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1.  Relationship between body satisfaction with self esteemand unhealthy body weight management 
A favorable or unfavorable attitude about self was named self esteem. According to Maslow theory to achieve quality of life and happiness, one must reach the gradual fulfillment of human needs, including a high degree of own self-esteem. Body dissatisfaction is a negative distortion of one's body which is especially mentioned by the women. Many studies have shown links between self esteem, body dissatisfaction, health and behaviors. this study intends to determine relationship between body satisfaction, self esteem and unhealthy weight control behaviors between women.
This cross-sectional study was done on 408 women employees in Isfahan University and Isfahan University of Medical Sciences during 1390. They were chosen according to the stratified random sampling method. Inclusion criteria were 1) willing to participate in the study and 2) lack of serious physical defect 3) not being in pregnancy or breastfeeding course. Exclusion criteria was filling out questionnaires incompletely. Data collection tool was a multidimensional questionnaire which comprised of 4 sections as following: demographic (5items), A self-administrative questionnaire for body Satisfaction (7 items), Rosenberg Self-Esteem Scale (10 items) and a standard Weight Control Behavior Scale (18 items). Cranach's alpha was 0.9 or higher for the different sections. Finally, collected data was analyzed with SPSS18 using the independent T-test, one-way ANOVA, Pearson correlation coefficient, regression, Spearman correlation.
Frequencies of participants by weight category were 14.1% for obese, 35.3% for overweight, 47.6% for normal weight. The mean body satisfaction score in the studied women was 63.26 ± 16.27 (from 100). Mean score of self esteem was 76.70 ± 10.45. 51.5% of women had medium self esteem, 47.5% had high self esteem. Pearson correlation showed that the variables of body Satisfaction (r = 0.3, P = 0.02), BMI (r = - 0.14, P < 0.003), education level (r = 0.22, P < 0.001), income (r = 0.14, P < 0.004), consumption of fruit (r = 0.13, P < 0.008) all correlated with self-esteem significantly. Women with higher self esteem used higher fruits had a good nutrition overall (r = 0.11, P = 0.02). 92.15%, 10.8% of women respectively participated in one of healthy and unhealthy weight control behavior. There was not any Relationship between self esteem and healthy weight control behavior while finding showed reverse relationship between self esteem and Unhealthy Dieting Behaviors.
It seemed women identity in our society tied to social appreciations that formed and supported by body satisfaction. When they feel their current appearance is differ from ideal appearance, they feel down and have lower self esteem and used unhealthy dieting behavior and low fruits daily. Due to importance of precise self evaluation, self esteem can be used to design and conduct public health programs, especially for women.
PMCID: PMC3778571  PMID: 24083279
Self esteem; unhealthy weight control behaviors; women
2.  The Relation of Self-Esteem and Illegal Drug Usage in High School Students 
Adolescence is the period of stress and strain. Researchers have shown that adolescents without strong social supports would have tendency towards smoking and drug abuse.
This study aimed to evaluate the relationship between low self-esteem and illegal drug abuse.
Materials and Methods
Participants were 943 grades nine to 12 high school students, from Sarakhs during 2010 - 2011. Adolescents participated in the study, completed two self-report questionnaires. The first questionnaire included questions about individual and family information, smoking and illegal drug abuse history, and the second was the Rosenberg's self-esteem scale.
53.8% of participants were male (507 individuals). The mean Rosenberg self-esteem score was 19.8 + 5.2, and the most frequent obtained scores were from 22 to 30. The difference of Rosenberg self-esteem score test between students who did not use any substance and those who had a history of smoking or drug abuse like heroin, pills, alcohols, betel nut (Nas) and other drugs (such as Pan and Hookah) was significant (P < 0.001). But this difference was not significant for marijuana (hashish) and opium. The difference of mean self-esteem scores between adolescents who lived with both or one of the parents, and those who did not live with any of parents, was significant (P = 0.04). There was also a significant association between the number of children in the family and self-esteem score.
The current study showed significant association between the Rosenberg self-esteem test results and smoking, and illegal drug abuse like heroin, pills, alcohol, Nas, and other substances. Therefore, increasing self-esteem is essential for preventing the adolescents’ emotional and behavioral disorders. This fact could guide us to the new approaches for smoking and drug-abuse prevention in adolescents.
PMCID: PMC3971778  PMID: 24719686
Self-Concept; Adolescent; Street Drugs
3.  Low self-esteem and psychiatric patients: Part I – The relationship between low self-esteem and psychiatric diagnosis 
The objective of the current study was to determine the prevalence and the degree of lowered self-esteem across the spectrum of psychiatric disorders.
The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. There were 957 psychiatric patients, 182 cases with conditions not attributable to a mental disorder, and 51 control subjects. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, individuals completed two questionnaires to measure self-esteem, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. Statistical analyses were performed on the scores of the two self-esteem scales.
