Components of self-esteem in affective patients and non-psychiatric controls

Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem

Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.

A narrative review of cross-sectional and prospective associations between self-schemas and bipolar disorder

The role of self-concept in bipolar disorder (BD) has not been well understood. The present review utilizes the notion of self-schema and interrogates existing research concerning evidence for cross-sectional and prospective associations between four schema-like constructs (i.e. trait self-esteem, dysfunctional beliefs concerning contingent self-worth, early maladaptive schemas and implicit self-esteem) and various facets of BD. Existing findings demonstrate various types of involvement of self-schemas in BD. Of particular clinical relevance, the present review suggests that low trait self-esteem and dysfunctional beliefs concerning contingent self-worth are risk factors for ongoing BD symptoms and mood episodes. The present review also yields important yet unaddressed questions with respect to the evaluative content of self-schemas associated with the hypo/manic phase of BD.

The psycho-periodic cube

The current diagnostic classification systems in psychiatry have been developed primarily for evidence-based clinical decision making with both categorical and dimensional approaches having their own advantages and disadvantages. Efforts have been made to improve these classification systems, and we are now at the point where we must expand beyond the one-dimensionality of these systems. In this paper, we propose that psychiatric disorders can be arranged in a three-dimensional classification system according to the degree of dysfunctions on three specific axes in a way that is similar to the arrangement of chemical elements according to their atomic weights in Mendeleyev's periodic table. For the three axes, we chose externalization, drive, and attention to represent the three-dimensional descriptions of mental health, namely, well-being in social, motivational, and cognitive areas, respectively. Throughout the paper, we explain our reasons for choosing these three axes and compare our hypothesis with categorical diagnostic systems as well as Cloninger's dimensional diagnostic system using personality disorders, affective disorders, and schizophrenia as the specific diagnostic samples.

Implicit and explicit self-esteem in remitted depressed patients

BACKGROUND AND OBJECTIVES

Low self-esteem is a symptom of depression and depression vulnerability. Prior research on self-esteem has largely focused on implicit (ISE) and explicit self-esteem (ESE) as two separate constructs, missing their interaction. Therefore, the current study investigated the interaction between ISE and ESE in a depression-vulnerable group (remitted depressed patients; RDs), compared to never-depressed controls (ND).

METHODS

Seventy-five RDs and 75 NDs participated in the study. To measure ESE, the Rosenberg Self-Esteem Scale (RSES) was used. The Implicit Association Test (IAT) and the Name Letter Preference Task (NLPT) were used to assess ISE.

RESULTS

RDs reported lower ESE than NDs. However, the two groups did not differ on ISE. RDs exhibited a damaged self-esteem or a low-congruent self-esteem, similar to what has been found in currently depressed patients. Moreover, damaged self-esteem was associated with residual depressive symptoms.

LIMITATIONS

The results need to be interpreted with care because the IAT and NLPT did not reveal the same associations with the clinical measures.

CONCLUSIONS

Implicit and explicit self-esteem may be different constructs in depression and studying the combination is important. The present study provides evidence indicating that damaged self-esteem may be more detrimental than low congruent self-esteem.

Implicit motives and cognitive variables: specific links to vulnerability for unipolar or bipolar disorder

Cognitive variables contribute to the etiology of affective disorders. With the differentiation between explicit and implicit measures some studies have indicated underlying depressogenic schemata even in bipolar disorders. We tested for differences in implicit motives and cognitive variables between patients with remitted unipolar and bipolar disorder compared to controls and in a high-risk sample. Additionally we investigated whether affective symptoms relate to those variables. We cross-sectionally examined N=164 participants (53 with bipolar disorder, 58 with major depression, and 53 without affective disorders) and a high-risk sample (N=49) of adolescent children of either parents with unipolar or bipolar disorder or of healthy parents. The Multi-Motive-Grid was used to measure the implicit motives achievement, affiliation, and power, in addition to the cognitive measures of self-esteem, dysfunctional attitudes, and perfectionism. Unipolar and bipolar groups did not differ from healthy controls in implicit motives but showed higher scores in the cognitive factors. Adolescents at high risk for unipolar disorder showed lower scores in the power and achievement motives compared to adolescents at low risk. Subsyndromal depressive symptoms were related to the cognitive variables in both samples. Our results underline the importance of cognitive-behavioral treatment for both unipolar and bipolar disorder.

