The
Relationship of Self-Esteem and Depression In Adolescence
by Kathie F. Nunley
(2001)
Preface
On May 14, 1996, a 15-year-old middle school student shot
his bus driver in the leg, forced all the students off the
bus and led police on a high speed chase through a residential
neighborhood in Salt Lake City. The chase ended when the boy
shot himself right before crashing the school bus into the
family room of a house. The boy, dressed in a cowboy hat and
poncho, was holding the obituaries of two recently deceased
classmates (Horiuchi, et al., 1996).
One month earlier across town, Caz and Joey, bright, popular
high school students were lab partners in honors physics class.
One morning, after a fight the night before with his father,
Caz was found dead, hanging from a pipe in the basement. Two
weeks later, Joey ran his car into a cement barrier wall at
70 miles an hour, killing himself instantly.
Depression During a Unique Period of Development
Major
depression effects one in fifty school children. Countless
others are effected by milder cases of depression which may
also effect school performance (Lamarine, 1995). The peak
age of depression correlates with the peak years of low self-esteem.
Feldman & Elliot (1990) write that the prime period for
low self-esteem is early and middle adolescence with a peak
period between the ages of thirteen and fourteen.
The suicide rate in teenagers has quadrupled in the last quarter
century making it the 3rd leading cause of adolescent death
in the nation. In Utah, it is the number one cause of death
in for individuals 15 - 44 years old (Wagner, 1996). A high
school with a population of 2,000 students can expect 50 attempted
suicides per year (Kahn,1995). And yet depression and other
affective disorders continue to be an area primarily ignored
by the public schools.
One of the factors that makes depression so difficult to diagnose
in adolescents is the common behavior changes that are normally
associated with the hormonal changes of this period (Lamarine,
1995). It has only been in recent years that the medical community
has acknowledged childhood depression and viewed it as a condition
which requires intervention.
History of Adolescent Depression
Historically, children were not considered candidates for
depression (Whitley,1996). Mostly because of Freudian notions
about the unconscious, depression had been viewed as a condition
which only effected adults. Today, childhood depression is
widely recognized and health professionals see depression
as a serious condition effecting both adolescents and young
children (Whitley, 1996; Lamarine, 1995).
Views on adolescent depression have changed significantly
even since the 1970's where childhood depression was thought
to be masked by other conditions (Kahn, 1995). The debate
continues, even today, as to whether other childhood and adolescent
behaviors are simply "masks" for childhood depression.
Fritz (1995), writes that depression may often be seen in
physical ailments such as digestive problem, sleep disorders
or persistent boredom. Lamarine (1995), considers that in
children, depression may often be mistaken for other conditions
such as attention deficit disorder, aggressiveness, physical
illness, sleep and eating disorders and hyperactivity. Although
depression in children may be confused with attention deficit
hyperactivity disorder (ADHD), ADHD must begin before the
age of 7 (Burford, 1995).
Other writers prefer to move past the philosophy of masked
depression and view adolescent depressive symptoms as similar
to those of adults (Kahn, 1995; Sanford, 1996; Fritz, 1995;
Rao, 1994).
Along with a reconsideration of depression in children, mania
and bipolar disorder (manic-depression) are being added to
the acceptable list of childhood and adolescent conditions.
The symptoms of mania in children or adolescents consist of
euphoria along with extreme anger and rage. Mania or manic-depression
may also be misdiagnosed and treated as a masking condition
such as and ADHD (Whitley, 1996).
Symptoms of Depression and Low Self-esteem
According
to some research (Fritz, 1995) about 5% of adolescents suffer
from depression symptoms such as persistent sadness, falling
academic performance and a lack of interest in previously
enjoyable tasks. In order to be considered major depression,
symptoms such as suicidal thoughts, lack of appetite and loss
of interest in social activities must continue for a period
of at least two weeks (Arbetter, 1993).
Research has also found a correlation between major depression
in adolescence and the likelihood of depression in young adulthood
(Rao, 1994). Not only were most depressed adolescents depressed
adults, but serious social adjustment problems plagued these
individuals as they moved into adulthood. And there is evidence
that depression in adolescents is likely to repeat itself
within a year or two. In fact, two-thirds of depressed teens
will be depressed again during their teenage years (Sanford,
1996; Fritz, 1995).