The results of the present study demonstrate that all psychiatric patients suffer some degree of lowered self-esteem. Furthermore, the degree to which self-esteem was lowered differed among various diagnostic groups. Self-esteem was lowest in patients with major depressive disorder, eating disorders, and substance abuse. Also, there is evidence of cumulative effects of psychiatric disorders on self-esteem. Patients who had comorbid diagnoses, particularly when one of the diagnoses was depressive disorders, tended to show lower self-esteem.
Based on both the previous literature, and the results from the current study, we propose that there is a vicious cycle between low self-esteem and onset of psychiatric disorders. Thus, low self-esteem increases the susceptibility for development of psychiatric disorders, and the presence of a psychiatric disorder, in turn, lowers self-esteem. Our findings suggest that this effect is more pronounced with certain psychiatric disorders, such as major depression and eating disorders.
PMCID: PMC151271  PMID: 12620127
Self-esteem; Psychiatric disorders
4.  Low self-esteem and psychiatric patients: Part II – The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients 
The objective of the present study was to identify the effects and relative importance of demographic factors and psychosocial stressors on self-esteem of psychiatric patients.
The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, patients and controls completed two self-esteem questionnaires, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. In addition, a large amount of demographic and psychosocial data was collected on all patients.
Significantly increased self-esteem was observed with an increase in age, educational achievement and income. Employed patients showed significantly higher self-esteem compared to unemployed patients. Female patients had a significantly lower self-esteem compared to male patients. The self-esteem of psychiatric patients did not vary significantly with their marital status. No relationship was detected between acute stressors and the self-esteem of psychiatric patients, although severe enduring stressors were associated with lower self-esteem in psychiatric patients.
The results of this large study demonstrate that the self-esteem of adult psychiatric patients is affected by a number of demographic and psychosocial factors including age, sex, educational status, income, employment status, and enduring psychosocial stressors.
PMCID: PMC151272  PMID: 12622872
Self-esteem; Demographic factors; Psychosocial stressors
5.  Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis 
BMC Psychiatry  2011;11:136.
Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations.
A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES).
Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression.
There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations.
PMCID: PMC3180364  PMID: 21854599
Self-esteem; First episode psychosis; Schizophrenia; Premorbid adjustment; Delusions; Hallucinations
6.  Impact of early adolescent anxiety disorders on self-esteem development from adolescence to young adulthood 
To examine the association between early adolescent anxiety disorders and self-esteem development from early adolescence to young adulthood.
Self-esteem was measured at mean ages 13, 16 and 22 for 821 participants from the Children in the Community Study, a population-based longitudinal cohort. Anxiety disorders were measured at mean age 13 years. Multilevel growth models were employed to analyze the change in self-esteem from early adolescence to young adulthood and to evaluate whether adolescent anxiety disorders predict both average and slope of self-esteem development.
Self-esteem increased during adolescence and continued to increase in young adulthood. Girls had lower average self-esteem than boys, but this difference disappeared when examining the effect of anxiety. Adolescents with anxiety disorder had lower self-esteem, on average, compared with healthy adolescents (effect size (ES) =−0.35, p<0.01). Social phobia was found to have the greatest relative impact on average self-esteem (ES=−0.30, p<0.01), followed by overanxious disorder (ES=−0.17, p<0.05), and simple phobia (ES=−0.17, p<0.05). Obsessive compulsive-disorder (OCD) predicted a significant decline in self-esteem from adolescence to young-adulthood ( =−0.1, p<0.05). Separation anxiety disorder was not found to have any significant impact on self-esteem development.
All but one of the assessed adolescent anxiety disorders were related to lower self-esteem, with social phobia having the greatest impact. OCD predicted a decline in self-esteem trajectory with age. The importance of raising self-esteem in adolescents with anxiety and other mental disorders is discussed.
PMCID: PMC3725205  PMID: 23648133
Anxiety disorder; Self-esteem development; Adolescence; Multilevel growth modeling; Longitudinal
7.  Implicit Self-Esteem Decreases in Adolescence: A Cross-Sectional Study 
PLoS ONE  2014;9(2):e89988.
Implicit self-esteem has remained an active research topic in both the areas of implicit social cognition and self-esteem in recent decades. The purpose of this study is to explore the development of implicit self-esteem in adolescents. A total of 599 adolescents from junior and senior high schools in East China participated in the study. They ranged in age from 11 to 18 years with a mean age of 14.10 (SD = 2.16). The degree of implicit self-esteem was assessed using the Implicit Association Test (IAT) with the improved D score as the index. Participants also completed the Rosenberg Self-Esteem Scale (α = 0.77). For all surveyed ages, implicit self-esteem was positively biased, all ts>8.59, all ps<0.001. The simple correlation between implicit self-esteem and age was significant, r = −.25, p = 1.0×10−10. A regression with implicit self-esteem as the criterion variable, and age, gender, and age × gender interaction as predictors further revealed the significant negative linear relationship between age and implicit self-esteem, β = −0.19, t = −3.20, p = 0.001. However, explicit self-esteem manifested a reverse “U” shape throughout adolescence. Implicit self-esteem in adolescence manifests a declining trend with increasing age, suggesting that it is sensitive to developmental or age-related changes. This finding enriches our understanding of the development of implicit social cognition.