Depression and aggression in never-married men in China: a growing problem

PURPOSE

China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. The impact on the psychological well-being of the large numbers of men who will never marry is unclear. This study was carried out to test the hypothesis that older never-married men are more predisposed to depression, low self-esteem and aggression.

METHODS

The study was a cross-sectional survey using a self-completion questionnaire conducted in high sex ratio rural areas of Yunnan and Guizhou provinces. The tools used were the Beck Depression Inventory, Rosenberg's Self-Esteem Scale and the Bryant-Smith Aggression questionnaire.

RESULTS

A total of 1,059 never-married men and 1,066 married men aged 30-40 completed questionnaires. Never-married men were financially poorer and had lower education levels than married ones. After adjusting for age, education and income, never-married men were significantly more likely to have lower self-esteem scores (P < 0.001), higher depression scores (P < 0.001), higher aggression scores (P < 0.001) and were more likely to have suicidal thoughts or wishes (P < 0.001) than married men.

CONCLUSION

The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services.

Is coping well a matter of personality? A study of euthymic unipolar and bipolar patients

BACKGROUND

Euthymic bipolar disorder (BD) patients often demonstrate better clinical outcomes than remitted patients with unipolar illness (UP). Reasons for this are uncertain, however, personality and coping styles are each likely to play a key role. This study examined differences between euthymic BD and UP patients with respect to the inter-relationship between personality, coping style, and clinical outcomes.

METHODS

A total of 96 UP and 77 BD euthymic patients were recruited through the CADE Clinic, Royal North Shore Hospital in Sydney, and assessed by a team comprising Psychiatrists and Psychologists. They underwent a structured clinical diagnostic interview, and completed self-report measures of depression, anxiety, stress, personality, coping, social adjustment, self-esteem, dysfunctional attitudes, and fear of negative evaluation.

RESULTS

Compared to UP, BD patients reported significantly higher scores on levels of extraversion, adaptive coping, self-esteem, and lower scores on trait anxiety and fear of negative evaluation. Extraversion correlated positively with self-esteem, adaptive coping styles, and negatively with trait anxiety and fear of negative evaluation. Trait anxiety and fear of negative evaluation correlated positively with eachother, and both correlated negatively with self-esteem and adaptive coping styles. Finally, self-esteem correlated positively with adaptive coping styles.

LIMITATIONS

The results cannot be generalised to depressive states of BD and UP, as differences in the course of illness and types of depression are likely to impact on coping and clinical outcomes, particularly for BD.

CONCLUSIONS

During remission, functioning is perhaps better 'preserved' in BD than in UP, possibly because of the protective role of extraversion which drives healthier coping styles.

Proneness to decreased negative emotions in major depressive disorder when blaming others rather than oneself

BACKGROUND

One widespread view holds that vulnerability to major depressive disorder (MDD) is linked to overall increases in negative emotionality. In contrast, cognitive attribution theories emphasize the importance of blaming oneself rather than others for negative events. Thus far, the contrasting predictions of these models have not been directly compared. Following the attributional perspective, we tested the hypothesis that people with remitted MDD show no overall bias towards negative emotions, but a selective bias towards self-blaming emotions relative to those emotions associated with blaming others.

SAMPLING AND METHODS

We compared a remitted MDD and a control group on a novel experimental test that allowed us to directly compare proneness to specific emotions associated with different types of self-blame (guilt, shame, self-contempt/disgust) and blame of others (other-indignation/anger, other-contempt/disgust) whilst controlling for negative valence and medication status, and excluding comorbidity.

RESULTS

In agreement with our hypothesis, individuals with remitted MDD exhibited an increased self-contempt bias (difference between contempt/disgust towards self and others) but no increased proneness to any other negative emotion or overall increases in perceived negative valence of stimuli. Moreover, the remitted MDD group exhibited reduced contempt/disgust towards others.

CONCLUSIONS

Our results corroborate the prediction that vulnerability to MDD is associated with an imbalance of specific self- and other-blaming emotions rather than a general increase in negative emotions. Based on the composition of our sample, we speculate that self-contempt bias may be particularly characteristic of melancholic MDD subtypes and could be useful for stratification of depression in the future.