One of the chief differences between adult and adolescent
depression is that depression in adolescents usually involves
more social and interpersonal difficulties which directly
leads to self-esteem problems. Adolescents are also more likely
to idealize suicide as a solution to feelings of helplessness.
Adolescents may also socially isolate themselves when depressed
out of feelings of guilt. Dramatic behaviors such as aggression
and an obsession or fascination with death often accompany
their depression (Lamarine, 1995).
Adolescent problems that correlate with low self-esteem include
depression, unsafe sex. criminal activity, and drug abuse.
(New model 1995). Educators and schools can be ideal scouts
for depression in adolescents. Since depression often results
in lower academic performance, behavior problems, and poor
socialization, schools are often the best place to observe
all these symptoms (Lamarine, 1995).
Causes and Correlations of Depression
Causes of depression number almost as high as symptoms of
depression. There appears to be a genetic factor to depression.
Families with a history of depression often exhibit the symptoms
during adolescence (Fritz, 1995). And depressed children frequently
come from parent who have been depressed. Besides genetic
predispositions to depression, social skills deficits may
also contribute. These social skills deficits are harder to
determine as it is difficult to find whether the inability
to form good social skills causes, or results from the depression
(Lamarine, 1995). Sexual orientation adjustment problems have
also been linked to depression, especially in communities
with strong social pressures. A study in currently underway
with the Utah Department of Health to study the link between
homosexuality and adolescent suicide (Wagner, 1996).
Coincidently, the peak age of depression and low self-esteem
coincides with the transition from elementary to junior high
school. This age may have an inability to deal with the new
social demands as well as academic demands of a new school
(Feldman & Elliot, 1990; Eccles, et. al., 1993).
There appears a relationship between latch-key kids and depression.
Unsupervised adolescents are more prone to substance abuse,
risk-taking,depression, and low self esteem (Richardson, et.
al., 1993). One of the factors that correlates with recurring
depression is a negative relationship between adolescents
and their fathers along with an inability of the mothers to
monitor behavior (Sanford, 1996).
There is an negative correlation between depression and athletic
participation. Although adolescents that participate in athletics
do not show a decrease in drug use, they do exhibit significantly
less depression and suicidal tendencies (Oler, 1994).
Depressed adolescents with a history of sexual abuse have
a higher incidence of posttraumatic stress disorder, but no
increase in the severity of depression symptoms nor tendency
for suicide (Brand, et. al., 1996).
Another factor associated with adolescent depression and negative
behaviors is difficulty in establishing autonomy in the adolescent's
relationship with parents.
Adolescent depression is seen in higher frequency in families
where the children have difficulty establishing their own
identity because of negative communication patterns and other
dysfunctional family attributes (Allen, et. al., 1994).
One topic that permeates the research on depression is the
concept of self- esteem. There has been a long standing correlation
between low self-esteem and depression. The views on self-esteem
are changing more rapidly than even the views on depression.
The traditional thinking with self-esteem was if one could
improve the way an individual perceived him or herself, then
the secondary behaviors that accompany low self-esteem would
disappear (New model, 1995). This traditional philosophy is
taking a new direction.
Relationship of Depression to Self-esteem
There is a strong correlation between a person's emotional
reactions and their involvement in social relationships. Therefore,
to increase one's self-esteem, one needs to improve one's
standing in interpersonal relationships rather than trying
to fix some perception about themselves. Research has shown
that it doesn't have to be the actual rejection of a person
by a social situation, it can simply be the imagined or anticipated
rejection. (At last, 1995).
New research indicates that the behaviors are not the result
of low self-esteem, but rather the result of social rejection
which leads to low self-esteem. In other words, self-esteem
does not cause a person to behave a particular way, it is
the result of poor social relationships (New model, 1995;
Rao, 1994).
Depression
and self-esteem may be viewed as a vicious cycle. The inability
to relate positively in social situations may lead to low
self-esteem which leads to depression. The depression then
leads to further inability to relate with others or be fully
accepted in social groups which then adds to the feelings
of low self-esteem (Davila, et. al., 1995).