PMCID: PMC3934976  PMID: 24587169
8.  The self-esteem and anxiety of children with and without mentally retarded siblings 
The study was carried out with the aim of determining the factors affecting and to evaluate anxiety situations and self-esteem of children with and without mentally retarded siblings.
Materials and Methods:
The sampling included 227 healthy children: 108 of them have mental retarded sibling and 119 of them do not have mental retarded sibling. The context of this study consisted of 15-18 year of age healthy children with mentally retarded siblings and 15-18 year of aged healthy children having at least one sibling between the dates February 15st and June 26st 2010. Personal Information Form, Rosenberg Self-Esteem Scale and Trait Anxiety Scale were used.
It was found out that trait anxiety of 17-18 aged of children with mental retarded sibling (47.04 ± 7.3) was higher than that of the children without mental retarded siblings (44.05 ± 11.23) (P < 0.05). It was observed that self-esteem of children with mentally retarded sibling was not affected from the handicap of their siblings (P > 0.05). Trait anxiety score averages of children with mentally retarded sibling and experience some difficulties due to his or her siblings's handicap (47.00 ± 7.76) were found higher than those of those of the children without any problem with the environment (42.61 ± 7.48) (P < 0.05).
Although the average score of trait anxiety and self-esteem in both groups were not significant different, score of trait anxiety for children with mentally disabled siblings was higher in comparison. It was concluded that anxiety of children with and without mentally retarded siblings increased as self-esteem of these children decreased.
PMCID: PMC3906787  PMID: 24523782
Mental retardation; self-esteem; sibling; trait anxiety
9.  Myopia, contact lens use and self-esteem 
To evaluate whether contact lens (CL) use was associated with self-esteem in myopic children originally enrolled in the Correction of Myopia Evaluation Trial (COMET), that after five years continued as an observational study of myopia progression with CL use permitted.
Usable data at the six-year visit, one year after CL use was allowed (n = 423/469, age 12-17 years), included questions on CL use, refractive error measurements and self-reported self-esteem in several areas (scholastic/athletic competence, physical appearance, social acceptance, behavioural conduct and global self-worth). Self-esteem, scored from 1 (low) to 4 (high), was measured by the Self-Perception Profile for Children in participants under 14 years or the Self-Perception Profile for Adolescents, in those 14 years and older. Multiple regression analyses were used to evaluate associations between self-esteem and relevant factors identified by univariate analyses (e.g., CL use, gender, ethnicity), while adjusting for baseline self-esteem prior to CL use.
Mean (±SD) self-esteem scores at the six-year visit (mean age=15.3±1.3 years; mean refractive error= −4.6 ±1.5D) ranged from 2.74 (± 0.76) on athletic competence to 3.33 (± 0.53) on global self-worth. CL wearers (n=224) compared to eyeglass wearers (n=199) were more likely to be female (p<0.0001). Those who chose to wear CLs had higher social acceptance, athletic competence and behavioural conduct scores (p < 0.05) at baseline compared to eyeglass users. CL users continued to report higher social acceptance scores at the six-year visit (p=0.03), after adjusting for baseline scores and other covariates. Ethnicity was also independently associated with social acceptance in the multivariable analyses (p=0.011); African-Americans had higher scores than Asians, Whites and Hispanics. Age and refractive error were not associated with self-esteem or CL use.
COMET participants who chose to wear CLs after five years of eyeglass use had higher self-esteem compared to those who remained in glasses both preceding and following CL use. This suggests that self-esteem may influence the decision to wear CLs and that CLs in turn are associated with higher self-esteem in individuals most likely to wear them.
PMCID: PMC3743944  PMID: 23763482
myopia; contact lenses; self-esteem; eyeglasses; adolescents
10.  Perceptions of Indian dental hygiene students toward their profession and its relationship with their explicit self-esteem scores 
Indian Journal of Dentistry  2014;5(4):202-210.
The purpose of this study was to investigate the perceptions toward the profession, the level of explicit self-esteem (ESE) of Indian students pursuing the course of dental hygienists, to evaluate the relationship between the two and to develop educational strategies to positively influence students’ perceptions. We also wished to evaluate the level of satisfaction of the students to the current status of professional employment in the country.
Materials and Methods:
Students in the second year of the dental hygienist 2-year course were asked to participate in a cross-sectional survey study. An instrument was used to obtain students’ perceptions about the profession by estimating the dimensions of “Motivation,” “Expectation” and “Environment”. Their self-esteem was evaluated using the Rosenberg self-esteem scale. Relationship of self esteem scores with perceptions towards profession was then evaluated.
Scores for dimensions including “Motivation,” “Expectation” and “Environment” were significantly high, as were the self-esteem scores. The level of ESE was positively correlated with their perceptions of the profession.
The perception of the Indian dental hygienist students was significantly high and positively correlated to the ESE scores. We also conclude that environmental factors may be more influential than innate cultural factors for the development of self-esteem.
PMCID: PMC4260386  PMID: 25565754
Dental hygiene education; perception; profession; self-esteem
Neurotoxicology  2007;29(2):278-285.