Factor Structures of the Rosenberg Self-Esteem Scale

The dimensionality of the Rosenberg Self-Esteem Scale was examined in this meta-analysis of 23 studies consisting of 80 independent samples representing a total sample of 32,491 participants. The 2-factor structure with a positive self-esteem factor defined by 5 positively worded items and a negative self-esteem factor defined by 5 negatively worded items was generally supported. However, samples in Schmitt and Allik (2005 ) generated a global self-esteem factor. High coefficients of congruence for noncounterpart factors revealed overlap between positive and negative self-esteem factors. Hence, the 1-factor solution is recommended unless further findings support that positive and negative self-esteem factors in fact measure substantively different underlying constructs.

Association of social anxiety with stigmatisation and low self-esteem in remitted bipolar patients

Aydemir O, Akkaya C. Association of social anxiety with stigmatisation and low self-esteem in remitted bipolar patients.

Background: In remitted bipolar disorder, it is aimed to show the association between social anxiety, self-esteem and stigmatisation.

Methods: From two university clinics, a sample of 150 remitted bipolar patients was included in this study. Patients were assessed with Liebowitz Social Anxiety Scale, Rosenberg Self-Esteem Scale and sense of stigmatisation subscale of Bipolar Disorder Functioning Questionnaire (Stigma) and were rated with Hamilton Depression Rating Scale and Young Mania Rating Scale for mood symptoms. Confirmatory path analysis was performed.

Results: The mean age of the patients was 39.5, and 52.7% (n = 79) were female. Ninety per cent (n = 135) of the patients had bipolar I disorder. The mean duration of the illness was 13.4 years and the mean number of episodes was 7.8. The model was subjected to confirmatory path analysis and the goodness-of-fit index was calculated to be 0.909, the confirmatory fit index was found to be 0.902 and the root mean square error of approximation was 0.097. Self-esteem was negatively associated with stigmatisation (r = −0.746). Social anxiety was positively associated with self-esteem (r = 0.494). Social anxiety was negatively associated with stigmatisation (r = −0.381).

Conclusions: In remitted bipolar patients, social anxiety is very high and this social anxiety seems to be caused by self-stigmatisation and low self-esteem.

Effects of depression, anxiety, self-esteem, and health behaviour on neonatal outcomes in a population-based Hungarian sample

OBJECTIVE

To investigate possible associations of maternal antenatal depression, anxiety and self-esteem with negative neonatal outcomes controlling for the effects of demographic covariates and health behaviour in a Hungarian sample.

STUDY DESIGN

A population-based monitoring system was established in 10 districts of health visitors in Szombathely, Hungary, covering every woman registered as pregnant between February 1, 2008 and February 1 2009. Three hundred and seven expectant women in the early stage of their pregnancy were surveyed using the Short Form of Beck Depression Inventory for the measurement of depression and the Spielberger Trait-Anxiety Inventory for the measurement of anxiety. Self-esteem was evaluated by the Rosenberg's Self-Esteem Scale. At the end of the follow-up period, data on 261 mothers and their singleton neonates were available. The relationship between the explanatory and outcome variables (birth weight, length, chest circumference, gestational age, and 1- and 5-min Apgar score) was tested in girls and boys separately by multiple linear regression analysis (Forward method). Categorical variables were used as "dummy variables".

RESULTS

Maternal depression, anxiety and health behaviour did not show any association with neonatal outcomes. Higher level of maternal self-esteem was associated with higher birth weight and birth length in boys and higher birth length in girls. Maternal education positively correlated with birth length, gestational age and chest circumference in boys, and with birth length in girls. In girls, maternal socioeconomic status showed a positive association with birth weight and gestational age, while common law marriage had a negative effect on birth weight and chest circumference.

CONCLUSIONS

Lower level of maternal self-esteem possibly leads to a higher level of maternal stress which may reduce fetal growth via physiologic changes. Gender differences in associations between demographic factors and neonatal outcome measures indicate differences in fetal development between boys and girls.

Self-esteem in remitted bipolar disorder patients: a meta-analysis

OBJECTIVES

Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls.

METHODS

Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses.

RESULTS

Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohen's d= -0.83), while significantly higher than that of remitted MDD patients (Cohen's d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD.

CONCLUSIONS

By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.

