggres-
sive behavior. Although most studies in the field of
aggressive behavior, violence and delinquency are
correlational, there is some prospective evidence
that low self-esteem is a risk factor in the de-
velopment of problem behavior. Interestingly,
low self-esteem as well as high and inflated self-
esteem are both associated with the development of
aggressive symptoms.
School dropout
Dropping out from the educational system could
also reflect rebellion or antisocial behavior resul-
ting from identity diffusion (an identity status based
on whether or not adolescents made firm commit-
ments in life. Adolescents classified as ‘diffuse’
have not yet thought about identity issues or,
having thought about them, have failed to make any
firm future oriented commitments). For instance,
Muha (Muha, 1991) has shown that while self-
image and self-esteem contribute to competent
functioning in childhood and adolescence, low self-
esteem can lead to problems in social functioning
and school dropout. The social consequences of
such problem behaviors may be considerable for
both the individual and the wider community.
Several prevention programs have reduced the
dropout rate of students at risk (Alice, 1993;
Andrews, 1999). All these programs emphasize
self-esteem as a crucial element in dropout
Self-esteem and risk behavior
The impact of self-esteem is also evident in risk
behavior and physical health. In a longitudinal
study, Rouse (Rouse, 1998) observed that resilient
adolescents had higher self-esteem than their
M. Mann et al.
non-resilient peers and that they were less likely
to initiate a variety of risk behaviors. Positive self-
esteem is considered as a protective factor against
substance abuse. Adolescents with more positive
self-concepts are less likely to use alcohol or drugs
(Carvajal et al., 1998), while those suffering with
low self-esteem are at a higher risk for drug and
alcohol abuse, and tobacco use (Crump et al., 1997;
Jones and Heaven, 1998). Carvajal et al. (Carvajal
et al., 1998) showed that optimism, hope and
positive self-esteem are determinants of avoiding
substance abuse by adolescents, mediated by
attitudes, perceived norms and perceived behav-
ioral control. Although many studies support the
finding that improving self-esteem is an important
component of substance abuse prevention (Devlin,
1995; Rodney et al., 1996), some studies found no
support for the association between self-esteem and
heavy alcohol use (Poikolainen et al., 2001).
Empirical evidence suggests that positive self-
esteem can also lead to behavior which is
protective against contracting AIDS, while low
self-esteem contributes to vulnerability to HIV/
AIDS (Rolf and Johnson, 1992; Somali et al.,
2001). The risk level increases in cases where
subjects have low self-esteem and where their
behavior reflects efforts to be accepted by others or
to gain attention, either positively or negatively
(Reston, 1991). Lower self-esteem was also related
to sexual risk-taking and needle sharing among
homeless ethnic-minority women recovering from
drug addiction (Nyamathi, 1991). Abel (Abel,
1998) observed that single females whose partners
did not use condoms had lower self-esteem than
single females whose partners did use condoms. In
a study of gay and/or bisexual men, low self-
esteem proved to be one of the factors that made it
difficult to reduce sexual risk behavior (Paul et al.,
To summarize, the literature reveals a number of
studies showing beneficial outcomes of positive
self-esteem, and conversely, negative outcomes
of poor self-esteem, especially in adolescents.
Prospective studies and intervention studies have
shown that self-esteem can be a causal factor in
depression, anxiety, eating disorders, delinquency,
school dropout, risk behavior, social functioning,
academic success and satisfaction. However, the
cross-sectional character of many other studies does
not exclude that low self-esteem can also be
considered as an important consequence of such
disorders and behavioral problems.
To assess the implications of these findings for
mental health promotion and preventive interven-
tions, more insight is needed into the antecedents of
poor self-esteem, and the mechanisms that link self-
esteem to mental, physical and social outcomes.
Mechanisms linking self-esteem
and health behavior
What are the mechanisms that link self-esteem to
health and social outcomes? Several theories used
in health promotion or prevention offer insight into
such mechanisms. In this section we discuss the
role of positive self-esteem as a protective factor in
the context of stressors, the developmental role of
negative self-esteem in mental and social problems,
and the role of self-esteem in models of health
Positive thinking about oneself
as a protective factor in the context
of stressors
People have a need to think positively about
themselves, to defend and to improve their positive
self-esteem, and even to overestimate themselves.
Self-esteem represents a motivational force that
influences perceptions and coping behavior. In the
context of negative messages and stressors, positive
self-esteem can have various protective functions.
Research on optimism confirms that a somewhat
exaggerated sense of self-worth facilitates mastery,
leading to better mental health (Seligman, 1995).
Evidence suggests that positive self-evaluations,
exaggerated perception of control or mastery and
unrealistic optimism are all characteristic of normal
human thought, and that certain delusions may
contribute to mental health and well-being (Taylor
and Brown, 1988). The mentally healthy person
appears to have the capacity to distort reality in
Self-esteem in a BSA for mental health promotion
a direction that protects and enhances self-esteem.