The notion that maternal personality characteristics influence cognitive development in their children has been grounded in stress moderation theory. Maternal personality traits, such as self-esteem, may buffer maternal stressors or lead to improved maternal-child interactions that directly impact neurodevelopment. This can be extended to suggest that maternal personality may serve to attenuate or exacerbate the effects of other neurotoxicants, although this has not been studied directly. We examined whether mothers’ self-esteem had a direct or main effect on their children's cognitive outcomes. We also explored the modifying effects of maternal self-esteem on the association between exposure to lead and neurodevelopment in these children. Study participants included 379 mother-child pairs from Mexico City. Data included the Coopersmith self-esteem scale in mothers, children's Bayley's Scale of Infant Development (BSID) scores, and sociodemographic information. Linear regression was used to model the relationship between maternal self-esteem and the Bayley's Mental Development Index (MDI) and Psychomotor Development Index (PDI) scores at age 24 months using regression models stratified by levels of maternal self-esteem. In adjusted models, each point increase in maternal self-esteem was associated with children having 0.2 higher score on the Bayley's MDI (p=0.04). Similar results were observed using the PDI outcome. Moreover, there was evidence that maternal self-esteem attenuated the negative effects of lead exposure, although the interaction fell short of conventional levels of statistical significance.
PMCID: PMC2495770  PMID: 18261800
child; cognition; lead; neurotoxicology; mother-child relations
12.  Defensive function of persecutory delusion and discrepancy between explicit and implicit self-esteem in schizophrenia: study using the Brief Implicit Association Test 
If delusions serve as a defense mechanism in schizophrenia patients with paranoia, then they should show normal or high explicit self-esteem and low implicit self-esteem. However, the results of previous studies are inconsistent. One possible explanation for this inconsistency is that there are two types of paranoia, “bad me” (self-blaming) paranoia and “poor me” (non-self-blaming) paranoia. We thus examined implicit and explicit self-esteem and self-blaming tendency in patients with schizophrenia and schizoaffective disorder. We hypothesized that patients with paranoia would show lower implicit self-esteem and only those with non-self-blaming paranoia would experience a discrepancy between explicit and implicit self-esteem.
Participants consisted of patients with schizophrenia and schizoaffective disorder recruited from a day hospital (N=71). Participants were assessed for psychotic symptoms, using the Brief Psychiatric Rating Scale (BPRS), and self-blaming tendency, using the brief COPE. We also assessed explicit self-esteem, using the Rosenberg Self-Esteem Scale (RSES), implicit self-esteem, using Brief Implicit Association Test (BIAT), and discrepancy between explicit and implicit self-esteem.
Contrary to our hypothesis, implicit self-esteem in paranoia and nonparanoia showed no statistical difference. As expected, only patients with non-self-blaming paranoia experienced a discrepancy between explicit and implicit self-esteem; other groups showed no such discrepancy.
These results suggest that persecutory delusion plays a defensive role in non-self-blaming paranoia.
PMCID: PMC4278784  PMID: 25565849
coping style; poor me paranoia; remitted paranoid delusion; external attribution
13.  Self-Esteem in Hearing-Impaired Children: The Influence of Communication, Education, and Audiological Characteristics 
PLoS ONE  2014;9(4):e94521.
Sufficient self-esteem is extremely important for psychosocial functioning. It is hypothesized that hearing-impaired (HI) children have lower levels of self-esteem, because, among other things, they frequently experience lower language and communication skills. Therefore, the aim of this study was to compare HI children's self-esteem across different domains with those of normal hearing (NH) children and to investigate the influence of communication, type of education, and audiological characteristics.
This large (N = 252) retrospective, multicenter study consisted of two age- and gender-matched groups: 123 HI children and 129 NH controls (mean age  = 11.8 years). Self-reports were used to measure self-esteem across four domains: perceived social acceptance by peers, perceived parental attention, perceived physical appearance, and global self-esteem.
HI children experienced lower levels of self-esteem regarding peers and parents than NH controls. Particularly HI children who attended special education for the deaf were at risk, even after correcting for their language development and intelligence. Yet, levels of global self-esteem and self-esteem involving physical appearance in HI children equalled those of NH controls. Furthermore, younger age at implantation and longer duration of having cochlear implants (CIs) were related to higher levels of self-esteem.
HI children experience lower levels of self-esteem in the social domains. Yet, due to the heterogeneity of the HI population, there is high variability in levels of self-esteem.
Clinicians must always be aware of the risk and protective factors related to self-esteem in order to help individual patients reach their full potential.
PMCID: PMC3983202  PMID: 24722329
14.  Modulation of Self-Esteem in Self- and Other-Evaluations Primed by Subliminal and Supraliminal Faces 
PLoS ONE  2012;7(10):e47103.
Past research examining implicit self-evaluation often manipulated self-processing as task-irrelevant but presented self-related stimuli supraliminally. Even when tested with more indirect methods, such as the masked priming paradigm, participants' responses may still be subject to conscious interference. Our study primed participants with either their own or someone else's face, and adopted a new paradigm to actualize strict face-suppression to examine participants' subliminal self-evaluation. In addition, we investigated how self-esteem modulates one's implicit self-evaluation and validated the role of awareness in creating the discrepancy on past findings between measures of implicit self-evaluation and explicit self-esteem.
