Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies.

TLDR: If future research supports the hypothesized causality of the vulnerability effect of low self- esteem on depression, interventions aimed at increasing self-esteem might be useful in reducing the risk of depression.

Abstract: Low self-esteem and depression are strongly related, but there is not yet consistent evidence on the nature of the relation. Whereas the vulnerability model states that low self-esteem contributes to depression, the scar model states that depression erodes self-esteem. Furthermore, it is unknown whether the models are specific for depression or whether they are also valid for anxiety. We evaluated the vulnerability and scar models of low self-esteem and depression, and low self-esteem and anxiety, by meta-analyzing the available longitudinal data (covering 77 studies on depression and 18 studies on anxiety). The mean age of the samples ranged from childhood to old age. In the analyses, we used a random-effects model and examined prospective effects between the variables, controlling for prior levels of the predicted variables. For depression, the findings supported the vulnerability model: The effect of self-esteem on depression (β = -.16) was significantly stronger than the effect of depression on self-esteem (β = -.08). In contrast, the effects between low self-esteem and anxiety were relatively balanced: Self-esteem predicted anxiety with β = -.10, and anxiety predicted self-esteem with β = -.08. Moderator analyses were conducted for the effect of low self-esteem on depression; these suggested that the effect is not significantly influenced by gender, age, measures of self-esteem and depression, or time lag between assessments. If future research supports the hypothesized causality of the vulnerability effect of low self-esteem on depression, interventions aimed at increasing self-esteem might be useful in reducing the risk of depression.

Figures

Table 1 (continued)

Table 5 Correlations and Standardized Regression Coefficients for Sample Characteristics Predicting the Self-Esteem Effect on Depression (k =69)

Table 1 (continued)

Table 4 Summary of Effect Sizes for Relation Between Self-Esteem (SE) and Anxiety (ANX)

Figure 1. The figure illustrates the coefficients meta-analyzed in the present research, exemplary for the relation between self-esteem and depression (the coefficients for the relation between self-esteem and anxiety were specified accordingly). The relations between the variables at the two measurement occasions are specified as cross-lagged effects and stability effects. The crosslagged effects indicate the prospective effect of one variable on the other (e.g., effect of selfesteem at Time 1 on depression at Time 2), after controlling for their stabilities across time (e.g., effect of depression at Time 1 on depression at Time 2). In addition to cross-lagged and stability effects, we also examined the cross-sectional correlation between the constructs, for Time 1 as an example.

Table 8 Analysis of Variance of Self-Esteem Effect on Depression by Depression Measure (k = 77)

Full text

Running Head: DOES LOW SELF-ESTEEM PREDICT DEPRESSION AND ANXIETY? 1
Does Low Self-Esteem Predict Depression and Anxiety?
A Meta-Analysis of Longitudinal Studies
Julia Friederike Sowislo and Ulrich Orth
University of Basel
© American Psychological Association. This article has been accepted for
publication but has not been through the copyediting, typesetting, pagination, and
proofreading process. This article may not exactly replicate the final, authoritative
version published in the journal. It is not the copy of record. Please cite this article
as follows:
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and
anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139, 213-
240. http://dx.doi.org/10.1037/a0028931
Author Note
Julia Friederike Sowislo and Ulrich Orth, Department of Psychology, University of Basel.
This research was supported by Swiss National Science Foundation Grant PP00P1-
123370 to Ulrich Orth.
Correspondence concerning this article should be addressed to Julia Friederike Sowislo,
Department of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland. E-
mail: julia.sowislo@unibas.ch