Conversely, individuals who are moderately depres-
sed or low in self-esteem consistently display an
absence of such enhancing delusions. Self-esteem
could thus be said to serve as a defense mechanism
that promotes well-being by protecting internal
balance. Jahoda (Jahoda, 1958) also included the
‘adequate perception of reality’ as a basic element of
mental health. The degree of such a defense, however,
has its limitations. The beneficial effect witnessed in
reasonably well-balanced individuals becomes in-
valid in cases of extreme self-esteem and significant
distortions of the self-concept. Seligman (Seligman,
1995) claimed that optimism should not be based on
unrealistic or heavily biased perceptions.
The protective role of self-worth is also present
in stress theories, in which positive thinking about
oneself is considered to buffer the impact of
stressors. The transactional model of stress and
coping, as developed by Lazarus and Folkman
(Lazarus and Folkman, 1984), is frequently used as
a theoretical basis of preventive interventions in
mental health. The model emphasizes cognitive
appraisals, which center on the evaluation of harm,
threats and challenges, as well as on the options to
cope with such threats. The transactional character
refers to the cognitive process in which particular
environmental conditions are appraised by a partic-
ular person with certain psychological character-
istics. Self-esteem is considered as one of the factors
that influence both the perception of threats and the
evaluation of possible coping reactions. Positive
self-esteem and self-confidence can buffer stress by
mitigating the perceived threat and by enhancing the
selection and implementation of efficacious coping
strategies. As Lazarus and Folkman state:
Viewing yourself positively can also be regarded
as a very important psychological resource for
coping. We include in this category those general
and specific beliefs that serve as a basis for hope
and that sustain coping efforts in the face of the
most adverse condition... Hope can exist only
when such beliefs make a positive outcome seem
possible, if not probable. [(Lazarus and Folkman,
1984), p. 159]
A high level of self-esteem together with strong
social support makes individuals less vulnerable to
stressors (Brown et al., 1990; Rutter, 1992). Self-
esteem can be seen as an internal moderator of
stressors and social support as an external moder-
ator (Caplan, 1974; Hobfool and Walfisch, 1984).
On a far more general level, this is reflected in
Albee’s (Albee, 1985) formula for the incidence of
emotional illness in society, used as a theoretical
fundament for primary prevention:
Incidence = organic causes and stressors/compe-
tence, coping skills, self-esteem and social support
Actions that increase the size of the numerator will
increase the incidence of dysfunctional behavior
in society and activities that reduce, modify or
eliminate these factors will diminish the incidence
of dysfunction. Efforts that reduce the size of the
denominator will correspondingly increase the
incidence, whereas actions that increase the size
of the denominator, such as self-esteem, will reduce
Identity, se lf-est eem, and the development
of externalizing and internalizing
Erikson’s (Erikson, 1965, 1968) theory on the
stages of psychosocial development in children,
adolescents, and adults and Herbert’s flow chart
(Herbert, 1987) focus on the vicissitudes of identity
and the development of unhealthy mental and social
problems. According to these theories, when a
person is enduringly confused about his/her own
identity, he/she may possess an inherent lack of
self-reassurance which results in either a low level
of self-esteem or in unstable self-esteem and
feelings of insecurity. However, low self-esteem—
likewise inflated self-esteem—can also lead to
identity problems. Under circumstances of insecu-
rity and low self-esteem, the individual evolves in
one of two ways: he/she takes the active escape
route or the passive avoidance route (Herbert,
1987). The escape route is associated with exter-
nalizing behaviors: aggressive behavior, violence
and school dropout, the seeking of reassurance
in others through high-risk behavior, premature
M. Mann et al.
relationships, cults or gangs. Reassurance and se-
curity may also be sought through drugs, alcohol or
food. The passive avoidance route is associated
with internalizing factors: feelings of despair and
depression. Extreme avoidance may even result in
suicidal behavior.
Whether identity and self-esteem problems
express themselves following the externalizing
active escape route or the internalizing passive
avoidance route is dependent on personality
characteristics and circumstances, life events and
social antecedents (e.g. gender and parental sup-
port) (Hebert, 1987). Recent studies consistently
show gender differences regarding externalizing
and internalizing behaviors among others in
a context of low self-esteem (Block and Gjerde,
1986; Rolf et al., 1990; Harter, 1999; Benjet and
Hernandez-Guzman, 2001). Girls are more likely
to have internalizing symptoms than boys; boys
are more likely to have externalizing symptoms.
Moreover, according to Harter (Harter, 1999), in
recent studies girls appear to be better than boys in
positive self-evaluation in the domain of behav-
ioral conduct. Self-perceived behavioral conduct
is assessed as the individual view on how well
behaved he/she is and how he/she views his/her
behavior in accordance with social expectations
(Harter, 1999). Negative self-perceived behavioral
conduct is also found to be an important factor
in mediating externalizing problems (Reda-Norton,
1995; Hoffman, 1999).
