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The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding.
To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors – identified from a cognitive model – before delusion onset.
A total of 100 patients with persecutory delusions completed a checklist about their subjective experiences in the weeks before belief onset. The checklist included items concerning worry, images, low self-esteem, poor sleep, mood dysregulation, dissociation, manic-type symptoms, aberrant salience, hallucinations, substance use and stressors. Time to reach certainty in the delusion was also assessed.
Most commonly it took patients several months to reach delusion certainty (n = 30), although other patients took a few weeks (n = 24), years (n = 21), knew instantly (n = 17) or took a few days (n = 6). The most frequent experiences occurring before delusion onset were: low self-confidence (n = 84); excessive worry (n = 80); not feeling like normal self (n = 77); difficulties concentrating (n = 77); going over problems again and again (n = 75); being very negative about the self (n = 75); images of bad things happening (n = 75); and sleep problems (n = 75). The average number of experiences occurring was high (mean 23.5, s.d. = 8.7). The experiences clustered into six main types, with patients reporting an average of 5.4 (s.d. = 1.0) different types.
Patients report numerous different experiences in the period before full persecutory delusion onset that could be contributory causal factors, consistent with a complex multifactorial view of delusion occurrence. This study, however, relied on retrospective self-report and could not determine causality.
This study aims to adapt and validate the most common measure of self-esteem, the Rosenberg Self-Esteem Scale (RSES), in the elderly Spanish population based on the initial one-factor model proposed by the author of the scale.
The factorial validity of the scale was tested using confirmatory factor analysis.
The study was carried out in the city of Valencia (Spain).
A total of 231 elderly people with a mean age 72.68 (SD=8.55).
The participants completed the questionnaire RSES for the validation process, sociodemographic data and Mini-Mental State Examination.
Confirmatory factor analysis with a five-item structure for the one-factor structure showed good fit indexes (Chi square  = 217.20, p < .05; CFI = .965; GFI = .980; RMSEA = .070 [90% confidence interval of RMSEA, .022-.087]), and reliability, as internal consistency, measure with Cronbach’s alpha was .732.
The adaptation of the RSES showed a unifactorial structure with good internal consistency. This reduced adaptation/version of the scale may facilitate clinical practice and be useful in research in older people.
Previous research has shown that psychoeducation for bipolar disorder (BD) improves symptoms and reduces relapse risk, but there is little research on how this impacts stigma, perceived recovery and views about diagnosis. The aim of this study was to explore whether a cognitive behaviour therapy (CBT)-based 12-week BD psychoeducation group conducted in a community mental health team for adults impacted perceived stigma, diagnosis-related self-esteem, recovery and views about diagnosis. The case series pre- and post-group had 23 participants across three groups. The Brief Illness Perception Questionnaire, views on Manic Depression Questionnaire, Bipolar Recovery Questionnaire and author-constructed questions were completed pre and post. Twenty participants completed the group. An intent-to-treat repeated measures multiple analysis of variance showed significantly improved perceived recovery and improvements in sense of control and understanding around their diagnosis. Other specific questions such as understanding of triggers and impact of thinking patterns also improved. However, there was no change in the perceived stigma or self-esteem associated with living with BD. CBT-based psychoeducation groups may help improve perceived recovery and factors such as sense of control in BD. However, there appears to be no impact on stigma and self-esteem, and the role of non-specific factors needs to be examined further.
Key learning aims
(1)To raise awareness of the impact of stigma and self-esteem in bipolar disorder.
(2)To understand the content and structure of CBT-based psychoeducation groups.
(3)To consider the potential benefits of CBT-based psychoeducation groups beyond symptoms and relapse reduction on factors such as perceived recovery.
