Motivation and emotion/Book/2014/Self esteem and depression

Overview


Self-esteem is a very important part of who we are as an individual, being that it is our holistic view of our own worth as a person (Steiger, Allemand, Robins, & Fend, 2014). So, what happens if your self-esteem is not at a healthy level? It is widely accepted that low self-esteem is correlated with depression (Sowislo & Orth, 2013), in that it can be a predictor of the disorder. Depression is a debilitating mental disorder, and a significant contributor to the global burden of disease (Sowislo & Orth, 2013). Therefore, the link between self-esteem and depression is worrisome, and an area that requires attention. The correlation between self-esteem and depression will be discussed, and several ways in which self-esteem can be improved, to minimise the risk of developing depression, will be explored. Implications for further research will also be addressed.

What is self-esteem?
What is the psychological construct we know as self-esteem? One of the first acknowledged and widely-accepted definitions of self-esteem was coined by a well-known founder in the field of psychology, William James, who described the term as an individual’s level of success compared with their own pretensions; that is, their hopes and aspirations (Sowislo & Orth, 2013). The focus of James’ theory was on the comparison between one's ideal self – all that an individual aspires to be – and their real self, with a view to the degree of discrepancy between each (Mruk, 2006). Following on from James’ theory, Morris Rosenberg developed the idea of self-esteem being based on an individual’s perceived worth as a person (Mruk, 2006).

In contemporary times, self-esteem can be summarised using each of the aforementioned theories, as an individual’s holistic view of their own worth, in relation to their real self and their ideal self (Steiger, Allemand, Robins, & Fend, 2014). In other words, how do you, as an individual, perceive yourself, overall, and what is your overall evaluation of your worth as a person (Orth, Robins, Widaman & Conger, 2014)? It is widely accepted that self-esteem has a crucial influence on our psychological wellbeing and our quality of life (Mruk, 2006). Someone with high self-esteem is likely to be fairly happy with who they are as an individual, with what they have achieved, and with where they are going in life. In contrast, someone with low self-esteem is likely to be less than satisfied with some, and perhaps even most – or all – aspects of their life. For some individuals, self-esteem levels can fluctuate, meaning that on some days the individual might feel confident and self-assured, whilst on others they might feel incompetent and hopeless (Sowislo, Orth & Meier, 2014). Self-esteem can also remain stable over time, so that an individual with low self-esteem, for example, can experience depleted confidence and feelings of incompetence continuously over a long period (Sowislo et al. 2014). Armed with a healthy self-esteem, we can make informed decisions, confidently tackle new challenges, and genuinely learn from any mistakes we make along the way (Plummer, 2014).

Self-concept
Our self-concept can be described as our overall interpretation of ourselves: Who do we think we are, as individuals; what goals and achievements do we think we can reach and attain; how are we perceived by others; and what would we like to become (Plummer, 2014)? We tend to strive to behave in ways that fit in with our self-concept, ensuring that any new information is either accepted or rejected, based on how we feel it sits with our personal belief system (Plummer, 2014).

Self-esteem, then, is intricately connected and rooted within the self-concept, being one’s measure of their own worth, in relation to their perceived view of who they are, and should aim to be, as a person. This leads us to the next topic: Self-evaluation.

Self-evaluation
The way in which a person evaluates their self-concept is a critical factor in determining whether or not they will have a healthy self-esteem (Plummer, 2014). Put simply, if an individual feels that they are not matching up with their ideal self-concept, their self-esteem is likely to suffer. An individual’s self-evaluation is significantly influenced by important people in their life; be that parents, teachers, or close friends, from whom approval is sought (Plummer, 2014). If those around us, whose opinions we care about, are disapproving and unsupportive, or if we do not feel loved, it certainly makes sense that our self-evaluation would be unfavourable, which in turn can affect our self-esteem.

What is depression?
Everyone has days where they feel down. Sometimes, those feelings can last for days, even weeks, or longer. It is also normal to experience grief following the loss of a beloved one in your life, but when the depressed mood or grief is ongoing, more days than not, for a period of six months or more, a clinical diagnosis of depression might be made (Wasserman, 2011).

