Self-esteem, symptom severity, and treatment response in adolescents with internalizing problems

BACKGROUND

Adolescents with low self-esteem often experience internalizing psychopathology (i.e., anxiety, depression). Self-esteem may therefore be a clinically relevant construct for assessment and treatment outcomes. We examined whether general and domain-specific (family, peer, academic) self-esteem are related to adolescents' internalizing symptom severity and response to cognitive behavioural therapy (CBT).

METHOD

Participants were 89 adolescents ages 14 to 18 years (M = 16.3, 70% females) from an outpatient clinic who were referred for CBT. Adolescents completed measures of self-esteem at baseline and measures of internalizing symptoms at baseline and at the end of a manualized group CBT intervention.

RESULTS

Lower peer and family self-esteem, but not academic self-esteem, were associated with more internalizing symptoms at baseline, after controlling for general self-esteem. However, only higher general self-esteem, and not any of the specific self-esteem domains, predicted lower internalizing symptoms at posttreatment. Follow-up analyses revealed differential associations between family and peer self-esteem domains and anxious and depressive symptoms.

LIMITATIONS

Only self-report measures were used. The relatively small sample size may have limited power to detect small effects.

CONCLUSIONS

Self-esteem in domains regarding family and peer relationships may be important in the evaluation of adolescents with internalizing problems. Adolescents with low general self-esteem may benefit less from CBT than other adolescents. Addressing negative self-perceptions may be necessary to reduce internalizing symptoms for adolescents with low self-esteem.

Subjective Recovery in Patients with Schizophrenia and Related Factors

Subjective recovery is a personally perceived recovery involving other factors beyond clinical recovery. This study aims at investigating the factors related to subjective recovery in patients with schizophrenia living in Turkey. This study assessed 120 clinically stable outpatients with schizophrenia or schizoaffective disorder using the clinical and psychosocial scales. Gender, type of the diagnosis of disease, and age of the illness onset were found to be correlated with the subjective recovery. Subjective recovery was significantly correlated with CGI-S (r = - 0.25), total PANSS score (r = - 0.29), global assessment of functioning (r = 0.27), social functioning (r = 0.43), internalized stigma (r = - 0.38), self-esteem (r = 0.56), depression (r = - 0.59), and hopelessness (r = - 0.55). Hopelessness and self-esteem were found to be predictive of the subjective recovery explaining 52% of the variance. It can be argued that efforts to promote hope and self-esteem contribute to the subjective recovery.

Health Risk Behaviors and Self-Esteem Among College Students: Systematic Review of Quantitative Studies

BACKGROUND

Due to their impact on premature mortality and long-term disabilities, a better understanding of health risk behavior (HRB) determinants among college students is crucial in order to build the most appropriate prevention tools. Although self-esteem appears to be a relevant candidate, a clear picture summarizing its multiple links with HRB is lacking to guide clinicians and researchers. This study aims to provide a systematic review of the associations between health risk behavior and self-esteem among college students.

METHODS

This search was performed in several databases on 02/02/17. Study eligibility criteria were original articles in peer-reviewed journals, in English; observational quantitative studies; among college students; and investigated the association between self-esteem and HRB. The PRISMA statements were complied with.

RESULTS

One hundred fifteen articles were included: 46 on substance use, 35 on sexual behavior, 11 on nutritional habits, 27 on physical activity, and 5 on other HRB. Most studies reported an association between higher self-esteem and healthier behavior. For alcohol consumption and number of sexual partners, both negative and positive associations have been reported. Directionality was investigated in a few studies suggesting potential bidirectional effects.

CONCLUSIONS

This review points out the need for consensus for the definition of self-esteem and HRB. There was high heterogeneity in (1) the measurement of self-esteem either in the concept measured (global vs. domain) or in the way to implement validated tools; and (2) the definition of HRB. Self-esteem seems to be a relevant target to intervene on HRB, especially alcohol abuse and physical activity.