The internalization of parental approval or
disapproval is critical during childhood and ado-
lescence. Studies have identified parents’ and peers’
supportive reactions (e.g. involvement, positive
reinforcement, and acceptance) as crucial determi-
nants of children’s self-esteem and adjustment
(Shadmon, 1998). In contrast to secure, harmonious
parent–child relationships, poor family relation-
ships are associated with internalizing problems
and depression (Kashubeck and Christensen, 1993;
Oliver and Paull, 1995).
Self-esteem in health behavior models
Self-esteem also plays a role in current cognitive
models of health behavior. Health education re-
search based on the Theory of Planned Behavior
(Ajzen, 1991) has confirmed the role of self-
efficacy as a behavioral determinant (Godin and
Kok, 1996). Self-efficacy refers to the subjective
evaluation of control over a specific behavior.
While self-concepts and their evaluations could be
related to specific behavioral domains, self-esteem
is usually defined as a more generic attitude towards
the self. One can have high self-efficacy for
a specific task or behavior, while one has a negative
evaluation of self-worth and vice versa. Neverthe-
less, both concepts are frequently intertwined since
people often try to develop self-efficacy in activities
that give them self-worth (Strecher et al., 1986).
Self-efficacy and self-esteem are therefore not
identical, but nevertheless related. The develop-
ment of self-efficacy in behavioral domains of
importance can contribute to positive self-esteem.
On the other hand, the levels of self-esteem and
self-confidence can influence self-efficacy, as is
assumed in stress and coping theories.
The Attitude–Social influence–self-Efficacy
(ASE) model (De Vries and Mudde, 1998; De
Vries et al., 1988a) and the Theory of Triadic
Influence (TTI) (Flay and Petraitis, 1994) are recent
theories that provide a broad perspective on health
behavior. These theories include distal factors that
influence proximal behavioral determinants (De
Vries et al., 1998b) and specify more distal streams
of influence for each of the three core determinants
in the Planned Behavior Model (Azjen, 1991)
(attitudes, self-efficacy and social normative be-
liefs). Each of these behavioral determinants is
assumed to be moderated by several distal factors,
including self-esteem and mental disorders.
The TTI regards self-esteem in the same sense as
the ASE, as a distal factor. According to this theory,
self-efficacy is influenced by personality character-
istics, especially the ‘sense of self’, which includes
self-integration, self-image and self-esteem (Flay
and Petraitis, 1994).
The Precede–Proceed model of Green and
Kreuter (Green and Kreuter, 1991) for the planning
of health education and health promotion also
recognizes the role of self-esteem. The model
directs health educators to specify characteristics
Self-esteem in a BSA for mental health promotion
of health problems, and to take multiple determi-
nants of health and health-related behavior into
account. It integrates an epidemiological, behav-
ioral and environmental approach. The staged
Precede–Proceed framework supports health edu-
cators in identifying and influencing the multiple
factors that shape health status, and evaluating
the changes produced by interventions. Self-esteem
plays a role in the first and fourth phase of the
Precede–Proceed model, as an outcome variable
and as a determinant. The initial phase of social
diagnosis, analyses the quality of life of the target
population. Green and Kreuter [(Green and Kreuter,
1991), p. 27] present self-esteem as one of the
outcomes of health behavior and health status, and
as a quality of life indicator. The fourth phase of
the model, which concerns the educational and
organizational diagnosis, describes three clusters
of behavioral determinants: predisposing, enabling
and reinforcing factors. Predisposing factors pro-
vide the rationale or motivation for behavior, such
as knowledge, attitudes, beliefs, values, and per-
ceived needs and abilities [(Green and Kreuter,
1991), p. 154]. Self-knowledge, general self-
appraisal and self-efficacy are considered as
predisposing factors.
To summarize, self-esteem can function both as
a determinant and as an outcome of healthy behavior
within health behavior models. Poor self-esteem
can trigger poor coping behavior or risk behavior
that subsequently increases the likelihood of certain
diseases among which are mental disorders. On the
other hand, the presence of poor coping behavior
and ill-health can generate or reinforce a negative
Self-esteem in a BSA to mental health
promotion a nd prevention in schools
Given the evidence supporting the role of self-
esteem as a core element in physical and mental
health, it is recommended that its potential in future
health promotion and prevention programs be
The design of future policies for mental health
promotion and the prevention of mental disorders is
currently an area of active debate (Hosman, 2000).
A key question in the discussion is which is more
effective: a preventive approach focusing on
specific disorders or a more generic preventive
Based on the evidence supporting the role of self-
esteem as a non-specific risk factor and protective
factor in the development of mental disorders and
social problems, we advocate a generic preventive
approach built around the ‘self’. In general,
changing common risk and protective factors (e.g.
self-esteem, coping skills, social support) and
adopting a generic preventive approach can reduce
the risk of the development of a range of mental
disorders and promote individual well-being even
before the onset of a specific problem has presented
itself. Given its multi-outcome perspective, we
have termed this strategy the ‘BSA’ in prevention
and promotion.