Aside from the fact that it can be a devastating mental illness, the significant prevalence of depression presents a problem; indeed, the World Health Organisation recognises depression, and depressive disorders, as being among the most significant contributors to the global burden of disease (Sowislo & Orth, 2013). Major Depressive Disorder presently ranks fourth in this list of contributors, and it is predicted that it will become the second biggest contributor by the year 2030 (Gili et al., 2013). In Australia, Depressive Disorders are experienced by approximately 6% of the population (Black Dog Institute [BDS], 2012). Generally, when people use the term ‘depression’, they are referring to Major Depressive Disorder, which includes the following clinical symptoms (Wasserman, 2011):

Symptoms of Major Depressive Disorder

 * Despondency – A general sense of despair
 * Anhedonia – Inability to gain pleasure from one’s usual activities
 * Increased or decreased appetite
 * Disturbed sleep or insomnia
 * Fatigue
 * Difficulty concentrating
 * Feelings of guilt

Can low self-esteem predict depression? How?
Research in this area strongly suggests that low self-esteem is a predictor of depression, regardless of age and gender (Orth, Robins & Widaman, 2012). For example, Sowislo and Orth (2013) conducted a meta-analysis of longitudinal data on the relationship between low self-esteem and depression. In their research, they found that low self-esteem had a statistically significant effect on depression, in that low self-esteem is one of the potential predictors for the onset of the disorder (Sowislo & Orth, 2013).

With regard to age, it appears to be especially important that a healthy self-esteem be developed and maintained during adolescence, to allow for the best chance of optimal mental health in later stages of life (Steiger, Allemand, Robins, & Fend, 2014). Self–esteem is not an entirely stable construct at any life stage, but it is particularly impressionable during adolescence (Steiger et al. 2014). Longitudinal research has indicated that if an individual goes into the adolescent developmental stages with low self-esteem, or, if self-esteem levels decline during these years, the individual is more likely to develop depression later in life (Steiger et al. 2014).

A healthy self-esteem is correlated with a number of positive life outcomes, such as better job performance and successful romantic relationships. Low self-esteem, however, is associated with negative life outcomes, much the opposite of those mentioned (Steiger, Allemand, Robins & Fend, 2014). If one or more undesirable life outcomes is experienced by a person, such as losing a job and becoming unemployed, whilst also suffering the breakdown of a romantic relationship, it is likely that the individual will also suffer from feelings of hopelessness, uselessness and doubts about their own worth – the makings of a low self-esteem. Some researchers studying the link between self-esteem and life outcomes are cautious in implying that one causes the other, or even that one is strongly influential on the other, instead acknowledging that a relationship between self-esteem and life outcomes does appear to exist. Other research, however, has suggested that self-esteem – low or high – does profoundly impact upon life outcomes, to the extent that it appears to even play a causal role (Orth, Robins & Widaman, 2012). Further research into this potentially causal effect would be of value.

Let us now discuss two dominant models in this field of research, which attempt to further explain the link between self-esteem and depression:

The vulnerability model
In relation to diathesis-stress theory – in which a predisposed, inherited vulnerability must combine with environmental stress to actualise – the vulnerability model states that negative self-evaluation can be causally linked to the onset of depression, in that it is a significant risk factor (Orth, Robins, Widaman & Conger, 2014; Sowislo & Orth, 2013). Rather than suggesting that negative thoughts of the self are a consequence of depression, as we will discuss next, the vulnerability model regards these negative thoughts and beliefs as potential predictors of depression (Sowislo & Orth, 2013). It certainly seems logical that individuals who evaluate themselves poorly, and whose self-esteem is low, might well be predisposed to potentially develop depression, more so than someone with a healthy self-esteem and a positive view of their worth and value as a person. Being that it is related to the diathesis-stress theory, the vulnerability model particularly links self-esteem as a precursor to depression when an individual is facing significant life stressors (Orth, Robins & Roberts, 2008). Therefore, theoretically speaking, a person with low self-esteem – the diathesis – who encounters negative life events, such as the ending of a significant relationship – the stressor - could develop depression as a result of the combination of the two factors.