TRIAL REGISTRATION

Registration number: PROSPERO (ID = CRD42017056599).

Assessing recovery-related behaviors, emotions, and cognitions among members of alcoholics anonymous over 7 days: Quantitative daily diary data

This was a quantitative daily dairy study that consisted of an initial baseline assessment followed by 7 nightly reports collected each evening. Participants were members of Alcoholics Anonymous (N = 113) and were recruited through social media networks (e.g., large recovery-related Facebook groups, twitter, Instagram, etc.), an email list from people in recovery who had previously participated in research, and through the use of snowball sampling. The analyses used in the resultant article was multilevel modeling with daily reports nested within individuals (LaBelle, 2020). These data may be reused for cross-sectional studies to look at relationships among the study variables, or across days to assess individual differences in behavior.

Internal consistency and correlation of the adverse childhood experiences, bully victimization, self-esteem, resilience, and social support scales in Nigerian children

OBJECTIVES

We evaluated the internal consistencies and the correlation between measures of adverse childhood experiences (ACE), bully victimization, self-esteem, resilience, and social support in children/adolescents in Nigeria.

RESULTS

The Cronbach's alphas were 0.67 for the ACE Questionnaire; 0.79 for the victimization subscale of the Illinois Bully Scale; 0.60 for Rosenberg's self-esteem scale; 0.81 for Connor-Davidson resilience scale; and 0.93 for multidimensional perceived social support scale. Social support was negatively correlated with ACE (r = - 0.21) and bully victimization (r = - 0.16) and was associated with higher self-esteem (r = - 0.29) and higher resilience (r = 0.15). Likewise, higher resilience was associated with fewer ACE (r = - 0.07), higher self-esteem (r = - 0.21), and higher bully victimization (r = 0.13). Higher self-esteem was associated with fewer ACE (r = 0.25) and lower bully victimization (r = 0.16), whereas bully victimization was positively correlated with ACE (r = 0.20). The correlations were all statistically significant.

"I'm Proud to be a Little Bit Different": The Effects of Autistic Individuals' Perceptions of Autism and Autism Social Identity on Their Collective Self-esteem

This study aimed to identify the attributes that autistic people perceive as positively and negatively impacting on their identity and wellbeing. In Study 1, we recruited 140 autistic participants for an online survey. Participants completed autism social identification and collective self-esteem measures and listed attributes they associated with autism. In Study 2, we conducted focus groups with 15 autistic people to explore how positively they perceived the attributes of autism. Participants then discussed the autism attributes in relation to their own experiences and identity. We found a positive relationship between the number of positive attributes participants associated with autism, and their collective self-esteem, to the extent that they identified with other autistic people.

Sport burnout inventory-Dual career form for student-athletes: Assessing validity and reliability in a Finnish sample of adolescent athletes

BACKGROUND

The pressure of pursuing an athletic career simultaneously with education may set adolescent student-athletes at risk for sport and school burnout. Although the 2 life domains of student-athletes are strongly intertwined, so far, there has not been an instrument for investigating sport burnout parallel to school burnout. The aim of the present study was to introduce a sport burnout measure for adolescents in a dual career context and investigate its validity and reliability by using confirmatory factor analysis.

METHODS

The participants were 391 student-athletes (51% females) who filled in a questionnaire of sport burnout and background variables in the beginning of upper secondary school.

RESULTS

A 3-factor model or a second-order-factor model described the data better and gave better reliability indices than a 1-factor model. The 3 dimensions of sport burnout were shown to be separate, but closely related constructs. Evidence for convergent and discriminant validity was obtained by correlating the 3 sport burnout dimensions with depressive symptoms, self-esteem, and sport task values.

CONCLUSION

The results suggest that Sport Burnout Inventory-Dual Career Form (SpBI-DC) is a valid and reliable instrument for investigating sport burnout among adolescent student-athletes.