Barriers of antenatal folate-supplementation: The role of depression and trait-anxiety on periconceptional folate-intake

Abstract Objective. The aim of the research was to reveal the effect of antenatal depressive symptoms and trait-anxiety on folate supplementation. Higher levels of depression, and trait-anxiety were hypothesized to be associated with insufficient folate intake among pregnant women in early pregnancy. Methods. Level of depressive symptoms, trait-anxiety, self-esteem, social capital, self-related health, and demographic factors (age, number of siblings, marital, educational, employment, and socioeconomic-status) were established among 185 Hungarian women in the first trimester of their pregnancies. Depressive symptoms and trait-anxiety were evaluated with the Short Hungarian Version of the Beck Depression Inventory and the Hungarian version of the Spielberger State-Trait Anxiety Inventory form Y (STAI-Y). Results. The higher levels of both trait-anxiety and self-esteem decreased the folate-intake significantly, OR=0.925 (95%CI=0.863-0.991; P=0.026) and OR=0.897 (95%CI=0.808-0.996; P=0.041) while depressive symptoms did not have an effect on it. The lower level of education (less than 8 elementary years) had similar effects (OR=0.228 [95%CI=0.064-0.817], P=0,023). The lack of trust had a significant role too (P=0.043): those, who were distrustful with other people, also had a lower chance of supplementation (OR=0.620; 95%CI=0.390-0.986). Conclusions. The way to increase the openness towards folate-supplementation leads through the treatment of psychological disturbances and the restoration of social trust.

The diagnostic value of endothelial function as a potential sensor of fatigue in health

Purpose:

Many epidemiological research studies have shown that vital exhaustion and psychosocial factors are associated with the occurrence of cerebrocardiovascular disease (CCVD). Fatigue is thought to induce endothelial dysfunction and may be linked to the occurrence of CCVD; however, no studies have investigated this potential link. We studied to determine the effect of fatigue on endothelial function in healthy subjects with no traditional CCVD risk factors or potential confounding factors to be controlled.

Subjects and methods:

Peripheral arterial tonometry (PAT) was used to evaluate endothelial function. The influence of the following parameters on endothelial function was analyzed in 74 office workers without traditional CCVD risk factors at health check-ups: endothelial function before and after work, subjective fatigue, lifestyle factors such as sleeping time, and psychosocial factors such as depression and social support.

Results:

Twenty-five subjects (33.8%) had low endothelial function; reactive hyperemia (RH)-PAT index <1.67, even though no abnormalities were reported in the health check-ups. There was no significant difference in endothelial function before versus after labor. Of note, endothelial function was associated with the individual’s level of subjective fatigue (t = 2.98, P = 0.008) and showed a daily fluctuation, sometimes to a pathological degree (<1.67).

Conclusion:

We showed that, even in healthy people, endothelial function fluctuates diurnally, with an interaction between the individual’s cognitive fatigue and the environment, sometimes to a pathological degree. Based on these findings, we suggest that endothelial function is an objective assessment tool of fatigue in healthy individuals.

Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life

This review provides an overview as to how the social and emotional impairments involved in Attention-Deficit/Hyperactivity Disorder affect the quality of life of patients and their families. A model of three categories into which the emotional difficulties fall, and how they impair quality of life, is also presented.

Treatment outcome in psychiatric inpatients: the discriminative value of self-esteem

Self-esteem has been identified as an important clinical variable within various psychological and psychiatric conditions. Surprisingly, its prognostic and discriminative value in predicting treatment outcome has been understudied.

OBJECTIVE

The current study aims to assess, in an acute psychiatric setting, the comparative role of self-esteem in predicting treatment outcome in depression, anxiety, and global symptom severity, while controlling for socio-demographic variables, pre-treatment symptom severity, and personality pathology.

DESIGN

Treatment outcome was assessed with pre- and post-treatment measures.

METHOD

A heterogeneous convenience sample of 63 psychiatric inpatients completed upon admission and discharge self-report measures of depression, anxiety, global symptom severity, and self-esteem.

RESULTS

A significant one-way repeated-measures multivariate analysis of variance (MANOVA) followed up by analyses of variance (ANOVAs) revealed significant reductions in depression (eta2 = .72), anxiety (eta2 = .55), and overall psychological distress (eta2 = .60). Multiple regression analyses suggested that self-esteem was a significant predictor of short-term outcome in depression but not for anxiety or overall severity of psychiatric symptoms. The regression model predicting depression outcome explained 32% of the variance with only pre-treatment self-esteem contributing significantly to the prediction.