DOES LOW SELF-ESTEEM PREDICT DEPRESSION AND ANXIETY? 2
Abstract
Low self-esteem and depression are strongly related, but there is not yet consistent evidence on
the nature of the relation. Whereas the vulnerability model states that low self-esteem contributes
to depression, the scar model states that depression erodes self-esteem. Furthermore, it is
unknown whether the models are specific for depression or whether they are also valid for
anxiety. We evaluated the vulnerability and scar models of low self-esteem and depression, and
low self-esteem and anxiety, by meta-analyzing the available longitudinal data (covering 77
studies on depression and 18 studies on anxiety). The mean age of the samples ranged from
childhood to old age. In the analyses, we used a random effects model and examined prospective
effects between the variables, controlling for prior levels of the predicted variables. For
depression, the findings supported the vulnerability model: the effect of self-esteem on
depression (β = -.16) was significantly stronger than the effect of depression on self-esteem (β =
-.08). In contrast, the effects between low self-esteem and anxiety were relatively balanced: self-
esteem predicted anxiety with β = -.10 and anxiety predicted self-esteem with β = -.08.
Moderator analyses were conducted for the effect of low self-esteem on depression; these
suggested that the effect is not significantly influenced by gender, age, measures of self-esteem
and depression, or time lag between assessments. If future research supports the hypothesized
causality of the vulnerability effect of low self-esteem on depression, interventions aimed at
increasing self-esteem might be useful in reducing the risk of depression.
Keywords: self-esteem, depression, anxiety, longitudinal studies

DOES LOW SELF-ESTEEM PREDICT DEPRESSION AND ANXIETY? 3
Does Low Self-Esteem Predict Depression and Anxiety?
A Meta-Analysis of Longitudinal Studies
There is an overwhelming amount of self-help literature that explains how people can
boost and sustain their self-esteem in order to improve their psychological adjustment. But does
self-esteem indeed contribute to psychological health or, to put it differently, does low self-
esteem compromise a person’s psychological adjustment? Previous research suggests that self-
esteem is linked to indicators of psychological adjustment such as happiness (H. Cheng &
Furnham, 2004; Diener & Diener, 1995), high positive affect and low negative affect (Orth,
Robins, & Widaman, 2011), and to the absence, or a low number, of psychological symptoms
such as depression (Orth, Robins, Trzesniewski, Maes, & Schmitt, 2009; J. E. Roberts &
Monroe, 1992) and bulimia (Vohs et al., 2001). However, with respect to many of these
variables, the precise nature of their relation with self-esteem has not ultimately been established
(Baumeister, Campbell, Krueger, & Vohs, 2003).
In the present research, we focus on the relation of self-esteem with two important
indicators of low psychological adjustment, specifically depression and anxiety.
1
The central goal
of this study is to evaluate the vulnerability and scar model of low self-esteem and depression, by
meta-analyzing the available longitudinal data. Moreover, we test whether the vulnerability and
scar model (if supported by the data) are specific for depression or whether they are also valid
models for anxiety. Finally, we examine moderators that might explain variability in the relation
between low self-esteem and depression.
Self-Esteem: Concept, Measurement, Function, and Consequences
Concept of Self-Esteem

DOES LOW SELF-ESTEEM PREDICT DEPRESSION AND ANXIETY? 4
The concept of self-esteem has elicited a large body of theoretical accounts and empirical
research (see, e.g., Baumeister, 1998; Kernis, 2006; Swann & Bosson, 2010). Historically, the
first influential definition of self-esteem dates back to James (1890), who considered self-esteem
to be the ratio of success and pretensions in important life domains. While James focused to a
stronger degree on the individual processes that form self-esteem, later symbolic interactionism
approaches stressed the social influences on self-esteem (Cooley, 1902; Goffman, 1959; Mead,
1934). For instance, in his conception of the looking-glass self, Cooley (1902) hypothesized that
self-views are based upon information gathered from explicit or implicit feedback from others.
More recent definitions of self-esteem emphasize the fact that self-esteem should be
distinguished from other components of the self-concept (such as self-knowledge and self-
efficacy), insofar as self-esteem represents the affective, or evaluative, component of the self-
concept; it signifies how people feel about themselves (Leary & Baumeister, 2000). This
affective self-evaluation is subjective at its core and is not based on specific behaviors (Robins,
Hendin, & Trzesniewski, 2001). According to Rosenberg (1989), high self-esteem “expresses the
feeling that one is ‘good enough’. The individual simply feels that he is a person of worth (… .)
He does not necessarily consider himself superior to others” (p. 31). Although Baumeister and
his colleagues share the view of self-esteem as self-appraisal with an affective component, they
expand the definition of self-esteem to include feelings of superiority, arrogance, and pride (e.g.,
Baumeister, 1998; Baumeister, Smart, & Boden, 1996).
In the literature, it is debated whether self-esteem is best conceptualized as a global
evaluation of the self (i.e., global self-esteem) or as an evaluation in specific self-relevant
domains such as intellectual abilities, physical appearance, and social competence (i.e., domain-
specific self-esteem; Swann & Bosson, 2010). One finding that sheds more light on this debate is

