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The Relationship of Self Esteem and Depression
in Adolescence
by Dr. Kathie F. Nunley

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.

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Email the author: Kathie@brains.org