Depression is associated with a multiplicity of adverse outcomes in adolescence, including peer victimization and low self-esteem. Depressive symptoms, peer victimization, and self-esteem are linked in cross-sectional studies, but no longitudinal study has been conducted assessing their developmental pathways in one integrated model across adolescence. We explored their temporal sequencing in a normative sample of 612 Canadian adolescents (54% girls) assessed annually over 5 years (Grade 7 to Grade 11). Potential confounders such as biological sex, ethnicity/race, and parent income and education were statistically controlled. We found evidence for the vulnerability model (self-esteem predicting depression) and the symptoms-driven model (depression predicting peer victimization). Our findings also supported the integration of these pathways into a self-perception driven model characterized by the indirect effect of self-esteem on later peer victimization via depressive symptoms. Specifically, poor self-esteem initiated a developmental cascade that led to poor mood and poor peer relations. These results highlight the importance of helping youth form a healthy identity that promotes positive mental health and peer relations, and the need to intervene with depressed, victimized, and at-risk adolescents to instill positive self-regard. Our results also emphasize the central role that self-perceptions play in the onset and maintenance of poor outcomes.
Interpersonal difficulties in borderline personality disorder (BPD) could be related to the disturbed self-views of BPD patients. This study investigates affective and neural responses to positive and negative social feedback (SF) of BPD patients compared with healthy (HC) and low self-esteem (LSE) controls and how this relates to individual self-views.
BPD (N = 26), HC (N = 32), and LSE (N = 22) performed a SF task in a magnetic resonance imaging scanner. Participants received 15 negative, intermediate and positive evaluative feedback words putatively given by another participant and rated their mood and applicability of the words to the self.
BPD had more negative self-views than HC and felt worse after negative feedback. Applicability of feedback was a less strong determinant of mood in BPD than HC. Increased precuneus activation was observed in HC to negative compared with positive feedback, whereas in BPD, this was similarly low for both valences. HC showed increased temporoparietal junction (TPJ) activation to positive v. negative feedback, while BPD showed more TPJ activation to negative feedback. The LSE group showed a different pattern of results suggesting that LSE cannot explain these findings in BPD.
The negative self-views that BPD have, may obstruct critically examining negative feedback, resulting in lower mood. Moreover, where HC focus on the positive feedback (based on TPJ activation), BPD seem to focus more on negative feedback, potentially maintaining negative self-views. Better balanced self-views may make BPD better equipped to deal with potential negative feedback and more open to positive interactions.
Healthcare professionals who work in palliative care units face stressful life events on a daily basis, most notably death. For this reason, these professionals must be equipped with the necessary protective resources to help them cope with professional and personal burnout. Despite the well-recognized importance of the construct “meaning of work,” the role of this construct and its relationship with other variables is not well-understood. Our objective is to develop and evaluate a model that examines the mediating role of the meaning of work in a multidisciplinary group of palliative care professionals. Using this model, we sought to assess the relationships between meaning of work, perceived stress, personal protective factors (optimism, self-esteem, life satisfaction, personal growth, subjective vitality), and sociodemographic variables.
Professionals (n = 189) from a wide range of disciplines (physicians, psychologists, nurses, social workers, nursing assistants, physical therapists, and chaplains) working in palliative care units at hospitals in Madrid and the Balearic Islands were recruited. Sociodemographic variables were collected and recorded. The following questionnaires were administered: Meaning of Work Questionnaire, Perceived Stress Questionnaire, Life Orientation Test-Revised, Satisfaction with Life Scale, Subjective Vitality Scale, Rosenberg Self-Esteem Scale, and the Personal Growth Scale.
The explanatory value of the model was high, explaining 49.5% of the variance of life satisfaction, 43% of subjective vitality, and 36% of personal growth. The main findings of this study were as follow: (1) meaning of work and perceived stress were negatively correlated; (2) optimism and self-esteem mediated the effect of stress on the meaning attached to work among palliative care professionals; (3) the meaning of work mediated the effect of stress on subjective vitality, personal growth, and life satisfaction; and (4) vitality and personal growth directly influenced life satisfaction.
Significance of results
The proposed model showed a high explanatory value for the meaning professionals give to their work and also for perceived stress, personal protective factors, and sociodemographic variables. Our findings could have highly relevant practical implications for designing programs to promote the psychological well-being of healthcare professionals.