CONCLUSIONS

The current study lends support to the importance of self-esteem as a pre-treatment patient variable predictive of psychiatric inpatient treatment outcome in relation with depressive symptomatology. Generalization to patient groups with specific diagnoses is limited due to the heterogeneous nature of the population sampled and the treatments provided. Implications for clinical practice and future research are discussed.

Self-esteem in adolescent patients with attention-deficit/hyperactivity disorder during open-label atomoxetine treatment: psychometric evaluation of the Rosenberg Self-Esteem Scale and clinical findings

To report on (1) psychometric properties of the Rosenberg Self-Esteem Scale (SES) studied in adolescents with ADHD, (2) correlations of SES with ADHD scale scores, and (3) change in patient-reported self-esteem with atomoxetine treatment. ADHD patients (12–17 years), treated in an open-label study for 24 weeks. Secondary analyses on ADHD symptoms (assessed with ADHD-RS, CGI, GIPD scales) and self-esteem (SES) were performed. One hundred and fifty-nine patients were treated. A dichotomous structure of the SES could be confirmed. Reliability and internal consistency were moderate to excellent. Highest coefficients were found for the correlation between SES and GIPD scores. Self-esteem significantly increased over time, accompanied by an improvement of ADHD symptoms and related perceived difficulties. The Rosenberg SES was shown to be internally consistent, reliable, and sensitive to treatment-related changes of self-esteem. According to these findings, self-esteem may be an important individual patient outcome beyond the core symptoms of ADHD.

Psychometric properties of the Rosenberg self-esteem scale in African American single mothers

The Rosenberg Self-Esteem (RSE) Scale is a commonly used measure of global self-esteem, an important element of mental health. The purpose of this cross sectional secondary analysis was to examine the psychometric properties of the scale in a sample of 98 African American single mothers. The RSE Scale showed adequate internal consistency with an alpha coefficient of .83. Two factors that accounted for a total of 54.7% of the variance were extracted. Self-esteem showed a strong negative relationship with both depressive symptoms and negative thinking. This study provides support for the internal consistency of the RSE Scale and partial support for its construct validity in this population. The RSE appears to represent a bidimensional construct of self-esteem for African American women, with the cultural influences of racial esteem and the rejection of negative stereotypes forming a separate and distinct aspect of this concept. The RSE Scale should be used and interpreted with caution in this population given these findings.

Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan

AIMS

The aim of the present study was to gain insight into the prevalence of depression and its association with self-esteem, family, peer and school factors in a large-scale representative Taiwanese adolescent population.

METHODS

A total of 12,210 adolescent students were recruited into the present study. Subjects with a score >28 on the Center for Epidemiological Studies' Depression Scale were defined as having significant depression; the Rosenberg Self-Esteem Scale, Adolescent Family and Social Life Questionnaire and Family C-APGAR Index were applied to assess subjects' self-esteem, family, peer and school factors. The association between depression and correlates were examined on t-test and chi(2) test. The significant factors were further included in logistic regression analysis.

RESULTS

Among 9586 participants (response rate: 86.3%), the prevalence of depression was 12.3%. The risk factors associated with depression in univariate analysis included female gender, older age, residency in urban areas, lower self-esteem, disruptive parental marriage, low family income, family conflict, poorer family function, less satisfaction with peer relationships, less connectedness to school, and poor academic performance. After adjusting the effects of sex, age and location, only subjects with lower self-esteem, higher family conflict, poorer family function, lower rank and decreased satisfaction in their peer group, and less connectedness to school were prone to depression on logistic regression.

CONCLUSION

The prevalence of depression is high in Taiwanese adolescents, and the multiple factors of family, peer, school and individuals are associated with adolescent depression. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

The cognitive side effects of modern ECT: patient experience or objective measurement?

This article explores the subjective experience of cognitive deficits of patients who are treated with electroconvulsive therapy, by using actual comments made in clinical situations. The material is divided into 4 themes: the need for clear information, the importance of validation of experience, the impact of daily disruptions, and the issue of self-esteem. It is argued that despite the low correlation which exists between objectively measured cognitive function and the subjectively experienced impairment, the discrepancy creates a need to take both perspectives into consideration rather than to rely on one or the other. The validity and limitations of using personal narrative as a relevant clinical parameter are discussed.