Self-esteem is considered one of the important
elements of the BSA. By fostering self-esteem, and
hence treating a common risk factor, it is possible to
contribute to the prevention of an array of physical
diseases, mental disorders and social problems
challenging society today. This may also, at a later
date, imply the prevention of a shift to other
problem behaviors or symptoms which might occur
when only problem-specific risk factors are ad-
dressed. For example, an eating disorder could be
replaced by another type of symptom, such as
alcohol abuse, smoking, social anxiety or de-
pression, when only the eating behavior itself is
addressed and not more basic causes, such as poor
self-esteem, high stress levels and lack of social
support. Although there is, as yet, no published
research on such a shift phenomenon, the high level
of co-morbidity between such problems might
reflect the likelihood of its existence. Numerous
studies support the idea of co-morbidity and
showed that many mental disorders have over-
lapping associated risk factors such as self-esteem.
There is a significant degree of co-morbidity
between and within internalizing and externalizing
problem behaviors such as depression, anxiety,
substance disorders and delinquency (Harrington
et al., 1996; Angold et al., 1999; Swendsen and
Merikangas, 2000). By considering the individual
M. Mann et al.
as a whole, within the BSA, the risk of such an
eventuality could be reduced.
The BSA could have practical implications.
Schools are an ideal setting for implementing BSA
programs, thereby aiming at preventing an array of
problems, since they cover the entire population.
They have the means and responsibility for the
promotion of healthy behavior for such a common
risk and protective factor, since school children are
in their formative stage. A mental health promotion
curriculum oriented towards emotional and social
learning could include a focus on enhancing self-
esteem. Weare (Weare, 2000) stressed that schools
need to aim at helping children develop a healthy
sense of self-esteem as part of the development of
their ‘intra-personal intelligence’. According to
Gardner (Gardner, 1993) ‘intra-personal intelli-
gence’ is the ability to form an accurate model of
oneself and the ability to use it to operate effectively
in life. Self-esteem, then, is an important component
of this ability. Serious thought should be given to the
practical implementation of these ideas.
It is important to clearly define the nature of
a BSA program designed to foster self-esteem
within the school setting. In our opinion, such
a program should include important determinants of
self-esteem, i.e. competence and social support.
Harter (Harter, 1999) stated that competence and
social support, together provide a powerful expla-
nation of the level of self-esteem. According to
Harter’s research on self-perceived competence,
every child experiences some discrepancy between
what he/she would like to be, the ‘ideal self’, and
his/her actual perception of him/herself, ‘the real
self’. When this discrepancy is large and it deals
with a personally relevant domain, this will result in
lower self-esteem. Moreover, the overall sense of
support of significant others (especially parents,
peers and teachers) is also influential for the
development of self-esteem. Children who feel that
others accept them, and are unconditionally loved
and respected, will report a higher sense of self-
esteem (Bee, 2000). Thus, children with a high
discrepancy and a low sense of social support
reported the lowest sense of self-esteem. These
results suggest that efforts to improve self-esteem in
children require both supportive social surround-
ings and the formation and acceptance of realistic
personal goals in the personally relevant domains
(Harter, 1999).
In addition to determinants such as competence
and social support, we need to translate the theo-
retical knowledge on coping with inner self-
processes (e.g. inconsistencies between the real
and ideal self) into practice, in order to perform
a systematic intervention regarding the self. Harter’s
work offers an important foundation for this. Based
on her own and others’ research on the development
of the self, she suggests the following principles to
prevent the development of negative self-esteem and
to enhance self-worth (Harter, 1999):
(1) Reduction of the discrepancy between the real
self and the ideal self.
(2) Encouragement of relatively realistic self-
(3) Encouraging the belief that positive self-
evaluations can be achieved.
(4) Appreciation for the individual’s views about
their self-esteem and individual perceptions on
causes and consequences of self-worth.
(5) Increasing awareness of the origins of negative
(6) Providing a more integrated personal con-
struct while improving understanding of self-
(7) Encouraging the individual and his/her signif-
icant others to promote the social support they
give and receive.
(8) Fostering internalization of positive opinions
of others.
Examples of school health promotion
programs t hat foster self-esteem
Haney and Durlak (Haney and Durlak, 1998) wrote
a meta-analytical review of 116 intervention studies
for children and adolescents. Most studies indicated
significant improvement in children’s and adoles-
cents’ self-esteem and self-concept, and as a result
of this change, significant changes in behavioral,
personality, and academic functioning. Haney and
Self-esteem in a BSA for mental health promotion
Durlak reported on the possible impact improved
self-esteem had on the onset of social problems.
However, their study did not offer an insight into
the potential effect of enhanced self-esteem on
mental disorders.
Several mental health-promoting school pro-
grams that have addressed self-esteem and the
determinants of self-esteem in practice, were
effective in the prevention of eating disorders
(O’Dea and Abraham, 2000), problem behavior
(Flay and Ordway, 2001), and the reduction of
substance abuse, antisocial behavior and anxiety
(Short, 1998). We shall focus on the first two
programs because these are universal programs,
which focused on ‘mainstream’ school children.