Although there is a vast bibliography on the negative consequences of unemployment for mental health, there are no studies that analyze the differences between men and women in relation to the consequences that unemployment could have simultaneously on self-esteem and depression. The main objective of this study was to analyze whether, unemployment is differentially associated with the self-esteem of men and women, and to test whether this circumstance can be considered a psychological mechanism by which we could explain differences in depression for men and women. Results show that self-esteem is a mediating variable (indirect effect = .11; 90% CI [.04, .19]), considering its differential impact on depression, but this mediation is moderated by the gender of the respondents (b = .21, 90% IC [.01, .40]. In summary, unemployment is associated with lower self-esteem, which in turn is related to greater depressive symptoms. This relationship is only observed for men and not for women.
Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships.
In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30–57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling.
Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43–3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex.
Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.
Self-esteem refers to how an individual appraises themselves and is associated with good mental health. A number of studies have identified the efficacy of cognitive behavioural therapy (CBT) in the treatment of low self-esteem based on the formulation and treatment trajectory developed by Fennell (1999). However, there has been little empirical enquiry into the efficacy of the programme delivered in primary care. The current study investigated the effectiveness of a CBT programme for low self-esteem delivered within primary care. Fifty-four participants attended a 9-week ‘Boost Your Mood’ group programme. Paired sample t-tests were conducted on pre- and post-group scores on measures of depression, anxiety and self-esteem. Results indicated that there were statistically significant improvements in levels of depression, anxiety and self-esteem post-treatment. Findings are consistent with the suggestion that group CBT may be effective at increasing levels of self-esteem and reducing levels of depression and anxiety when delivered in a primary care setting.
While poor parental bonding has been linked with psychological distress, few studies have assessed bonding with mothers and fathers separately among adolescents and whether there are gender differences in the relationships between bonding and psychological distress. Additionally, low self-esteem has been shown to predict psychological distress, but low self-esteem may develop as a result of poor bonding with parental figures. We explored the relationships between (a) perceived maternal and paternal bonding factors and (b) psychological distress, and examined whether self-esteem mediated these relationships in a non-clinical sample of 337 adolescents (aged 13–17 years, M = 14.17, 50.6% female) in Canberra, Australia. Relative to males, females reported lower levels of self-esteem and higher levels of psychological distress. For females, low self-esteem and perceived maternal or paternal rejection predicted higher levels of psychological distress, whereas low self-esteem predicted psychological distress for males. Implications for future research and further considerations are discussed.
The aim of this research was to assess the mediating role of self-esteem and optimism in the correlation between test anxiety and life satisfaction. The study group comprised 201 females (50.6%), 185 males (46.6%) and 11 students without stated gender (2.8%) for a total of 397 high school students. The ages of adolescents included in the study group varied from 14 to 19, with a mean age of 16.09 (SD = 1.09). The research used the Test Anxiety Inventory, Satisfaction with Life Scale, Self-Esteem Scale, Life Orientation Test and a personal information form developed by the researchers as data collection tools. According to the results of correlation analysis, there were significant correlations between test anxiety, self-esteem, optimism and life satisfaction. According to the mediation test results, self-esteem and optimism have full mediating roles in the correlation between test anxiety and life satisfaction. The results obtained are discussed with reference to the literature.
Background: Based on the vulnerability model, several studies indicate that low self-esteem seems to contribute to depressive symptoms. Aims: The aim of this study was to treat depressive symptoms in a cognitive behavioural group therapy, focusing on the enhancement of self-esteem, and to explore co-variation in depressive symptoms and the level of self-esteem. Method: The Multidimensional Self-esteem Scale (MSWS) and the Beck Depression Inventory (BDI) were administered to 147 psychiatric in-patients with current depressive symptoms due to an affective disorder (major depression, bipolar I, dysthymia). Self-esteem was measured pre-treatment (t0) and post-treatment (t4, after 5 weeks of eight group sessions); the BDI was applied weekly. A linear mixed growth analysis was conducted to estimate the change in depressive symptoms including interactions with self-esteem. Results: Within the 5 weeks of group therapy, depressive symptoms showed a linear decline, which was stronger for patients with higher gains in self-esteem between t0 and t4. Self-esteem at t0 was unrelated to the change in depression but predicted self-esteem at t4. Conclusions: Treating depressive symptoms in a cognitive behavioural group therapy in a naturalistic setting might have a positive effect on the process of recovery. Moreover, depressive symptoms and level of self-esteem seemed to co-vary.