Do Low Self-Esteem and High Stress Lead to Burnout Among Health-Care Workers? Evidence From a Tertiary Hospital in Bangalore, India

Background

Low self-esteem can be an issue among health-care workers due to the hierarchical medical system. Health-care workers are also in a high pressure environment that can lead to stress and burnout. This study was conducted to estimate the proportion of health-care workers with low self-esteem, high stress, and burnout and the factors associated with these in a private hospital in Bangalore city.

Methods

This cross-sectional study included a random sample of health-care workers of various cadres - doctors, nurses, nursing aides, technicians, and workers in ancillary departments such as laundry, dietary, central sterile supply department, and pharmacy, with probability proportional to size. Rosenberg Scale for Self-esteem, Cohen's Perceived Stress Scale, and Shirom-Melamed Burnout Measure were used as study tools.

Results

Among the 306 health-care workers, there were high levels of low self-esteem (48.4%), stress (38.6%), and burnout (48.7%), with the lowest levels being among doctors. Those aged younger than 30 years had significantly lower self-esteem and greater stress.

Conclusions

Health-care workers with low self-esteem were nearly thrice more likely to suffer high stress, Odds Ratio (OR) = 2.84 (1.36-5.92), and those who were stressed had more than three times higher chance of experiencing burnout, OR = 3.6 (2.02-6.55). Path analysis showed that low self-esteem among health-care workers had a direct effect on burnout, as well as an indirect effect through stress (mediator variable). This study indicates the need for screening and counseling for low self-esteem, stress, and burnout as part of a periodic medical examination of all cadres of health workers.

Interactive effects of personal resources and job characteristics on mental health: a population-based panel study

Purpose

We examined 10 job characteristics in a large population-based sample and tested for positive and negative effects on mental health. In addition, we tested for possible effects on mental health from interactions with locus of control and self-esteem.

Methods

The sample comprised longitudinal data on 2353 male and 1960 female employees from the German socio-economic panel collected between 2010 and 2012. Mental health was assessed with the mental component summary score derived from the short-form 12 health survey. We computed hierarchical regression analyses while controlling for potential confounds and baseline mental health. Interaction effects were specified with post hoc simple slope analyses.

Results

Time pressure, interruptions, job insecurity, and conflicts were negative predictors of mental health in all models. The personal resource of self-esteem was a positive predictor. Moreover, there were interactions: opportunities for promotion were beneficial only for employees with medium or high levels of self-esteem, whereas the contrary was true for employees with very low self-esteem. Working on weekends was negatively related to mental health for people with moderate to low internal control but not for people with high internal control.

Conclusions

The findings suggest that there are job demands that are related to poor mental health regardless of personal resources. These aspects are important to consider in workplace risk assessment. By contrast, with other job characteristics (e.g., opportunities for promotion, weekend work), the effects vary between individuals.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01555-0) contains supplementary material, which is available to authorized users.

The effects of hardcore smokers' depression and self-esteem on daily smoking amount

BACKGROUND

This is a secondary data analysis designed as a longitudinal study aimed at investigating the effects of depression and self-esteem on daily smoking amounts among hardcore smokers over time.

METHODS

The subjects of this study were 264 hardcore smokers aged 19 years or older who participated in all waves of the 9th-13th Korea Welfare Panel Studies. Self-report questionnaires were used to collect data. Data analyses were performed using SPSS WIN 24.0 and AMOS 18.0, and data were analyzed using a latent growth model.

RESULTS

The intercept of depression and self-esteem among the subjects had statistically significant effects on the intercept of the daily smoking amount. The slope of depression and self-esteem among the subjects also had statistically significant effects on the slope of the daily smoking amount. The slope of depression indirect affected the slope of daily smoking amount via the level of self-esteem.

CONCLUSION

It is important to determine the initial levels and the rates of change of depression, self-esteem, and daily smoking amount among hardcore smokers. In order to reduce the daily smoking amount among hardcore smokers, interventions for depression and methods to improve self-esteem among hardcore smokers should be considered.