The prevention of eating disorders program ‘Every-
body’s Different’ (O’Dea and Abraham, 2000) is
aimed at female adolescents aged 11–14 years old.
It was developed in response to the poor efficacy of
conventional body-image education in improving
body image and eating behavior. ‘Everybody’s
Different’ has adopted an alternative methodology
built on an interactive, school-based, self-esteem
approach and is designed to prevent the develop-
ment of eating disorders by improving self-esteem.
The program has significantly changed aspects of
self-esteem, body satisfaction, social acceptance
and physical appearance. Female students targeted
by the intervention rated their physical appearance,
as perceived by others, significantly higher than
control-group students, and allowed their body
weight to increase appropriately by refraining from
weight-loss behavior seen in the control group.
These findings were still evident after 12 months.
This is one of the first controlled educational
interventions that had successfully improved body
image and produced long-term changes in the
attitudes and self-image of young adolescents.
The ‘Positive Action Program’ (Flay and Ordway,
2001) serves as a unique example of some BSA
principles in practice. The program addresses the
challenge of increasing self-esteem, reducing prob-
lem behavior and improving school performance.
The types of problem behavior in question were
delinquent behavior, ‘misdemeanors’ and objection
to school rules (Flay and Ordway, 2001). This
program concentrates on self-concept and self-
esteem, but also includes other risk and protective
factors, such as positive actions, self-control, social
skills and social support that could be considered as
determinants of self-esteem. Other important deter-
minants of self-esteem, such as coping with internal
self-processes, are not addressed. At present, the
literature does not provide many examples of BSA
studies that produce general preventive effects
among adolescents who do not (yet) display
behavioral problems (Greenberg et al., 2000).
To conclude, research results show beneficial
outcomes of positive self-esteem, which is seen to
be associated with mental well-being, happiness,
adjustment, success, academic achievements and
satisfaction. It is also associated with better re-
covery after severe diseases. However, the evolving
nature of self-esteem could also result in negative
outcomes. For example, low self-esteem can be
a causal factor in depression, anxiety, eating
disorders, poor social functioning, school dropout
and risk behavior. Interestingly, the cross-sectional
characteristic of many studies does not exclude
the possibility that low self-esteem can also be
considered as an important consequence of such
disorders and behavioral problems.
Self-esteem is an important risk and protective
factor linked to a diversity of health and social
outcomes. Therefore, self-esteem enhancement can
serve as a key component in a BSA approach in
prevention and health promotion. The design and
implementation of mental health programs with
self-esteem as one of the core variables is an
important and promising development in health
The authors are grateful to Dr Alastair McElroy for
his constructive comments on this paper. The
authors wish to thank Rianne Kasander (MA) and
M. Mann et al.
Chantal Van Ree (MA) for their assistance in the
literature search. Financing for this study was
generously provided by the Dutch Health Research
and Development Council (Zorg Onderzoek Neder-
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... A unique characteristic of selfesteem is that it is susceptible to change, especially among children and adolescents (11,12). Thus, due to the strong association between self-esteem and mental health outcomes, and the malleable nature of self-esteem, self-esteem-based interventions might potentially be able to improve mental health (13). ...
... Lastly, the current review and meta-analysis was unable to control for potential confounding factors, including age and follow-up periods. While trajectory of self-esteem has been shown to change over time (13), we were unable to separate data between the adolescent group and the adult group in the current review due to the small number of studies. Similarly, given the enduring nature of suicide (55), studies with longer follow-up periods are needed to confirm these results. ...
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Suicide is a serious social issue and is often treated using psychological interventions. The current systematic review and meta-analysis aimed to investigate the effectiveness of self-esteem-related interventions on suicidal behaviors. A systematic literature search for randomized controlled trials (RCTs) including a self-esteem component was conducted on 29 May 2021 and updated on 4 April 2022. In total, 12 studies were included in the systematic review and five studies were included in the meta-analysis. Small effect sizes were found for suicidal ideation at post intervention [ g = −0.24, 95% CI (−0.48, 0.00)] and a 3-month follow-up [ g = −0.36, 95% CI (−0.62, −0.11)]. However, these results should be interpreted cautiously due to the limited number of included studies and varied sample population. In conclusion, the current review suggests that future intervention studies should incorporate self-esteem enhancement in the treatment of suicidal behaviors, especially for suicidal ideation. Systematic Review Registration
... As an overall reflection of an individual's self-worth (9), the capacity to feel worthy of happiness and be able to successfully address life challenges, self-esteem is an important determinant of mental health and development (10,11). Low self-esteem can lead to selfstigmatizing and loss of self-efficacy (12). It has been associated with several psychological, physical, and social consequences, including depression, anxiety, suicide, eating disorders, (11)(12)(13)(14) violent behavior, (11) and substance use (14). ...
... Low self-esteem can lead to selfstigmatizing and loss of self-efficacy (12). It has been associated with several psychological, physical, and social consequences, including depression, anxiety, suicide, eating disorders, (11)(12)(13)(14) violent behavior, (11) and substance use (14). Both anxiety and low selfesteem are often accompanied by depression. ...
