Gittins CB, Hunt C (2020) Self-criticism and self-esteem in early adolescence: Do they predict depression? PLoS ONE 15(12): e0244182; Dec 18 2020. doi:10.1371/journal.pone.0244182
Abstract: Beck’s theory suggests that forming negative self-cognitions is a key early step in the development of depression. However, others have suggested the reverse, arguing that depression leads to development of negative self-beliefs. As such, there is debate about whether these cognitions are precursors to, or alternatively are caused by, depression. Although Beck’s theory is supported in older adolescents, it has not been clearly seen in younger adolescents. This study aimed to assess the relation between two major self-cognitions (self-esteem and self-criticism) and depressive symptoms in early adolescence. Two-hundred and forty-three Australian adolescents (mean age = 12.08, 52% female) completed measures of self-esteem, self-criticism and depressive symptoms at baseline, then approximately 12- and 24-months later. Growth-curve modelling was used to assess changes in the variables. Cross-lagged analysis assessed whether either of the self-cognition variables predicted depressive symptoms, or if depressive symptoms predicted self-cognitions. Results indicated that self-criticism and depressive symptoms increased over the time period, while self-esteem decreased, and these changes were all related. Self-esteem predicted depressive symptoms from Time 2 to Time 3, while depressive symptoms predicted self-esteem from Time 1 to Time 2. Self-criticism did not predict depressive symptoms, nor did depressive symptoms predict self-criticism. These links appeared largely independent of gender. Self-esteem and depressive symptoms during the early adolescent period thus appear to have a somewhat reciprocal relation, while self-criticism does not appear to predict the development of depression. As such, while low self-esteem does appear to have an important role of in the development of depression in this age group, it is not strictly predictive, nor is this effect seen across all negative self-cognitions.
Discussion
Both depressive symptoms and self-criticism significantly increased from ages 12 to 14, while self-esteem significantly decreased, as demonstrated by growth curve analysis. These changes were also significantly associated with each other. Furthermore, initially depressive symptoms predicted reduction in self-esteem, but later, lower self-esteem levels predicted increased depressive symptoms, shown through cross-lagged analysis. Self-criticism did not significantly predict either depressive symptoms or self-esteem, although self-esteem did predict reduced self-criticism from ages 13 to 14. This pattern remained unchanged when controlling for gender.
These findings ultimately support the possibility of a reciprocal-causality model in this population. Although pathways from self-esteem to depressive symptoms and the reverse for both time-lapses were not seen, there was nevertheless a sense of reciprocity seen across the two-year period. Thus, depressed mood appears to influence how adolescents evaluate their own worth, and negative beliefs about the self as a whole appears to increase the likelihood of developing depressed mood, at least for this age group.
The findings did not suggest an indirect relation in which one self-cognition predicted the other, which subsequently predicted depressive symptoms. There was evidence, in support of Katz and Nelson’s [40] assertion, that reduced self-esteem predicted subsequent self-criticism, demonstrated here from Time 2 to Time 3. However, there is no suggestion in the current data that self-criticism predicts later depressive symptoms. Further, even when self-esteem was removed from the model, self-criticism did not predict depressive symptoms. As such, based on these data, it is unlikely that there is any significant direct predictive relation between self-criticism and symptoms of depression.
The evidence for some reciprocity between self-esteem and depressive symptoms rather than vulnerability may reflect the age of the current sample. Much of the research which has supported the vulnerability model over the scar model has been on older adolescents (15 years) and adults [26, 27]. Shahar and Henrich [31] supported the scar model but only in a young adolescent sample, aged 12 to 13. Similarly, Burwell and Shirk [32], in a sample with a mean age of 13.6, demonstrated reciprocity between self-esteem and depressive symptoms. Shahar and Henrich [31] argued that, in line with developmental theory [15, 16], self-beliefs are more changeable during this period, thus they are more susceptible to influence from factors such as depressed mood.
These results suggest a refinement of Beck’s [1, 2] theory that all types of negative beliefs about the self generally create vulnerability to depression. At least for early adolescents, self-esteem appears to be more important than self-criticism in the development of depression. Although changes in self-criticism and depressive symptoms appear associated, these variables do not specifically predict each other. Our findings are in line with previous research, which has failed to demonstrate prospective links between self-criticism alone and depression [35, 37, 38, 42].