Methodology/Principal Findings
Participants' own face or others' faces were subliminally presented with a Continuous Flash Suppression (CFS) paradigm in Experiment 1, but supraliminally presented in Experiment 2, followed by a valence judgment task of personality adjectives. Participants also completed the Rosenberg Self-Esteem Scale in each experiment. Results from Experiment 1 showed a typical bias of self-positivity among participants with higher self-esteem, but only a marginal self-positivity bias and a significant other-positivity bias among those with lower self-esteem. However, self-esteem had no modulating effect in Experiment 2: All participants showed the self-positivity bias.
Our results provide direct evidence that self-evaluation manifests in different ways as a function of awareness between individuals with different self-views: People high and low in self-esteem may demonstrate different automatic reactions in the subliminal evaluations of the self and others; but the involvement of consciousness with supraliminally presented stimuli may reduce this dissociation.
PMCID: PMC3473034  PMID: 23091607
15.  Self-concept evaluation and migraine without aura in childhood 
Self-esteem is related to the broadly understood concept of self-schemas and is a crucial mechanism for a correct psychological development in children and adolescents. The impact of the many psychological difficulties linked to the migraine without aura (MoA) and recurrent headache attacks, such as anger and separation anxiety, on self-esteem has not yet been well investigated. The aims of the present study were to assess self-esteem levels in an objective way and to verify their possible relationship and correlation with the frequency and intensity of migraine attacks, in a population of children and adolescents affected by MoA.
The study population was comprised of 185 children (88 males [M],97 females [F]) aged between 6 and 12 years (mean 9.04 ± 2.41 years) referred consecutively for MoA to the Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples and of 203 healthy controls (95 M, 108 F) with mean age 9.16 ± 2.37 years, recruited from schools in Campania. The monthly headache frequency and the mean headache duration were assessed from daily headache diaries kept by all the children, and MoA intensity was assessed on a VAS (visual analog scale). To further evaluate their level of self-concept, all subjects filled out the Multidimensional Self-Concept Scale (MSCS).
The two study groups were comparable for age (P = 0.621), sex (P = 0.960), and z-score BMI (P = 0.102). The MoA group showed a significant reduction in the MSCS total score (P < 0.001) and in the Social (P < 0.001), Affect (P < 0.001), Family (P < 0.001), and Physical (P < 0.001) domains of the MSCS compared with the control group. The Pearson’s correlation analysis showed a significantly negative relationship between MoA clinical characteristics and MSCS scores, and similarly the frequency of attacks was significantly negatively related with the Social (r = −0.3176; P < 0.001), Competence (r = −0.2349; P = 0.001), Physical (r = −0.2378; P = 0.001), and total (r = −0.2825; P < 0.001) scores of the MSCS. On the other hand, the MoA duration was significantly negatively related with the Social (r = −0.1878; P = 0.01), Competence (r = −0.2270; P = 0.002), Physical (r = −0.1976; P = 0.007), and total (r = −0.1903; P = 0.009) scores of the MSCS.
Our study first identified differences in self-esteem levels, with an objective tool, in children affected by MoA compared with controls, suggesting the need for evaluation of self-esteem for better psychological pediatric management of children with migraine.
PMCID: PMC3742352  PMID: 23950647
children; self-esteem; MSCS
16.  The Impact of Leadership Programme on Self-Esteem and Self-Efficacy in School: A Randomized Controlled Trial 
PLoS ONE  2012;7(12):e52023.
Leadership training programs by experiential learning among adolescents are very popular worldwide and in particular developed countries, but there exists few studies which formally assessed their impact on the psychological well-being of program participants. This study evaluated the effectiveness of leadership training programs on self-esteem and self-efficacy among adolescents.
Methodology/Principal Findings
a total of 180 students of the same grade of one secondary school were randomized into an intervention (n = 50) and a control group (n = 130). The students in the intervention group participated in a 6-month program of leadership training and service learning, while the control group did not participate in any training. Their self-esteem and self-efficacy were assessed by Rosenberg Self-Esteem questionnaire and Chinese Adaptation of the General Self-Efficacy Scale, respectively, before and after the program. Both scales have been recognized internationally as valid and reliable survey instruments to measure these psychological attributes. The scores were compared by Student’s tests according to gender. A total of 180 students were enrolled during the study period October, 2009 to May, 2010. Their mean age was 15.18 years (0.62) and 56.7% were male. Students allocated to the intervention and control group had statistically similar demographic characteristics except gender (male 36.0% vs. 64.6%, p = 0.001). Overall, the self-esteem scores increased by 1.28 and decreased by 0.30 (p = 0.161) while the self-efficacy scores increased by 0.26 and decreased by 0.76 (p = 0.429) in the intervention and control group, respectively. Among female students, the intervention group showed significant improvements in both self-esteem (2.38 vs. −0.24, p<0.001) and self-efficacy (1.32 vs. –0.04, p = 0.043).