This research opens a new area of study into the relationship
between depressed people and their environment. Following
Bronfenbrenner's (1986) notion of the mesosystem model of
interactions, the relationships between an individual and
the various environments of influence, must be considered
just as important as the individual's self.
Since poor interpersonal problem solving skills lead to higher
levels of depression, which in turn leads to more interpersonal
difficulties, one may argue that teaching problem solving
skills is the intervention solution. However, there does not
appear to be a relationship between adolescent cognitive problem
solving abilities and interpersonal skills. Therefore, one
could conclude that it is not that adolescents do not know
how to solve problems but they lack the desire or willingness
to use those interpersonal skills (Davila, et. al, 1995).
Feldman and Elliot (1990) report that there is a direct relationship
between the perception of social success and self-esteem.
This success may include confidence in appearance, academic
ability, athletic ability, and social belonging. Self-esteem
is then, a barometer of how well one is doing socially. It
monitors the acceptance level of the people and groups in
the surrounding environment. Similar to Maslow's hierarchy
of needs (Huffman, et. al.,1994), this new theory supports
the idea that people seek a certain amount of social acceptance
and belonging which will take precedence over other factors
such as self-actualization (New Model, 1995; At last, 1995).
Other factors effect depression and other affective adolescent
problems. Parental influences on self-esteem are reported
by Feldman and Elliot (1990) who find that parents who model
openness and acceptance of new ideas can have a positive effect
on their child's self-esteem. Other parental factors include
encouragement for children to form their own view points,
as well as a secure family relationship to form a basis for
exploration.
Transition from elementary to junior. high school or from
junior high to senior high increases feeling of low self-esteem.
Students who do not make such a change in school have a reduced
incidence of low self-esteem. Unfortunately, some students,
particularly females, do not recover from this low self image
in later adolescence (Feldman & Elliot, 1990).
Competition is a popular blame agent for low self-esteem.
It is easy for an adolescent to interpret a competitive loss
with failure, thereby damaging self-esteem. Not only does
competition damage self-esteem, it hinders interpersonal relationships.
Instead of being a demonstration of strength and confidence,
competition is a show of insecurity (Kohn, 1993). Competition
may be viewed as a disservice by educators who should be improving
the adolescent's ability to relate well with others. Instead,
this spirit of competition held in many school activities
serves to block healthy communication. Regarding competition
in schools, Kohn writes, "Kids face it all the time in an
award assembly, an event usually held in school auditoriums
that instantly transforms most people present into losers"
(p.1).
Competition implies comparisons which should be eliminated
from parenting for the sake of self-esteem, according to Evitt
(1990). Rather than make comparisons between children, which
makes the child feel inferior, parents should acknowledge
and encourage the natural differences found in individuals.
Self-esteem has also been linked to problem solving skills.
Lochman, et. al., (1993), studied the relationship in aggressive
adolescent boys and their social problem solving skills. The
study was based on the idea that exhibited behaviors are the
result of a person's goals and their expectation that their
behavior will lead to that goal.
Goals set by socially unpopular adolescents tend to focus
on non-social goals involving peer relations. As might be
expected, aggressive adolescents value dominance and revenge
over affiliation. These adolescents had a higher incidence
of depression, which points to lack of self-esteem. Interestingly,
while popular students were very clear in their goals of affiliation,
non-popular students were unclear in their goals. While unpopular
students ranked dominance and revenge higher, they also indicated
a significant value for affiliation. This leads researchers
to conclude that aggressive, or unpopular children have greater
internal conflict than popular children.
This creates difficulty in social negotiations, leading to
low self-esteem, leading to depression. These researchers
(Lochman, et. al., 1993) suggest that intervention should
include helping problemed adolescents find more socially acceptable
strategies for problem solving which will enable them to reach
their personal goals.
Interventions
Various therapies have been used with adolescent depression.
Psychoanalytical therapies target the unconscious conflicts
resulting in the depression. Behavior therapies design reinforcement
programs to change behavior patterns. Cognitive therapies
look to improve and examine metacognition and increase more
positive thought patterns (Lamarine, 1995).