Does high teacher autonomy support reduce smartphone use disorder in Chinese adolescents? A moderated mediation model

The Interaction of Person-Affect-Cognition-Execution model (I-PACE; Brand, Young, Laier, Wölfling, & Potenza, 2016) proposes that addictive behavior is the result of the interaction of multiple factors. According to I-PACE model, perceived social support (teacher autonomy support), self-esteem, and gratification (life satisfaction) contribute to adolescent smartphone use disorder (SUD) (Brand et al., 2016). However, previous studies have rarely examined the interactive effects of teacher autonomy support, self-esteem and life satisfaction on adolescent SUD. The present study examined these relationships using a moderated mediation model in which self-esteem played a mediating role and life satisfaction played a moderating role in the relation between teacher autonomy support and adolescent SUD. A sample of 1912 Chinese adolescents completed measures of teacher autonomy support, self-esteem, life satisfaction, and adolescent SUD. Self-esteem mediated the association between teacher autonomy support and adolescent SUD. In addition, the relation between teacher autonomy support and SUD was moderated by life satisfaction: when the effect of life satisfaction was high, teacher autonomy support negatively predicted adolescent SUD, whereas when the effect of life satisfaction was low, teacher autonomy support was positively related to adolescent SUD. These findings advance our understanding of the effect of teacher autonomy support, self-esteem and life satisfaction on adolescent SUD. Limitations and implications of this study are discussed, such as teacher autonomy support may not reduce adolescent SUD, especially when their life satisfaction is low.

Psychological well-being and weight-related teasing in childhood obesity: a case-control study

PURPOSE

The prevalence of childhood obesity continues to increase worldwide. The aims of this study were to (1) assess the psychological well-being and rates of teasing of Spanish children with obesity (OG) and compare them with their non-overweight peers (NG), and (2) analyze the mediating role of weight-related teasing on the relation between children's BMI z score and psychological well-being.

METHODS

The cross-sectional study included 50 preadolescents with obesity, matched with non-overweight children according to age, sex, and socioeconomic status, who were assessed via self-report instruments measuring anxiety, depression, self-esteem, and teasing.

RESULTS

The OG reported higher anxiety, depression, and teasing, and lower self-esteem. SEM revealed that children who scored worse on instruments assessing psychological well-being had higher BMI z scores. Weight-related teasing predicted poor psychological well-being scores and weight-related teasing mediated the relation between BMI and psychological well-being.

CONCLUSIONS

The high rates of anxiety, depression, and weight-related teasing, as well as the low self-esteem, which was observed amongst the children with obesity, raise concerns about the quality of life of this population. Furthermore, the finding that weight-related teasing mediated the relationship between BMI and psychological well-being adds to a growing body of research, highlighting the harmful effects of weight-related stigma. Overall, these results highlight the importance of early intervention to assess for, and address, the presence of weight-related teasing and psychological well-being difficulties in preadolescents with obesity.

LEVEL OF EVIDENCE

Level III, case-control study.

Portion perfection and Emotional Freedom Techniques to assist bariatric patients post surgery: A randomised control trial

BACKGROUND

Although significant health improvements are indicated from weight-loss following bariatric surgery, many individuals are unable to lose weight or maintain their weight-loss. The current study aimed to assess whether post-surgery care comprising Emotional Freedom Techniques (EFT), an emerging energy psychology intervention, combined with a behaviour-based nutrition and portion control eating plan in an online self-guided delivery would aid weight-loss and maintenance in bariatric patients.

METHODS

A 6-month randomised controlled parallel-group trial. Participants (N = 343; aged 21-69 years; BMI ≥30 kg/m2) had undergone bariatric surgery (12 + months prior) and were randomly assigned to one of three treatment groups: Portion Perfection for Bariatric Patients (PPBP; n = 109), PPBP combined with an eight-week online self-paced EFT treatment (n = 107), and a treatment as usual (TAU) control (n = 127). Participants completed measures of BMI, emotional eating, uncontrolled eating, food cravings, and self-esteem at 8-week post-treatment (n = 158) and 6-month follow-up (n = 109).