Objective: We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. Methods: We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). Results: A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.
... According to the sociometric theory, self-esteem also reflects the emotional state of an individual in his or her integration with interpersonal relationships. In other words, self-esteem is a subjective measure of the relationship between an individual and society, as well as other important persons [27]. Self-esteem is essentially associated with health, resilience, and adaptation [28]. ...
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The aim of this study was to test a model that takes into account self-esteem and perceived social support as potential mediators of the relationship between resilience and emotional regulation. The study involved 251 adolescents aged between 14 and 19 years (M = 16.85). The study procedure consisted of completing paper-and-pencil questionnaires to measure resilience, self-esteem, and answer questions about perceived social support and emotional regulation. Bootstrap sampling analysis showed statistically significant serial mediation (B = 0.030; p < 0.001). As a result of the analysis, a positive direct relationship between resilience and emotional regulation was observed (B = 0.061; p < 0.001). Our results suggest that self-esteem and perception of social support may mediate the relationship between resilience and emotional regulation. The findings have an applicable value. They can be used to develop preventive and educational programs, as well as therapeutic interventions. The obtained results show that interventions aimed at resilience can improve self-assessment and perceived social support and thus favor the high level of emotional regulation skills in the adolescent group.
... Beberapa hasil penelitian melaporkan hubungan yang signifikan harga diri dengan penilaian diri . Harga diri berhubungan dengan keberhasilan akademis, kesejahteraan, dan masalah kesehatan mental (Baumeister, et al. 2003;Mann, et al. 2004;Arsandaux). ...
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ABSTRAK Harga diri merupakan komponen yang penting bagi kesehatan dan hubungan interpersonal. Harga diri rendah situasional dapat memicu munculnya masalah kesehatan jiwa pada mahasiswa. Intervensi keperawatan jiwa spesialis dibutuhkan untuk membantu mahasiswa yang mengalami harga diri rendah situasional. Logoterapi sebagai intervensi keperawatan jiwa spesialis dapat membantu individu menemukan makna dan tujuan hidup. Tujuan penelitian untuk mengetahui efektifitas intervensi logoterapi terhadap harga diri rendah situasional. Desain Penelitian menggunakan desain quasi eksperimen none group pre test-post test. Sampel sebanyak 30 mahasiswa berdasarkan teknik purposive sampling dengan kriteria inklusi mahasiwa kelas regular, semester satu dan mengalami Self-esteem is an essential component of health and interpersonal relationships. Low situational self-esteem can trigger mental health problems in college students. Specialist psychiatric nursing interventions are needed to help college students who experience low situational self-esteem. Logotherapy as a specialist psychiatric nursing intervention can help individuals find meaning and purpose in life. The purpose of the study was to determine the effectiveness of the logotherapy intervention on low situational self-esteem. Design The study used a quasi-experimental none, group pre-test-post-test design. The sample is 30 college students based on purposive sample technic with inclusion criteria of regular class students, first semester and experiencing low situational self-esteem. Logotherapy intervention effectivity was analyzed using Paired sample T-Test. The results showed that the p-value was 0.016 (ρ˂0.05), and there was a significant difference between low situational self-esteem before and after logotherapy. The conclusion is that logotherapy effectively increases situational self-esteem experienced by college students.
... Previous studies found that positive coping styles are associated with lower odds of psychological distress and internet addiction in both community and clinical samples during COVID-19 (Fu et al., 2020;Rogowska et al., 2020;Yu et al., 2020). Self-esteem, as an internal personal resource, is a set of attitudes toward one's thoughts, feelings, meanings, and merits as a human being (Rosenberg, 1965;Swann and Seyle, 2006), which is crucial for a broad spectrum of internalizing problems (e.g., depression and anxiety) and externalizing problems (e.g., substance abuse and violence) (Mann et al., 2004). However, only a few studies have investigated the mediating role of self-esteem in linking stress and psychological distress during COVID-19 (Rossi et al., 2020;Lee et al., 2021). ...
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The closed-off management of the university during coronavirus disease 2019 (COVID-19) may be associated with an elevated odds of psychological and behavioral issues among college students. We aimed to use the stress-process model to explore the potential mechanisms for this phenomenon. A total of 924 college students were recruited via posters, peer referrals, and class attendance. Among them, 82 (9%) were probable depression, 190 (20.8%) were probable anxiety, and 69 (7.5%) were internet addiction. Parallel mediation was used to test this theoretical model. For personal resources, the perceived risk of COVID-19 was positively associated with psychological distress via negative coping style (β = 0.051) and internet addiction via negative coping style or self-esteem (β = 0.023 for negative coping style, β = 0.015 for self-esteem). For social resources, the perceived risk of COVID-19 was positively associated with psychological distress and internet addiction via roommate relationships (β = 0.19 for psychological distress, β = 0.046 for internet addiction). Negative coping styles and roommate relationships are possible psychological mechanisms linking the perceived risk of COVID-19, psychological distress, and internet addiction.