Evidence suggests adolescent self-esteem is influenced by beliefs of how individuals in their reference group perceive them. However, few studies examine how gender- and violence-related social norms affect self-esteem among refugee populations. This paper explores relationships between gender inequitable and victim-blaming social norms, personal attitudes, and self-esteem among adolescent girls participating in a life skills program in three Ethiopian refugee camps.
Ordinary least squares multivariable regression analysis was used to assess the associations between attitudes and social norms, and self-esteem. Key independent variables of interest included a scale measuring personal attitudes toward gender inequitable norms, a measure of perceived injunctive norms capturing how a girl believed her family and community would react if she was raped, and a peer-group measure of collective descriptive norms surrounding gender inequity. The key outcome variable, self-esteem, was measured using the Rosenberg self-esteem scale.
Girl's personal attitudes toward gender inequitable norms were not significantly predictive of self-esteem at endline, when adjusting for other covariates. Collective peer norms surrounding the same gender inequitable statements were significantly predictive of self-esteem at endline (ß = −0.130; p = 0.024). Additionally, perceived injunctive norms surrounding family and community-based sanctions for victims of forced sex were associated with a decline in self-esteem at endline (ß = −0.103; p = 0.014). Significant findings for collective descriptive norms and injunctive norms remained when controlling for all three constructs simultaneously.
Findings suggest shifting collective norms around gender inequity, particularly at the community and peer levels, may sustainably support the safety and well-being of adolescent girls in refugee settings.
This research aimed to reveal the relationship between self-harm behaviour, body image, and self-esteem, and examined whether there was a difference between the body image and self-esteem of the adolescents who exhibited self-harm behaviour and those who did not. The study was conducted with the participation of 263 high school students — 143 females (54.3%) and 120 males (45.6%) — who studied in various high schools in the Trabzon province, Turkey. The students’ ages ranged from 15 to 18; the mean age was 17.02 (SD = 1.59). The research was conducted using the Inventory of Statements about Self-Injury, the Body Perception Scale, the Rosenberg Self-Esteem Scale, and a personal information form. The research concluded that there was a significant relationship between body image and self-esteem of the adolescents, and that body image and self-esteem were the significant regressors of self-harm behaviour.
The Subjective Vitality Scale (SVS) assess the subjective experience of being full of energy and alive, a clinically relevant outcome measure of positive psychological well-being. The purpose of this paper was to translate the 7-item SVS into Spanish and examine its psychometric properties. In Study 1 (n = 790 adolescents) and Study 2 (n = 130 athletes) reliability and exploratory factor analysis (EFA) were carried out. In Study 1 and Study 3 (n = 197 dancers) evidence of validity of inferences based on SVS scores estimating relationships with other variables (life satisfaction, global self-esteem and emotional and physical exhaustion) was obtained. In Study 2 invariance across time was tested. Finally in Study 3, the factorial structure was cross-validated using confirmatory factor analysis (CFA). Results of EFA showed a one-factor solution. CFA also supported a unidimensional factor structure for the Spanish 6-item SVS (RMSEA = .050 (90% CI = .00, .080); NNFI = .993; CFI = .996). Reliability analysis indicated a strong internal consistency in all study samples (α ranged from .82 to .89). Further, results from multi-sample analysis supported the replicability of SVS factor structure across time. Finally, the SVS scores showed the expected correlations patterns (all them significant, p < .01) with the measured outcomes. In conclusion, the Spanish version of the SVS demonstrated adequate psychometric properties, indicating that the scale can be confidently used to measure the experience of possessing energy and aliveness; furthermore, differences across time can be meaningfully carried out.