RESULTS

Mixed-design analyses of variances were conducted to examine the effect of the interventions on outcome measures (pre-intervention, 8-week post-intervention, and 6-month follow-up). Emotional eating decreased significantly from pre-intervention to post-intervention for the PPBP and PPBP with EFT groups, and at 6-month follow-up for the TAU group only. There were no statistically significant between-group differences in other outcome variables. However, at 6-months the PPBP with EFT group experienced the greatest improvements in emotional eating (-16.33%), uncontrolled eating (-9.36%), and self-esteem (+4.43%), compared to PPBP only or TAU.

CONCLUSION

The effect of EFT combined with the eating plan on psychological variables was largely inconsistent with prior research and discussion of how this may be optimised in future trials is discussed.

CLINICAL TRIAL REGISTRATION

ACTRN12616001257459.

A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring?

Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.

Impact of problematic internet use on the self-esteem of adolescents in the selected school, Kerala, India

BACKGROUND

Internet use is one of the essential tools of our present-day society whose impact is seen on adolescents such as increased use of the internet because they have free easy and daily access to the internet. Problematic internet use has become a global phenomenon that causes serious problem to the affected individual leading to impairment in psychological well-being.

AIM

The present study aims to assess the level of problematic internet use and self-esteem among adolescents in selected schools, Kochi, Kerala, India.

SETTING

The study conducted in Private Aided School, in Kothamangalam Thaluk of Ernakulam Dist., Kerala.

METHOD

The study with the cross-sectional design was conducted for a period of one month among 60 students and participants were selected using non-probability, convenient sampling. The samples were provided with a self-administered questionnaire after obtaining written consent from their parents and the students.

RESULT

Karl-Pearson coefficient indicated a significant negative correlation between self-esteem and Internet addiction (r = -0.649 and p < 0.001).

CONCLUSION

The use of internet has been found to have a powerful impact on adolescents, especially in areas of self-esteem, and at times, it may affect their social life and relationship with the family.

Quality of life and self-esteem in 7-year-old children with familial high risk of schizophrenia or bipolar disorder: the Danish High Risk and Resilience Study-VIA 7-a population-based cohort study

It is well established that children with familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) have a higher risk of developing mental disorders, however, little is known of to what degree the genetic and environmental vulnerabilities affect the quality of life and self-esteem of these children. We aimed to compare the quality of life and self-esteem between children with FHR-SZ or FHR-BP and controls. We used Danish nationwide registers to retrieve a cohort of 522 7-year-old children with FHR-SZ or FHR-BP and controls. Quality of life was assessed with the 'Health-related Quality of Life Screening Instrument', KIDSCREEN-27, and the scale 'Social Acceptance (Bullying)' from the KIDSCREEN-52. Self-esteem was assessed with the self-report scale 'I think I am'. Assessors were blind to familial risk status of the children. Children with FHR-SZ displayed lower levels of the general quality of life, as well as lower scores on the 'Psychological Well-being' scale and the 'School Environment' scale of the KIDSCREEN-27 compared with controls. Both children with FHR-SZ and FHR-BP reported more bullying victimization compared with controls. Children with FHR-SZ reported lower self-esteem on the total scale of 'I think I am', as well as on the 'Skills and talents', the 'Psychological well-being', and the 'Relationships with others' subscales compared with controls. The findings of lower quality of life and self-esteem in children with FHR-SZ together with more bullying victimization in both familial high-risk groups call for studies on low risk, early intervention strategies towards this group of vulnerable children.