These findings may speak to the conceptual differences between the two self-cognition constructs. Self-esteem is considered a general attitude towards the self as a holistic object [8]. In contrast, self-criticism is a general approach to the self as a whole, but is contingent upon self-perceived failure [9]. While Beck [2] specified that negative life events are necessary in combination with negative self-cognitions to increase risk for depression, this may be more true for self-criticism–a thinking style that may lay dormant unless activated by a negative event–than for self-esteem–a more ongoing sense of self rather than response to events. There is some empirical evidence to suggest that high self-criticism alone is not enough to confer increased vulnerability to depression and that negative life events are also necessary. Abela and Taylor [38] found that while self-criticism alone did not predict depression scores, a significant interaction effect between self-criticism, self-esteem and negative life events was present, such that when participants with higher levels of self-criticism and lower levels of self-esteem experienced a negative life event, this combination significantly predicted depressive symptoms.
Gender effects
These analyses also demonstrated some support for our expectation of higher levels of negative self-cognitions and depressive symptoms for girls compared to boys, with some significant gender differences seen. Notably, girls’ depressive symptoms increased, and self-esteem decreased, at a significantly greater rate than boys’ symptoms. At the start of the test period (age 12), boys and girls demonstrated similar levels of self-esteem and of depressive symptoms. However, at 13 years, controlling for initial levels of the variables, girls’ self-esteem was significantly lower, and depressive symptoms significantly higher, than boys’ symptoms. At 14 years, controlling for autoregressive effects, there was no significant difference in depressive symptoms or self-esteem levels for girls and boys, suggesting the possibility that the peak point of differentiation of these variables is at around age 13. As such, these findings provide some support for the prediction that negative symptoms and cognitions would be higher in girls than boys
However, some other aspects of the findings provide minimal support for gender differences. When overall models were examined, the major relations demonstrated between the three variables remained unchanged when gender was added. In the growth curve model, the changes in the variables remained significantly related. Similarly, in the cross-lagged model, Time 1 depressive symptoms continued to predict Time 2 self-esteem and Time 2 self-esteem continued to predict Time 3 depression scores, while self-criticism continued not to predict depressive symptoms or self-esteem. Taken together, our findings suggest some evidence for higher levels of depressive symptoms, and higher rate of increase of these symptoms, in girls. However, no evidence of difference in the overall pattern of relations between self-esteem, self-criticism and depression for girls compared to boys was demonstrated.
Clinical implications
The current study examined relations between self-cognitions and depressive symptoms in a sample of healthy adolescents. Nevertheless, the finding that low self-esteem, but not high self-criticism, conveys direct risk for depressive symptoms may have important implications for the treatment of adolescents with, or at risk of, depression. It supports targeting self-esteem in interventions that aim to prevent depression, but also suggests that self-criticism should not necessarily be a specific focus. Further, the evidence of a reciprocal relation between self-esteem and depressive symptoms may have ramifications for depression treatment. Clinicians such as Greenberger and Padesky [63] have recommended focusing on ‘hot’ cognitions–those that are the most emotionally salient to the client–when conducting cognitive therapy. These findings suggest that, in addition to this approach, it may also be particularly important to ensure cognitions relating to negative self-esteem are also addressed, regardless of whether they are especially emotive to the client, as part of relapse prevention.
Strengths and limitations
These results should be interpreted in light of the following limitations. The observational nature of these data limits the causal assumptions that can be drawn from this research. Although cross-lagged models are designed to address this issue by controlling for autoregressive effects, nevertheless causal relations cannot be definitively determined. Furthermore, although depressive symptoms were measured, it is unclear whether these results would generalise to clinically diagnosed depression. Other factors that have been found to influence relations between self-cognitions and depression, such as negative events [38], were not included in the current research. While this enabled focus on the primary variables of interest, this is an area of research which would further elaborate on these relations.
All participants were the same grade, and most were the same age at each time point. However, age was not measured in months which would have provided more variation, and therefore the analysis may have been improved by controlling age in months. Nevertheless, given that the age range would have remained limited, this is unlikely to have had a major effect. Cross-lagged modelling is an analytical approach that is widely used and well accepted in the field (e.g. [64, 65]). In recent years, some researchers have argued that it does not take into account the possibility of stable between-person differences in the variables, and therefore runs the risk of amalgamating between-person effects with within-person effects [66, 67]. As such, this is a potential limitation of the study, which may lead to an over-estimate of the effects, and should be considered when interpreting these findings. Nevertheless, the general pattern of findings is likely to be unchanged with an alternative cross-lagged analytical approach.
This research also has a number of strengths. It is one of few studies to examine self-criticism and self-esteem together in relation to depressive symptoms and, as such, is one of the first studies to uncover the links between these three constructs. Furthermore, by using both growth curve and cross-lagged approaches, we were able to address two related but separate issues: whether the change in these variables is related and whether they predict each other. By using three data-points rather than two, we were able to examine the repeated relations and thus develop a more comprehensive understanding of these connections.
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