Leadership training program were not found to be effective to enhance self-esteem and self-efficacy in adolescents, except girls who showed modest increase in these outcomes. Future research should assess the reasons why these programs are effective among female.
PMCID: PMC3525562  PMID: 23272199
17.  Damaged Self-Esteem is Associated with Internalizing Problems 
Implicit and explicit self-esteem are assumed to be important factors in understanding the onset and maintenance of psychological problems. The current study aims to examine the association between implicit and explicit self-esteem and their interaction with depressive symptoms, suicidal ideation, and loneliness. Specifically, the relationship between the size and the direction of the discrepancy between implicit and explicit self-esteem with depressive symptoms, suicidal ideation, and loneliness were examined. Participants were 95 young female adults (M = 21.2 years, SD = 1.88) enrolled in higher education. We administered the IAT to assess implicit self-esteem, and the Rosenberg self-esteem scale to measure explicit self-esteem while psychological problems were assessed through self-reports. Results showed that discrepancies between implicit and explicit self-esteem were positively associated with depressive symptoms, suicidal ideation, and loneliness. In addition, the direction of the discrepancy was specifically relevant: damaged self-esteem (i.e., high implicit self-esteem and low explicit self-esteem) was consistently associated with increased levels of depressive symptoms, suicidal ideation, and loneliness. In contrast, defensive or fragile self-esteem (i.e., low implicit and high explicit self-esteem) was solely associated with loneliness. These findings provide further support that specifically damaged self-esteem is an important vulnerability marker for depressive symptoms, suicidal ideation, and loneliness.
PMCID: PMC3613594  PMID: 23565101
damaged; implicit cognition; self-esteem; suicidal ideation; depression; loneliness
18.  Body Image and Self-Esteem among Adolescents undergoing an Intervention Targeting Dietary and Physical Activity Behaviors 
Health promotion interventions can lead to awareness of health risk and subsequent adoption of beneficial changes in behavior. However, it is possible that interventions targeting behaviors associated with childhood obesity may also increase the likelihood of unhealthy eating and physical activity obsessions and behaviors.
To determine the effect of a one-year intervention targeting physical activity, sedentary and diet behaviors among adolescents on self-reported body image and self-esteem.
Body image and self-esteem were assessed for adolescents participating in the PACE+ study, a randomized controlled trial of a one-year behavioral intervention targeting physical activity, sedentary, and dietary behaviors. The Body Dissatisfaction subscale of the Eating Disorder Inventory and Rosenberg Self-Esteem scale were used to assess body image and self-esteem respectively, and measurements were performed at baseline, 6 and 12 months. Demographic characteristics and weight status of participants were also ascertained. Analysis of responses was performed via both between-group and within-group repeated measure analyses.
657 adolescents completed all measurements. Body image differences were found for age, sex and weight status at baseline, while self-esteem differences were demonstrated for sex, ethnicity and weight status. There were no intervention effects on body image or self-esteem for either girls or boys. Self-esteem and body satisfaction did not worsen as a result of participating in the PACE+ intervention for either boys or girls whether or not they lost or maintained their weight or gained weight. Girls assigned to the PACE intervention who experienced weight reduction or weight maintenance at either 6 or 12-months reported improvements in body image satisfaction (p=0.02) over time compared to subjects who had experienced weight gain during the 12-month study period.
Adverse effects on body satisfaction and self-esteem were not observed among adolescents undergoing this behavioral intervention. These results suggest that a behavioral intervention directed at improving physical activity and diet habits may be safely undertaken by adolescents, including those who are at risk for overweight and overweight, without adverse psychological consequences. Inclusion of specific elements in the intervention that directly addressed body image and self-esteem issues may have reduced the risk for negative psychological effects.
PMCID: PMC1819585  PMID: 17321425
19.  Effect of Supportive Nursing Care on Self Esteem of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial 
Journal of Caring Sciences  2014;3(2):149-156.
Introduction: Self-esteem is an important potential indicator in etiology, diagnosis and treatment of patients with severe mental illness. ECT is a popular treatment for these patients that can effect on their self-esteem and reinforce their problems. The purpose of this study is to determine the effect of supportive nursing care in increasing self esteem of patients receiving ECT. Methods: This clinical trial was conducted in the Baharan psychiatric hospital of Zahedan. A total of 70 cases of patients who received ECT were randomly allocated to control (n=35) and intervention (n=35) groups. The data were collected by demographic characteristics questionnaire and Rosenberg Self Esteem Scale (RSES). Intervention group received the supportive nursing care. The control group received only routine treatment. Self esteem level was measured and compared before and after intervention for two groups. The data was analyzed by SPSS using the χ2, t-test and ANCOVA. Results: Results showed that both groups were homogeneous on the socio- demographic characteristics. The mean self esteem in the intervention group compared with the control group was significantly increased. While controlling the effects of individual and social variables, the result shows significant differences between two groups in the mean scores of self esteem after the intervention. Conclusion: The results suggest that supportive nursing care can have positive effect on self esteem of patients receiving ECT. It is recommended to use this method for increasing self esteem of these patients.