The Mediating Effect of Depression and Disability in the Relationship Between Schizophreniaand Self-Esteem

Depressive symptoms, in addition to positive and negative symptoms, are commonly observed in the course of schizophrenia. These symptoms may cause disability and reduced self-esteem. Disability and lower self-esteem may disrupt the quality of life and lead to social isolation. Demonstrating the relationships among these concepts and correcting possible disturbances may help to augment treatment compliance and improve the prognosis. In this study, the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and the Rosenberg Self Esteem Scale (RSES) were applied along with a sociodemographic data form to 146 patients with schizophrenia. Path analyses were used to demonstrate the direct effect of schizophrenia severity on self-esteem and its indirect effect through disability and depression, the mediating effect of depression in the relationship between schizophrenia severity and disability, and the mediator effect of disability in the bidirectional relationship between self-esteem and depression. Statistically significant results were obtained. In multivariate regression analysis, significant effects on disability were demonstrated for PANSS General Psychopathology subscale, CDSS, and RSES. These data suggest that attention should be focused on concepts such as depression, disability, and self-esteem in schizophrenia patients.

Internalization of Western Ideals on Appearance and Self-Esteem in Jamaican Undergraduate Students

Beauty ideals in the Caribbean are shifting with increased exposure to Western and European standards of appearance. Previous research has shown a consistent link between internalization of Western beauty ideals and depressive symptoms and other forms of psychological disturbance among diverse populations including Caribbeans. We examined the association between internalization of Western beauty ideals and depressive symptoms as well as the potential mediating role of self-esteem on this relation in N = 222 students (155 females, 79 males) attending a tertiary institution in Kingston, Jamaica. Internalization of Western ideals was inversely associated with self-esteem (r =- .35, p < .01) and positively associated with depressive symptoms (r =.13, p < .05). In a model adjusted for age and sex, results revealed a significant indirect effect of internalization of Western ideals of appearance on depressive symptoms via self-esteem (estimate= .21, SE = .05, 95% confidence interval [.13, .32]). The potent effects of culture must be better understood as intercontinental travel becomes less important as a mechanism for cultural exposure and exchange, and there is a significant increase of digital and internet access in the Caribbean. The current study suggest that Caribbeans are at significant risk for internalizing Western ideals of beauty, subsequently diminishing their self-esteem, and ultimately increasing depression symptomatology. The benefits and consequences of cultural exchange should continue to be a topic for research studies.

Psychological predictors of 'living well' with dementia: findings from the IDEAL study

Objectives: Increasingly, research has explored how psychological resources enable adaptation to illness. However, it is unclear whether psychological resources protect against the potential negative effects on living well with a progressive and life-limiting condition such as dementia. This paper examines the association between psychological resources and the ability to 'live well' with dementia.Method: Data from 1547 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort were used. Multivariate linear regression was employed to examine the association between self-reported measures of psychological resources (self-efficacy, optimism and self-esteem) and indices of capability to 'live well' (quality of life, well-being and life satisfaction).Results: All three measures of psychological resources had positive and independent associations with indices of living well and the effect sizes were similar. Effect sizes reduced when accounting for shared variance between psychological resources, showing some overlap in these constructs.Conclusion: Self-efficacy, optimism and self-esteem were each associated with capability to 'live well'. Overlap between these three resources is evident and when combined they may provide greater resilience when dealing with the challenges of living with dementia. Interventions for people with dementia could seek to improve levels of these potentially-modifiable psychological resources.

Does body shame mediate the relationship between parental bonding, self-esteem, maladaptive perfectionism, body mass index and eating disorders? A structural equation model

PURPOSE

Body shame has been strongly associated with eating pathology. However, less is known about the predisposing factors linked to these feelings and how they interact with other variables in eating disorder development. Thus, the aim of the present study was to provide a preliminary understanding of the relationship between body shame and some of the major risk factors for eating disorder onset, identifying the possible mechanisms of action. Specifically, we tested a structural equation model in which perceived parental bonding, self-esteem, perfectionism, and body mass index are associated with eating disorder risk via body shame.

METHODS

1156 high school students aged 13-20 were screened by means of self-report measures of parental behavior, self-esteem, perfectionism, body shame and eating disorder risk. The height and weight of each individual were measured.