Unfortunately it is harder to medically treat adolescent depression
than adult depression because adolescents are less likely
to respond to the medication (Fritz, 1995). Therefore, alternative
treatments such as counseling have proven more successful.
Physicians will prescribe anti-depressant medication to a
depressed adolescent, but if that child appears suicidal,
a psychological counselor will also become involved (Burford,
1995).
Many schools have targeted depression by teaching students
coping strategies for stress. These programs are most effective
with those students that are at-risk for depression (Lamarine,
1995). School administrators and teachers feel that although
courses may be offered for the adolescents themselves, the
more successful programs are those that are taught to parents
for working with adolescents in their own homes (Evitt, 1990).
An important factor in preventing depression is a positive
relationship with parents. This is especially important in
early adolescence (Sanford, 1996).
Hindering solution strategies, is the stigma that remains
attached to mental health problems, especially for youth.
This makes it difficult for educators to consider emotional
problems as a cause for poor academic performance (Lamarine,
1995). It is important however, to recognize the signs of
adolescent depression early, before the depression interferes
with the child's interpersonal relationships which will ultimately
affect self-esteem.
According to Evitt (1990) self-esteem classes are one of the
most popular topics for parenting classes. Nationally, task
forces are calling for more parent workshops and classes on
how to improve the self-esteem of children. Based on the idea
that parents have a more powerful impact on children than
the schools, many of these programs are being offered at convenient
times for parents such as evenings or lunch hours.
Other intervention programs have attempted to increase self-esteem
through exercise. Depression has been reduced through the
improvement of body image that comes with exercise. Exercise
can be particularly beneficial if it is through a non-competitive
sport such as swimming (West, 1993).
Other programs are aimed at improving children's self esteem
through music coupled with exercise. These programs not only
target improvement of self-esteem, but also an improvement
in interpersonal relationships (Foreman, 1993). By increasing
a person's interpersonal social skills, self-esteem improves
(At last, 1995). According to Evitt (1990), some ways parents
can improve self-esteem in their adolescent include improving
communication, limit setting and setting expectations, and
nurturing a sense of responsibility. To insure a sense of
security in the home, parents should set clear expectations
and limits. To improve responsibility, parents should determine
all the tasks a child is capable of doing and then insist
on them doing them.
Apparently if self-esteem remains low, adolescents will seek
out groups in order to find a collective self-esteem. Discrimination
between these groups increases personal self-esteem. The greater
the need for group or collective self-esteem, the greater
the discrimination. Long, et.al. (1995), found that people
with particularly low personal self-esteem rely on group or
collective self-esteem more than those with high personal
self-esteem. It was shown that persons with high personal
self-esteem discriminated not only between their group and
others, but also within their own group, as whole group competitions
may rely on attributes often out of the individual's control.
Conversely, individuals with low personal self-esteem discriminate
very little within their own group, as they depend on the
collective self-esteem of their group to compensate for their
weakness. Perhaps then, gang membership is a positive step
toward reducing depression in persons with low self-esteem.
The only real difference between belonging to a gang and belonging
to an athletic team is the rules.
Recommendations
To effectively target adolescent depression, schools need
to target self-esteem. The approach to improving self-esteem
should be different from the traditional view of individualized
pep talks. Self-esteem can only be improved when the environment
in which the person lives improves -- improvement, in terms
of interpersonal skills and social acceptance. Those adolescents
with particularly low self-esteem need to have the opportunity
for belonging. A collective self-esteem through group and
team membership can be especially helpful for persons whose
family environment lacks the acceptance and support necessary
for healthy self-development.
The junior and senior high schools need to continue to examine
the isolation created by these large impersonal institutions.
We are subjecting all adolescents to these places at a time
when belonging, community, and interpersonal skills are so
critical and imperative. The damage that can be done at this
age may be long lasting and permanent, even deadly.
Kathie
F. Nunley is an educational psychologist, author, researcher
and speaker living in southern New Hampshire. Developer of
the Layered Curriculum® method of instruction, Dr. Nunley
has authored several books and articles on teaching in mixed-ability
classrooms and other problems facing today's teachers. Full
references and additional teaching and parental tips are available
at: http://Brains.org
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Dr Kathie Nunley