PMCID: PMC4134177  PMID: 25276758
Supportive care; Self esteem; Electroconvulsive therapy; Patients
20.  The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents 
BMC Public Health  2007;7:80.
The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey.
A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15–18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-spesific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables.
Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents.
The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.
PMCID: PMC1888702  PMID: 17506879
21.  Could a brief assessment of negative emotions and self-esteem identify adolescents at current and future risk of self-harm in the community? A prospective cohort analysis 
BMC Public Health  2013;13:604.
Self-harm is common in adolescents, but it is often unreported and undetected. Available screening tools typically ask directly about self-harm and suicidal ideation. Although in an ideal world, direct enquiry and open discussion around self-harm would be advocated, non-psychiatric professionals in community settings are often reluctant to ask about this directly and disclosure can be met with feeling of intense anxiety. Training non-specialist staff to directly ask about self-harm has limited effects suggesting that alternative approaches are required. This study investigated whether a targeted analysis of negative emotions and self-esteem could identify young adolescents at risk of self-harm in community settings.
Data were collected as part of a clinical trial from young people in school years 8–11 (aged 12–16) at eight UK secondary schools (N = 4503 at baseline, N = 3263 in prospective analysis). The Short Mood and Feelings Questionnaire, Revised Child Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, personal failure (Children’s Automatic Thoughts Scale), and two items on self-harm were completed at baseline, 6 and 12 months.
Following a process of Principal Components Analysis, item reduction, and logistic regression analysis, three internally reliable factors were identified from the original measures that were independently associated with current and future self-harm; personal failure (3 items), physical symptoms of depression/anxiety (6 items), positive self-esteem (5 items). The summed score of these 14 items had good accuracy in identifying current self-harm (AUC 0.87 girls, 0.81 boys) and at six months for girls (0.81), and fair accuracy at six months for boys (AUC 0.74) and 12 months for girls (AUC 0.77).
A brief and targeted assessment of negative emotions and self-esteem, focusing on factors that are strongly associated with current and future self-harm, could potentially be used to help identify adolescents who are at risk in community settings. Further research should assess the psychometric properties of the items identified and test this approach in more diverse community contexts.
PMCID: PMC3733623  PMID: 23800153
Self-harm; Screening; Adolescents; Negative emotions; Self-esteem
22.  Self Perceptions of Young Adults who Survived Severe Childhood Burn Injury 
The transition of pediatric burn survivors into adulthood is accompanied by a reformulation of their self concept. In order to anticipate the need for and guide development of appropriate psychosocial interventions, this study examines how young adults who were burned as children perceive themselves and how this perception might affect their self-esteem.
82 young adult burn survivors (45 males, 37 females) were assessed using the Tennessee Self-Concept, 2nd Edition (TSCS2) to determine how the participants perceive themselves and their interaction with society. To gain insight into the possible effects of these self-concept scores, relationships were analyzed between self-concept, a behavioral assessment (Young Adult Self-Report, YASR) and a psychiatric symptom assessment (Structured Clinical Interview for DSM-IV Axis I Disorders, SCID I).
This group of burn survivors scored significantly lower in self-concepts, reflected in TSCS2 sub-scale scores of Physical function, appearance, and sexuality, Moral conduct, Personal values, Academics and work, and Identity than did the reference population. Pearson correlation coefficients showed that as Moral, Personal, Family and Social aspects of self concept decreased, clinical problems endorsed on the YASR sub-scales increased, including Anxiety Somatic, Attention, Intrusive and Aggressive. Persons with lower self-concept scores on the TSCS2 Personal, Family, and Social Scales, were more withdrawn on the YASR. Similarly those with lower TSCS2 scores on the Personal and Family Scales endorsed significantly more Thought Problems on the YASR. Affective distress on the SCID I was associated with significantly lower self concept. TSCS2 Total Self Concept, Personal, and all of the Supplementary Scale scores were significantly lower for the group with an affective disorder. Those whose SCID I scores were consistent with a current anxiety disorder had significantly lower scores for the TSCS2 Total Self Concept and Personal. Lower self-concept was associated with endorsement of SCID I symptoms (Identity, p= .0018, Satisfaction, p=.0018, and Behavior, p= .0004). Although the major limitation of this study using the TSCS2 is the lack of a matched reference population to compare with the burn survivors, the TSCS2 does help in gaining insight into the self esteem issues of this population.
PMCID: PMC3594050  PMID: 23202876
self concept; self-esteem; burns; adults; pediatric burn survivors
23.  Moroccan parents caring for children with juvenile idiopathic arthritis: positive and negative aspects of their experiences 
Juvenile idiopathic arthritis (JIA) can lead to serious disability in children and adolescents, requiring intensive home care usually provided by parents .These parents must also cope with physical, familial, social and financial constraints.
The aim of this study is to evaluate the positive and negative impacts of caregiving on parents to children with JIA, and identify diseases-related variables that affect these outcomes.