RESULTS

In predicting eating disorder risk, parental protectiveness (β = 0.09), body mass index (β = 0.18), self-esteem (β = - 0.14) and body shame (β = 0.58) had a direct effect on this variable and overall our model accounted for 58% of its variance. The experience of shame related to one's body appeared to have a considerably significant influence on eating disturbances vulnerability and it also serves as a mediator between other risk factors and eating disturbance risk. A series of multi-group analyses indicated no significant difference between males and females.

CONCLUSION

The emotion of shame may enhance our understanding of eating disorders, as well as being a salient factor for the development of preventive programs and treatment approaches.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Online/offline self-disclosure to offline friends and relational outcomes in a diary study: The moderating role of self-esteem and relational closeness

Previous work suggests that the experiences of online and offline self-disclosure are heterogeneous among individuals. Yet little work has been done to identify the moderating role of individual characteristics and pre-existing relationship characteristics on the diverse relational outcomes. The present study using a 7-day diary design examined whether individuals' self-esteem level and relational closeness would moderate the relationships between online and offline self-disclosure to offline friends and two relational outcomes, that is, relationship satisfaction and trust in friendships. The analyses on 686 diary responses from 98 participants revealed that offline self-disclosure generally predicted greater relationship satisfaction and trust in friendships, whereas the role of online self-disclosure was not statistically significant. More importantly, self-esteem moderated the pattern associated with offline self-disclosure but not that with online self-disclosure. Specifically, offline self-disclosure predicted greater benefits to people with lower self-esteem relative to people with higher self-esteem. Moreover, pre-existing relational closeness moderated the relationship between offline self-disclosure and trust in friendships such that casual friendships benefited more from offline self-disclosure than close friendships did. The present study highlights the importance of personal characteristics and relationship characteristics in understanding the heterogeneous relational influence of different communication modes.

The Effects of Self-Esteem, Coping, and Voice-Related Quality of Life on Communicative Participation Before and After BOTOX® Treatment for Spasmodic Dysphonia

OBJECTIVES/HYPOTHESIS

The purpose of this study was to (1) investigate the percent change in communicative participation in individuals with spasmodic dysphonia (SD) pre- and post-BOTOX® treatment; and (2) to investigate if percent change in communicative participation is predicted by change in self-esteem, coping, and/or Voice-Related Quality of Life (V-RQOL) pre- and post-BOTOX® treatment.

STUDY DESIGN/METHODS

A cross-sectional study of 49 patients was conducted across three clinics, with each participant completing the Rosenberg Self-Esteem Scale, the Voice Disability Coping Questionnaire (VDCQ), the V-RQOL instrument, and the Communication Participation Item Bank (CPIB) before BOTOX® treatment and 10-14 days following BOTOX® treatment.

DATA ANALYSIS

For Research Question 1, a paired t test was applied to test the equality of means for CPIB and to test the pre-post changes among other composite measurements before and after the BOTOX® treatment. For Research Question 2, a multivariable linear regression model was applied with percent change in CPIB as a main outcome, and change in Rosenberg Self-Esteem Scale, VDCQ, and the V-RQOL as independent variables (or covariates) in order to test the associations.

RESULTS

The results indicated that pre- and post-BOTOX® measures of communicative participation are not statistically significantly different among the participants with SD. There was a strong positive correlation between change in coping and voice-related QOL.

CONCLUSIONS

A better understanding of the relationship between communicative participation and voice-related QOL is warranted. Item analysis of the V-RQOL and the VDCQ may illustrate coping strategies and functional impairments and provide further information regarding highly variable communicative participation among individuals with SD.