... General health, self-esteem, and internet addiction Recent evidence has shown the relationship of general health (i.e., a state of physical, mental, and social well-being; not merely the absence of disease or infirmity) and self-esteem (i.e., an individual's subjective evaluation of their own worth) with Internet addiction severity. These findings have indicated that people with poor general health and low self-esteem spend more time on social networking sites than other people (Bahrainian et al., 2014;Bidi, Namdari-Pejman, Kareshki & Ahmadnia, 2012;Kawyannejad, Mirzaei, Valinejadi et al., 2019;Ko, Yen, Yen, Chen & Chen, 2012;Mann, Hosman, Schaalma & De Vries, 2004;Mei et al., 2016;Yao et al., 2014;Younes, Halawi, Jabbour et al., 2016). In fact, the Internet is a refuge that allows these people to have more control over impression management and self-presentation and satisfy their need to belong (Kandell, 1998;Niemz, Griffiths & Banyard, 2005). ...
This research aimed to explore the gender‐related differences in Internet addiction levels, the associated factors behind Internet addiction, and the mediating roles of general health and self‐esteem in the relationship between personality traits and Internet addiction among college students. A total of 318 college students in Iran participating in this study completed sociodemographic information form and self‐report measures of Internet addiction, personality traits, general health, and self‐esteem. The results showed higher frequencies of low and moderate–severe levels of addiction among female and male students, respectively. Further, younger age, male gender, singleness, high scores on neuroticism, poor general health, and low self‐esteem might be linked to Internet addiction. The overall hypothesis that general health and self‐esteem mediated the effect of neuroticism on Internet addiction was also supported. Our findings highlighted the necessity of evaluating general health and self‐esteem among Internet‐addicted students. Further, these variables can be targeted by psychiatrists and psychologists for effective cognitive‐behavioral therapy among Internet‐addicted students.
... Although some models do not consider self-esteem to be a component of well-being, eudemonic theories of well-being do consider components of self-esteem, such as selfacceptance, within the concept of well-being [16]. Other theorists further refer to the fact that self-esteem shares a significant amount of variance with well-being indices and therefore conclude that self-esteem is essential to well-being [17]. A younger subjective age is related to higher optimism and higher self-esteem [18], and the latter two are well-known predictors of health outcomes [19,20]. ...
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Introduction: The current study aimed to find reciprocal effects between subjective age and functional independence during rehabilitation from osteoporotic fractures and stroke and whether these effects can be mediated by indicators of well-being. Methods: Participants were 194 older adults (mean age = 78.32 years, SD = 7.37; 64.8% women) who were hospitalized following an osteoporotic fracture or stroke. Participants completed measures of subjective age and well-being (i.e., optimism, self-esteem, and life satisfaction) several times during rehabilitation. Functional Independence Measure (FIM) was completed by nursing personnel at admission and at discharge. Results: Younger subjective age at admission predicted higher FIM scores at discharge. The reverse effect, that is, of FIM scores at admission on subjective age at discharge, was nonsignificant. Optimism during hospitalization mediated the effect of subjective age on subsequent FIM scores while self-esteem and life satisfaction did not. Sensitivity analyses further showed that the effect of subjective age on FIM was significant for both fracture and stroke patients. Discussion: The findings highlight the effect of subjective age on rehabilitation outcomes among osteoporotic fractures and stroke patients and suggest several potential mechanisms behind this effect. Rehabilitation outcomes following osteoporotic fractures or strokes could improve if subjective age and an optimistic outlook are taken into consideration.
... Low selfesteem is associated with the pathogenesis of numerous mental illnesses, including depression, eating disorders, and addiction. [31][32][33] In the same direction, many studies disclosed the negative influence of social media on users' self-esteem [34][35][36][37][38][39][40][41] which is also consistent with the current research. Students during the discussion witnessed the negative influence of social media especially Facebook on their self-esteem. ...
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The general purpose of this study was intended to investigate social media utilization: its contribution and risk factors on the Biopsychosocial wellbeing of Madda Walabu university students, Ethiopia. The lack of research on social media utilization among students in MWU is the basic reason for conducting the current research. Madda Walabu University Robe, Goba campus students were the aggregate population of the study. The mixed research design was employed from these populations; the researchers selected 409 individuals by using a proportionate stratified sampling technique. Beck's social media addiction which is Likert scale questionnaires and discussion points were used to collect pertinent data. To analyse the data, percentage, mean score, and the standard deviation was implemented for quantification by using SPSS version 20 whereas narration and paraphrasing are for qualitative data. The result found that social media has both positive and negative effects on students' Biopsychosocial wellbeing. The researchers recommended life skill training is very important in alleviating the problem.