The scar model
The scar model is a theory that states that low self-esteem is merely one of the symptoms acquired by depression (Orth, Robins, Widaman & Conger, 2014). Unlike the vulnerability model, the scar model suggests that low self-esteem is not a causal factor of depression; it is a consequence, as an individual who has suffered depression can be left with permanent psychological ‘scars’ in their self-concept, thus affecting their self-esteem (Orth et al. 2014).

While low self-esteem is often listed as one of the prevailing symptoms of depression, this does not necessarily mean that it is caused by depression. Indeed, if an individual already has a low self-esteem, it is unlikely that this would change with the onset of a depressive disorder. Of the two theories, the vulnerability model has not only proven to have a much larger effect, but is considered much more robust with a number of factors, such as gender and age, and other potentially influential variables, making it the generally more supported model (Orth et al. 2014; Orth, Robins & Meier, 2009; Sowislo & Orth, 2013).

The vulnerability and scar models are mentioned in numerous bodies of psychological research, and the vulnerability model is generally supported and acclaimed, particularly when compared with the scar model. In line with the vulnerability model, the previously-mentioned life outcomes such as social and romantic relationships and employment also appear to be affected by self-esteem in that an individual may experience adverse life outcomes as a result of low self-esteem, rather than low-self esteem being a consequence of unfavorable life outcomes (Sowislo & Orth, 2013). What comes across again and again in the literature is that findings regarding the correlation between self-esteem and depression are robust and relative to a diverse population. Factors such as age, gender and culture do not appear to be immune to this relationship, and, as such, future research into considerations for depression treatment options should take into account low self-esteem as a potential influencing factor.

In what ways can self-esteem be improved to lower the risk of depression?
The overarching aim of the present book, and subsequently this chapter, is to improve our motivational and emotional lives through the field of psychological science. We have discussed how important self-esteem is to the psychological health of an individual, and the potentially damaging consequences correlated with low self-esteem, with a focus on the link between self-esteem and depression, so now let us now turn to some ways that may help to improve self-esteem. Research indicates that intervention, by increasing someone’s self esteem, could be very useful when attempting to prevent the onset of depression (Sowislo & Orth, 2013). Indeed, increasing one’s self-esteem is considered helpful and effective in the short-term, and can also have many positive, longer-lasting implications (Sowislo & Orth, 2013). Those implications might include the previously mentioned life outcomes, such as job satisfaction, positive relationships, and better overall health. We will now discuss, as ways to potentially increase self-esteem: social support, being physically active, and parenting styles, as well as considerations for further research.

Social support
The support of social networks is important to any individual, and particularly one with low self-esteem. At the most basic of levels, having loving, accepting and nurturing social contacts enables an individual to have the best chance of thriving, and the best chance of a healthy self-esteem. Learned helplessness – a response to negative life experiences and social environments – can occur when an individual does not have a supportive social framework around them, resulting in persistent feelings of hopelessness (Wasserman, 2011).

While it seems logical that providing support to someone with low self-esteem, within your social framework, could be significantly beneficial to that individual, one group of researchers goes further, suggesting that the type of support given to those with low self-esteem is equally of importance (Marigold, Cavallo, Holmes & Wood, 2014). The researchers found, during their studies, that the support provided by social contacts – such as friends, relatives and spouses – was much more effective if it fit with what the recipient felt they needed, to suit their perceived needs, as opposed to an objective perception made by the well-meaning social contact (Marigold et al. 2014). In other words, you might feel you are providing the best support you can for someone with low self-esteem, but various factors might mean a different approach would be more helpful. Our needs can differ, for example, according to our age, gender and culture, and even the timing of help offered can be of importance (Marigold et al. 2014). Marigold et al. (2014) suggest that a helpful approach in providing social support to someone who appears to have low self-esteem, is to simply listen and sympathise with whatever that person needs to express, rather than – with the best of intentions – trying to ‘shake someone out of it’, and uplift their mood by having them see the positives in a given situation.



Get moving
It is widely accepted that physical exercise and activity promote a range of health benefits. From the positive effects on our fitness, to the increased endorphins – the ‘feel-good’ hormone – being physically active is beneficial to both our physiological and mental health.