Avatar Creation in Videogaming: Between Compensation and Constraint

Objective: We examine the extent that videogame avatars provide players with opportunities for identity exploration, aiming to test the findings of self-discrepancy theory research on the user/avatar relationship with novel cognitive anthropological methods. Specifically, we examine if avatar traits are idealized (more representative of players' ideal rather than actual self) or actualized (more representative of players' actual self) as a function of players' self-esteem. Materials and Methods: Utilizing cognitive anthropological methods, we examine the relationship between actual, avatar, and ideal selves. We first asked 21 respondents to list traits they associated with their various selves. We then asked 57 new respondents to perform four pile sorts of the salient items from these lists (1 unconstrained sort of like-traits, and 3 sorts of terms indicative of respondents' ideal/actual/avatar self). Analysis of this "free list" and "pile sort" data allowed us to clarify (in a manner sensitive to gamer culture) relationships between respondents' various conceptions of self, including how those relationships were modified by self-esteem. Illustrative quotes from the interviews further clarified these relationships. Results: Paired t-test analysis shows that informants as a whole describe their avatar compared with actual selves with fewer negative terms (idealization). Low-esteem players actualize what they deem as positive traits onto their avatars, while simultaneously idealizing avatars' negative traits by minimizing them. Compared with low-esteem gamers, high-esteem players associate significantly more positive attributes with all their various selves-actual, avatar, and ideal-while describing avatar compared with actual selves with fewer positive terms and comparable numbers of negative terms (the latter a process of actualization). Conclusion: Results point to the necessity of theoretical accounts that recognize that avatars may reflect a complex relationship with the user's actual and ideal self, without assuming that avatar play frees gamers from offline social, psychological, or bodily constraints.

Meanings and perceptions of women regarding the practice of yoga in pregnancy: A qualitative study

BACKGROUND AND PURPOSE

Considering that pregnancy triggers profound transformations in the life experience of women, among them the need to adapt to a body in a constant process of physiological, psychic, social and emotional change, it is important to identify to what extent yoga can contribute to this process. For this reason, the present study aimed to comprehend the meanings and perceptions of women regarding the practice of yoga during pregnancy.

MATERIALS AND METHODS

A qualitative and descriptive study was carried out with nine women at different gestational ages who were practicing yoga in places with alternative and integrative therapies for pregnant women located in São Paulo, Brazil. Data collection was performed through semi-structured interviews and the women's statements were transcribed, analysed and grouped into three thematic categories.

RESULTS

The analysis of the interviews allowed the identification of three categories 'Benefits of practicing yoga', 'Self-knowledge, autonomy and self-care' and 'Empowerment for the moment of the birth'. These findings allowed us to understand how the women perceived the practice of yoga in the pregnancy and considered it fundamental to the recognition that they were competent and skilled to manage and control their bodies during childbirth.

CONCLUSION

It was concluded that the practice of yoga provided physical and psychosocial benefits for the women of this study, including strengthening of the pelvic floor, pain relief, improvement of breathing, reduction of stress and anxiety, and strengthening of self-confidence, self-esteem and autonomy in the management of the pregnancy and in caring for themselves.

Disentangling the effects of intergenerational transmission of depression from adolescence to adulthood: the protective role of self-esteem

This study aimed to disentangle time-stable and time-varying effects of maternal and paternal depression on trajectories of adolescent depression from ages 13 to 23 and examined whether self-esteem moderates the examined associations. Sex differences in the direct effects of parental depression and its interacted effects with self-esteem were further explored. Data were collected from a sample of 2502 adolescents and their parents participating in a panel study spanning from the year 2000 to 2009 in northern Taiwan. Multilevel modeling was conducted to disentangle the time-stable and time-varying effects of parental depression on adolescent depression. The moderating role of self-esteem and the potential sex differences in the transmission process were tested by adding two- and three-way interactions among parental depression, self-esteem, and sex of adolescents in the models. As predicted, significant time-stable intergenerational transmission of depression was found, indicating that adolescents of parents with higher levels of depression were at increased risks for depression. Self-esteem was further found to buffer the negative effects of maternal depression on development of depression in offspring. No sex-specific intergenerational transmission of depression was observed. In sum, both maternal and paternal depression contributed to elevated levels of adolescent depression. The effects of maternal depression, however, may not be uniform, but depend on levels of self-esteem. Intervention and prevention strategies that enhance self-esteem may help participants withstand the negative effects of maternal depression.