DOES LOW SELF-ESTEEM PREDICT DEPRESSION AND ANXIETY? 5
that both global and domain-specific self-evaluations show predictive ability for important
outcomes, as long as these outcomes exhibit the same degree of specificity as the self-evaluation
which is used as a predictor (specificity-matching principle; Swann, Chang-Schneider, &
McClarty, 2007). More precisely, global self-esteem seems to have predictive ability for
outcomes measured at a global level (such as several outcomes bundled together; for an example
see Trzesniewski et al., 2006), whereas domain-specific self-esteem seems to have predictive
ability for outcomes measured at a specific level (e.g., academic self-esteem predicts academic
outcomes; Marsh, Trautwein, Lüdtke, Koller, & Baumert, 2006).
With regard to the relation between self-esteem and psychological adjustment, there are
three reasons for focusing on global self-esteem rather than domain-specific self-esteem. First,
most of the theories linking self-esteem to psychological adjustment address global self-esteem
but not domain-specific self-esteem (e.g., Abramson, Seligman, & Teasdale, 1978; Blatt,
D'Afflitti, & Quinlan, 1976; G. W. Brown & Harris, 1978). Second and relatedly, most studies in
this field have used measures of global self-esteem (for reviews see Orth, Robins, & Roberts,
2008; Zeigler-Hill, 2010). Third, according to the specificity-matching principle it seems
reasonable to examine global self-esteem in this context, because indicators of psychological
adjustment such as depression and anxiety are relatively global constructs that combine a number
of cognitive, affective, and somatic symptoms (Swann et al., 2007).
Measurement of Self-Esteem
Measures of self-esteem reflect the distinction between global and domain-specific self-
evaluations (for a review see Blascovich & Tomaka, 1991). Frequently used measures of global
self-esteem, all of which are multi-item scales, include the Rosenberg Self-Esteem Scale
(Rosenberg, 1965), the Janis-Field Feelings of Inadequacy Scale (Fleming & Courtney, 1984),

Frequently asked questions

Q1. What contributions have the authors mentioned in the paper "Running head: does low self-esteem predict depression and anxiety? 1 does low self-esteem predict depression and anxiety? a meta-analysis of longitudinal studies" ?

In the analyses, the authors used a random effects model and examined prospective effects between the variables, controlling for prior levels of the predicted variables. If future research supports the hypothesized causality of the vulnerability effect of low self-esteem on depression, interventions aimed at increasing self-esteem might be useful in reducing the risk of depression. In contrast, the effects between low self-esteem and anxiety were relatively balanced: selfesteem predicted anxiety with β = -. 10 and anxiety predicted self-esteem with β = -. 08. Moderator analyses were conducted for the effect of low self-esteem on depression ; these suggested that the effect is not significantly influenced by gender, age, measures of self-esteem and depression, or time lag between assessments. 

Q2. What is the problem of the exclusive reliance on self-report methodology?

Although the vast majority of the measures used are reliable and well-validated, a problem of the exclusive reliance on self-report methodology is that correlations between measures may be artificially inflated by shared method variance. 

Q3. Why has cross-lagged correlation analysis been critiqued?

Cross-lagged correlation analysis has been critiqued because cross-lagged correlations not only reflect the prospective influence of the predictor on the outcome, but also depend on the stability of the outcome (Locascio, 1982; Rogosa, 1980). 

Q4. What was the number of studies on which the other cross-lagged effects were based?

the number of studies on which the other cross-lagged effects were based was relatively low (i.e., 42, 18, and 10 studies), which limited the statistical power of moderator analysis. 

Q5. How did the authors deal with missing data in the moderator analyses?

The authors therefore used the complete case analysis method (i.e., listwise deletion) to deal with missing data in the moderator analyses (Pigott, 2009). 

Q6. What is the main reason why the present meta-analysis did not allow testing the common cause model?

The present meta-analysis did not allow testing the common causemodel because very few of the primary studies examined third variables that could serve as a common cause (as mentioned above, it would for example be interesting to test whether neuroticism is a common cause of low self-esteem and depression).