Physically healthy individuals report feeling more independent, and better able to contribute to society, which in turn helps to promote a higher self-esteem (Orth, Robins & Widaman, 2012). Being physically active has antidepressant qualities, due in part to the aforementioned release of endorphins, and it also strengthens one's self-efficacy: an individual’s belief in their ability to complete goals and tasks (Moore, Mitchell, Beets & Bartholomew, 2013). Older adults can also benefit greatly from physical activity, both physiologically and psychologically (Moore et al. 2013). Using the Exercise and Self-Esteem Model, one group of researchers found that, along with physical benefits, exercise in adults aged sixty years and above had a number of positive cognitive advantages, including an increased self-esteem (Moore et al. 2013).

Perceived physical appearance, whether that be positive or negative, can also influence one's self-esteem (Steiger, Allemand, Robins & Fend, 2014). And while it should certainly not be the be-all and end-all in determining how we feel about ourselves, it makes sense that feeling and knowing that we are striving to be physically in shape can help in promoting a healthy perception of ourselves and our achievements, and therefore support a positive self-esteem. Making positive changes to our physical activity levels can not only positively impact upon our perceived self-efficacy, it also has associated benefits for our physical appearance, which can directly influence our self esteem levels (Moore et al. 2013).



Parenting style
Parents are important role models in their children’s lives, and the relationship between parent and child can play a significant part in the child’s psychological wellbeing, continuing into later life stages (Wasserman, 2011). Children, who from a young age have had their self-esteem built up by their primary caregiver, may well find it much easier to rely on their own feelings of self-worth in later life, rather than looking continuously to others for approval and validation of worth (Plummer, 2013). Judging our self-worth on the opinions of others can prove damaging, for example, receiving negative feedback from an employer could leave an individual with low self-esteem feeling worthless, even when the feedback is intended as constructive criticism (Steiger, Allemand, Robins & Fend, 2014). It is therefore of the utmost importance that parents nurture their child’s self-esteem, to prepare them with the best chance for optimal mental health in later life, as an adolescent and adult. Indeed, adolescence is generally regarded as an, at times, particularly turbulent life stage, with plenty of change, experimentation and uncertainty. It is also a time of heightened self-awareness, a part of which involves the struggle to find a self-identity (Plummer, 2013). Adolescence is a time when many individuals may depend less on parental opinions, and more on the opinions of their social peers, therefore, perhaps, the more developed and healthy one's self-esteem as a child, the better the chance of going through adolescence with the basis of a secure, positive self-regard.



Considerations for further research
After conducting a thorough search of the available data, it becomes apparent that not a great deal of research has been carried out with regard to methods for improving self-esteem. Aside from the aforementioned points of social support, physical activity and parenting style, a relatively minor amount of research mentions Cognitive Behaviour Therapy, a fairly widely used form of psychotherapy used to treat a number of disorders, by attempting to change negative thoughts and beliefs of the self (Butler, Chapman, Forman & Beck, 2006). Being that it is considered effective in altering thoughts of uselessness and hopelessness (Butler et al. 2006), for example, it would be of value to further explore the use of this therapy exclusively for low self-esteem. Another consideration, which again has received little attention, is the implementation of methods to help improve self-esteem in the classroom, seeing as teachers play an important part as role models in children’s, and adolescent’s, lives.

Table 1. Activity: Challenge Negative Thoughts

Imagine yourself in a situation where your automatic thoughts might be negative ones, and try to change them into a positive. Have a look at the two examples below, then have a go at the third:

Conclusion
Many, perhaps even a majority of researchers, would agree that a link between self-esteem and depression not only exists, but that self-esteem can, to some degree, predict the onset of depression. This predictability can largely be explained using the vulnerability model, which appears in a number of key research articles. Both low self-esteem and depression can have a profound effect on one’s mental health, happiness, and quality of life. So, then, anything that can be done to address the issue of low self-esteem, to improve an individual's overall psychological health and to lower the risk of the development of depression, would be beneficial. Social support, physical activity and parenting styles can all play an important role in the promotion of a positive self-esteem, but further research into these and other potential interventions would be of value.

It should be remembered that self-esteem is relatively malleable, meaning it can always be built upon and improved – it is never too late to strive for a healthy self-esteem.