Traditionally studies have neglected emotion in psychosis, possibly as a consequence of psychiatry's emphasis on psychotic symptoms rather than individuals’ lived experience of emotions before, during and after psychotic episodes. This study sought to investigate how individuals experienced their emotions and delusions in the context of psychosis. A qualitative Interpretative Phenomenological Analysis (IPA) research methodology was used. Semi-structured interviews were conducted with a purposively sampled group of eight participants recruited from a local Early Intervention in Psychosis service. Four themes were generated by the analysis. The first highlighted emotional experiences prior to the onset of psychosis: ‘struggling with life distress’. The second highlighted the intense emotional experience within psychotic experiences: ‘transformed world and intense emotion’. The third theme highlighted self-critical tendencies in the post-onset phase of psychosis: ‘blame and guilt after the breakdown’. The final theme highlighted a mixture of emotions in the post-onset phase: ‘confusion, despair and hope’. There were many clinical implications highlighted in the study including the value of normalizing participants’ emotional experiences in order to promote engagement in services and of assessing for self-criticism, despair and hope following the psychotic experience, alongside therapeutically addressing the varying levels of emotional experiences before, during and after a psychotic breakdown.
The Rosenberg Self-Esteem Scale is the most widely used instrument to assess self-esteem. In light of the absence of adaptations in Colombia, this study seeks to validate and adapt this scale in the Colombian population, and perform factorial equivalence with the Spanish version. A total of 1,139 seniors (633 Colombians and 506 Spaniards) were evaluated; the individuals answered the Rosenberg Self-Esteem Scale and sexual self-esteem scale. The average score of the items was similar to the questionnaire’s theoretical average, and standard deviations were close to one. The psychometric properties of the items are generally adequate with alphas of .83 and .86 and significant (CI = .95) and correlations with the sexual self-esteem scale ranging from .31 and .41. Factorial equivalence was confirmed by means of a structural equation model (CFI = .912 and RMSEA = .079), thus showing a strong level of invariance.
The objective of this study is to design and implement an intervention program centered on preventing functional dependence.
A pre/post quasi-experimental (typical case) design study with a control group was conducted on a group of 75–90-year-old individuals with functional dependence (n = 59) at three nursing homes in Madrid (Spain). The intervention program consists of two types of activities developed simultaneously. Some focused on emotional well-being (nine 90-minute sessions, once per week), whereas others focused on improving participants’ physical condition (two 30-minute sessions, twice per week). The simple randomized participants included 59 elderly individuals (Intervention Group = 30, Control Group = 29) (mean age 86.80) [SD, 5. 19].
Fifty-nine participants were analyzed. The results indicate that the program is effective in improving mood, lowering anxiety levels (d = 0.81), and increasing both self-esteem (d = 0.65) and the perception of self-efficacy (d = 1.04). There are improvements in systolic pressure and functional dependence levels are maintained. Linear simple regression (independent variable pre-Barthel) shows that the pre-intervention dependence level can predict self-esteem after the intervention.
We have demonstrated that the program is innovative with regard to bio-psychosocial care in elderly individuals, is based on actual practice, and is effective in increasing both self-esteem and self-efficacy. These variables positively affect functional capabilities and delay functional dependence.
This study explored cyberbullying, coping resources and coping styles in a sample of 107 10- to 12-year-old Australian primary school students. Approximately 13% of participants reported experiencing single episodes of cyberbullying victimisation, while almost half of the participants (48.6%) reported being repeatedly cyberbullied. Technological responses employed by cyberbullying victims included blocking, deleting, and changing passwords. Those who reported a single episode of cyberbullying had higher levels of self-esteem compared to the never cyberbullied or repeatedly cyberbullied groups, but there were no significant differences in attachment, locus of control, and coping styles. These findings have important implications for teachers, parents, school psychologists, and researchers in terms of defining and operationalising cyberbullying, and developing cyberbullying interventions for primary school children.
This study addressed the role of influencer and influencee peer status in social influence of status-unrelated behaviours among emerging adults, while disentangling two forms of peer status, being liked (preference) and being powerful (popularity). Peer influence was examined in 67 women (M age = 20.5 years, SD = 2.1 years) using an experimental design. Popularity of the influencers and influencees (participants), as well as influencees’ preference and self-esteem were considered. Peer influence was measured through imitation of status-unrelated behaviours and task partner choice. In both tasks, influencees moved away from, rather than towards, a popular peer. Popular young women with low self-esteem were most likely to imitate a popular peer. Unpreferred young women with high self-esteem were least likely to imitate a popular peer. The findings demonstrate that the role of peer status in social influence processes is not limited to adolescence, and that the peer status of influencers and the influencees continues to affect social influence on status-unrelated behaviour in emerging adulthood.