Cross-sectional study including 47 patients diagnosed with JIA defined by the International League of association for Rheumatology (ILAR) 2001 classification. Socio-demographic, clinical and biological data related to patient and disease were collected. Positive and negative effects of caregiving on parents of children with JIA were assessed via a validated instrument; the Caregiver Reaction Assessment (CRA).The CRA assesses parent’s self-esteem, financial problems, health problems, disrupted schedule and lack of family support. All parents completed the CRA questionnaire. A statistical analysis was conducted to determine the influence of disease-related variables on caregivers.
Forty-seven patients were included with 40.4% female. The average patient age was 11 years, and a mean patient body mass index (BMI) was 18. Forty patients were in school. Median disease duration of JIA was 4 years. The most frequent arthritis subtype was persistent oligoarthritis in 12-patients. Nearly 15% had extra-articular manifestations most frequently ocular involvement (6.4%). Median of global Visual analogic scale (VAS) was 20 and median Child health assessment questionnaire (CHAQ) was 0. The primary caregiver was the mother for all patients. Mean maternal age was 38 years, 42% of mothers were illiterate, and nearly all (95%) were without employment. The mean values of different dimensions of the CRA were respectively: self-esteem 3.5, financial problems 3.7, health problem 2.4, disrupted schedule 3.6 and familial support 2.9. Disrupted schedule of parents was correlated with disease severity assessed by physician VAS (p = 0.02). Financial problems of parents were significantly associated with disease duration (p = 0.04). There was no significant association between the type of JIA, activity or severity of the disease and other dimensions of the CRA.
This study suggests that the management of children with JIA has a high negative impact among caregiving parents, represented mainly by the disruption of their activities, the lack of family support, financial problems and health problems. However, caregiving often also improves caregiver’s self-esteem (feeling of gratification to be helping).
PMCID: PMC3854764  PMID: 24138932
Juvenile idiopathic Arthritis; Caregiver; CRA; Burden; Care at home
24.  A randomized control trial of the effect of yoga on Gunas (personality) and Self esteem in normal healthy volunteers 
International Journal of Yoga  2009;2(1):13-21.
To study the efficacy of yoga on Gunas (personality) and self esteem in normal adults through a randomized comparative study.
Materials and Methods:
Of the 1228 persons who attended motivational lectures, 226 subjects aged 18–71 years, of both sexes, who satisfied the inclusion and exclusion criteria, and who consented to participate in the study were randomly allocated into two groups. The Yoga (Y) group practised an integrated yoga module that included asanas, pranayama, meditation, notional correction, and devotional sessions. The comparison group practised mild to moderate physical exercises (PE). Both groups had supervised practices for one hour daily, six days a week, for eight weeks.
Guna (personality) was assessed before and after eight weeks using the self-administered “The ’Gita” Inventory of Personality” (GIN) to assess Sattva, Rajas, and Tamas. Self esteem in terms of competency (COM), global self esteem (GSE), moral and self esteem (MSE), social esteem (SET), family self esteem (FSE), body and physical appearance (BPA), and the lie scale (LIS) were assessed using the self esteem questionnaire (SEQ).
The baseline scores for all domains for both the groups did not differ significantly (P > 0.05 independent samples t-test). There were significant pre-post improvements in all domains in both groups (P < 0.001 paired t-test). The number of persons who showed improvement in Sattva and decrease in Tamas was significant in the Y but not in the PE group (McNemar test). The effect size for self esteem in the Y group is greater than for the PE group in three out of seven domains.
This randomized controlled study has shown the influence of Yoga on Gunas and self esteem in comparison to physical exercise.
PMCID: PMC3017961  PMID: 21234210
Guna; self esteem; Yoga
25.  Applying an Educational-participatory Program based on the PRECEDE Model for Promoting Self-esteem and Mental Health of Students in Iran 
The students’ vulnerability to different problems can have an impact on their mental health. Regarding the lack of evidence on the effectiveness of interventional programs based on health education planning models in this area in developing countries, an educational-participatory program based on the PRECEDE model was used, to promote the medical science students’ self-esteem and mental health status, in Iran.
In this experimental study, 154 students from the universities of medical sciences in the north east of Iran were selected by stratified random sampling method. Then, they were randomly assigned to two groups of case and control. The questionnaires, including the enabling, reinforcing, and predisposing factors, the Rosenberg self-esteem scale, and the GHQ-28 were used for data collection. Then, an intervention plan, including focus group discussions and training of selected life skills, based on the PRECEDE model, was conducted for the case group.
The predisposing, reinforcing, and enabling factors, and the self-esteem and mental health of the students showed a significant difference between the case and control groups. The Pearson correlation coefficient showed that there was a correlation between mental health and knowledge (P =0.008), between self-esteem and knowledge (P =0.02), self-esteem and attitude (P =0.01), and mental health and attitude (P = 0.03).
Health promotion planning by using life skills training based on the PRECEDE model can result in participation and empowerment, in order to promote the self-esteem and mental health of the students.
PMCID: PMC3354393  PMID: 22624080
Mental health; PRECEDE model; self-esteem; students

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