This study investigated the predictive roles of family structure, mental health, and self‐esteem in dropout risk among school‐going adolescents in the Ibadan Municipality of Oyo State, Nigeria. A quantitative research design approach was adopted. A total of 287 school‐going adolescents with consistent record of absenteeism were randomly selected from 14 schools in the Ibadan Municipality. A single adapted questionnaire divided into sections was used to collect data. The hypotheses raised were tested using the Pearson's product–moment correlation and multiple regression analysis. The study established that the relationship between dropout risk, lack of family structure (r = 0.491, n = 287, p < 0.05), mental health (r = 0.373, n = 287, p < 0.05), and self‐esteem (r = 0.428, n = 287, p < 0.05) of the participants was significant. Furthermore, the joint influence of the predictive variables (family structure, mental health, and self‐esteem) was also significant on dropout risk (R = 0.489, adjusted R2 of 0.398). The study concludes that dropout risk among school‐going adolescents can be safeguarded with factors such as family structure, mental health, and self‐esteem as guided against. Hence, the family structure, mental health, and self‐esteem are very crucial if the upsurge of school dropout that is bedeviling the society will be reduced to bearable level or eradicated.
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The rote of psychosocial risk and protective factors in successful adolescent development under circumstances of socioeconomic disadvantage was investigated among 1,638 high school students in a large, urban school district. Success referred to 2 important developmental tasks: engagement in school and avoiding more than minimal involvement in problem behavior. Significant negative effects on success were found for disadvantage and for risk factors, whereas protective factors had significant positive effects. In addition, protection moderated the effects of risk, especially for more disadvantaged youth. Further, in longitudinal analyses, both risk and protective factors accounted for significant variance in change in successful outcomes over time and development. Key risk factors are Low Expectations for Success, Low Self-Esteem, Hopelessness, and having Friends as Models for Problem Behavior. Key protective factors are Attitudinal Intolerance of Deviance. Positive Orientation to Health, and having Friends as Models for Conventional Behavior. Strengthening protective factors, as well as reducing risk, may enhance successful development, especially in disadvantaged life circumstances.
The study analyzes the relationships between personality dimensions (NEO-FFI, STAI) and self-esteem indicators (Rosenberg's Self-Esteem Scale; Self-Concept Clarity Scale - Campbell el al., 1990; State Self-Esteem Scale - Heatherton and Polivy, 1991) in 14-17 year old high school students. In adolescents with high score in self-esteem indicators under study we found significantly higher extroversion and conscientiousness. Low self-esteem correlated significantly with high neuroticism, high state and high trait anxiety. A comparison of the relationships between agreeableness and openness personality dimensions and self-esteem indicators in girls and boys indicated significant variability and intersexual differences. According to our results, neuroticism, extroversion, conscientiousness, state and trait anxiety are reliable predictors of self-esteem.
This study sought to (a) determine the proportion of children of alcoholics (COAs) among an African American adolescent population aged 12 to 19 (N = 649); and (b) examine the influence of and relationship between COA status, self-esteem, age, and gender on their involvement in alcohol drinking. Although 52% identified themselves as alcohol drinkers, an insignificant number of these (4.4%, or 2.3% of the sample) reported abusing alcohol. One in four were COAs; 27% of alcohol users were COAs. Age, low self-esteem, and COA status were found to be strong predictors of alcohol drinking among these youth. The hypothesis that positive self-esteem places African American youth in a position of strength to counter the adverse consequences of parental alcoholism and other debilitating circumstances was confirmed.
Although there is a long history of research examining relationships between intrapersonal factors and adolescent substance use, such relationships have not always been clearly delineated. The present study focused on three factors generally associated with physical and mental well being: dispositional optimism, hope, and self-esteem. These constructs were examined in relation to a social influence model as applied to the deterrence of substance use. A cross-sectional study was undertaken employing adolescents (n = 1,985) representative of a multi-racial/ethnic population. The results suggest that optimism, hope, and self-esteem are determinants of avoiding substance use, with the effects of these variables being mediated by attitudes, perceived norms, and perceived behavioral control. Additionally, the structural equation modeling analysis suggests a more general protective dimension predominantly accounts for the relationships between the personality factors and the mediators of avoiding substance use. These findings suggest efforts to prevent substance use may be more effective if they address more global intrapersonal factors in conjunction with the more immediate determinants of substance use.
Terror management theory posits that awareness of mortality engenders a potential for paralyzing terror, which is assuaged by cultural worldviews: humanly created, shared beliefs that provide individuals with the sense they are valuable members of an enduring, meaningful universe (self-esteem), and hence are qualified for safety and continuance beyond death. Thus, self-esteem serves the fundamental psychological function of buffering anxiety. In support of this view, studies have shown that bolstering self-esteem reduces anxiety and that reminders of mortality intensify striving for self-esteem; this research suggests that self-esteem is critical for psychological equanimity. Cultural worldviews serve the fundamental psychological function of providing the basis for death transcendence. To the extent this is true, reminders of mortality should stimulate bolstering of one's worldview. More than 80 studies have supported this idea, most commonly by demonstrating that making death momentarily salient increases liking for people who support one's worldview and hostility toward those with alternative worldviews. This work helps explain human beings' dreadful history of intergroup prejudice and violence: The mere existence of people with different beliefs threatens our primary basis of psychological security; we therefore respond by derogation, assimilation efforts, or annihilation.