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The impact of self-esteem and social support on college students' mental health.

INTRODUCTION

Over the years, the prevalence of mental health problems has increased significantly in number of cases and severity among U.S. adults nationwide (Reeves et al., 2011). Data from the most recent National Survey on Drug Use and Health indicated that one in five American adults reported experiencing a mental illness in the past year (Substance Abuse and Mental Health Services Administration [SAMHSA], 2010). The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR) defines mental illness as an umbrella term for having had a diagnosable mental, behavioral, or emotional disorder (American Psychiatric Association, 2000). According to the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, substantial financial burden mental health problems causes in the U.S. are approximately $300 billion (Reeves et al., 2011).

Mental illnesses account for nearly half of the health disparities affecting young adults in the U.S. (World Health Organization, 2008). The college student population is burdened by mental health problems, including increased depression and anxiety (Mowbray et al., 2006). The National College Health Assessment found that nearly 30% of undergraduate students reported that they were "so depressed that it was difficult to function" at some time in the past year (American College Health Association, 2009). Regarding mental illness trends among college students, the rates are more than twice as high among individuals 18 to 25 years of age (29.9%) than among persons 50 years of age and older (14.3%) (SAMHSA, 2010). In fact, because mental illness rates are high among younger individuals, it is not surprising that suicide is the third leading cause of death for college students (Centers for Disease Control and Prevention, 2010). According to a study involving 70 colleges nationwide, 10% of the 26,000 undergraduate and graduate students reported feeling mentally ill and seriously considering suicide within the previous year of taking the survey (Drum, Brownson, Burton-Denmark, & Smith, 2009). University students who show behavioral risk factors related to mental health problems include signs of depression, changes in academic performance, substance-abuse, energy loss and social isolation (King, 2006).

There are several risk factors associated with developing mental health problems during the college years related to general life experiences, low self-esteem, and low social support (Brockelman, 2009; National Mental Health Association, 2001). Mental health problems, including anxiety and depression, may have substantial implications for academic performance (Eisenberg, Gollust, Golberstein, & Hefner, 2007; Ruthing, Haynes, Stupnisky, & Perry, 2009), substance abuse (Lenz, 2004; Weitzman, 2004), self-esteem (Hubbs, Doyle, Bowden, & Doyle, 2012) and social relationships (McCarthy & Salotti, 2006; Ruthing, Haynes, Stupnisky, & Perry, 2009). Regarding general life experiences, college is a unique transitional period and may be the most stressful time in students' lifetimes (Mattanah et al., 2010; National Mental Health Association, 2001). Some college stressors include missing family and friends, feeling isolated, experiencing conflict in relationships, finding a balance between social life and school work, and finances (Kisch, Leino, & Silverman, 2005; Mowbray et al., 2006).

Self-esteem and social-support are interrelated concepts that serve as protective factors against developing mental health problems during the college years (Mattanah et al., 2010). Moreover, social support has been proven to serve as a buffer against major health problems among college students (McCarthy & Salotti, 2006; Merianos, King, & Vidourek, 2012) and is associated with feelings of well-being (Wodka & Barakat, 2007). Social support has been associated with high self-esteem including positive attitudes and feelings of-wellbeing (Papikonomou, 2007). Previous research has indicated that the effects of mental health problems, including depression and anxiety, are predictive of college students' self-determination and quality of relationships (Brockelman, 2009). Most students who experience emotional health problems turn to important individuals in their lives instead of seeking professional services (Lenz, 2004).

Although mental illnesses are a growing concern among young adults, college campus personnel have opportunities to reach students about preventing mental disorders as well as increasing the number of students seeking treatment. By 24 years of age, approximately three-fourths of lifetime mental disorders typically have their first onset as defined in DSM-IV, including anxiety and mood disorders (Kessler et al., 2005). Despite college students being at elevated risk for suffering from mental disorders, little is actually known regarding the impact of different types of social support felt from others. Some studies have been inconclusive on the health-related outcomes of the receipt of social support (Albrecht & Goldsmith, 2003). Research related to mental health problems among college students primarily focuses on stress or suicide (Stockdale et al., 2007). Therefore, the present study was conducted to expand the literature by assisting health professionals with information that can be used to develop comprehensive prevention efforts for college students. The purpose of this study was to examine the influence of self-esteem and social support from family, friends, and significant others on college students' perceptions of mental health problems. Analyses were also conducted to determine whether mental health problems differed significantly based on gender, grade level, and diagnosed chronic illnesses.

METHODS

Participants

College students (N = 238) at a Midwestern university served as participants for this study. Most of the participants were female (66%), white (80%), and were freshman and sophomores (82%). Students' ages ranged from 18 to 24 years of age (M = 19.1, SD = 1.2). Students reported family income levels varied, with 7% at $20,000 or below, 13.2% between $21,000 and $40,000, 18.2% between $41,000 and $60,000, 16.1% between $61,000 and $80,000, 21.5% between $81,000 and $100,000, and 24% over $100,000. Six percent of students did not report family income levels. This research study was approved by the University of Cincinnati's institutional review board (IRB). All students volunteered to participate in this study by signing required informed consent forms. Students received credit through a subject pool as an incentive to participate. All survey responses were kept confidential and anonymous.

Instrumentation

The following sections of the ongoing study (Nabors, Ritchey, Sebera, & Haney, 2012) were used for the present study: (1) Personal and family information; (2) Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet, Dahlem, Zimet, & Farley, 1988); (3) Rosenberg Self-Esteem Scale (RSE) (Rosenberg, 1965); (4) Centers for Disease Control and Prevention's Health-Related Quality of Life (HRQOL) "Healthy Day Measures" questions. To provide information on social support, the 12-item MSPSS survey consisted of three subscales that assessed the perceptions of college students' social support from family, friends, and significant others via a 7-point Likert type scale (1 = very strongly disagree; 2 = strongly disagree; 3 = mildly disagree; 4 = neutral, 5 = mildly agree; 6 = strongly agree; 7 = very strongly agree). The Family Support subscale (N = 4) required students to indicate their agreement of how family plays a role in their lives including: "My family tries to help me," "I get the emotional help and support I need from my family," "I can talk about my problems with my family," and "My family is willing to help me make decisions." The Friend Support subscale (N = 4) required students to indicate their agreement of how friends play a role in their lives including: "My friends really try to help me," "I can count on my friends when things go wrong," "I have friends with whom I can share my joys and sorrows," and "I can talk about my problems with my friends." The Significant Other subscale (N = 4) required students to indicate their agreement of how significant others play a role in their lives including: "There is a special person who is around when I am in need," "There is a special person with whom I can share my joys and sorrows," "I have a special person who is a real source of comfort to me," and "There is a special person in my life who cares about my feelings."

To assess self-esteem of participants, the RSE consisted of 10 items and required students to indicate their agreement with general feelings about themselves via a 4-point Likert type scale. For the scoring interpretation for half of the questions, participants indicated their level of agreement with positive statements (1 = strongly disagree, 2 = disagree; 3 = agree; 4 = strongly agree), including: "On the whole, I am satisfied with myself," "I feel that I have a number of good qualities," "I am able to do things as well as most other people," "I feel that I am a person of worth, at least on an equal plane with others," and "I have a positive attitude toward myself." Half of the items were reversed in valence resulting in the scoring being reversed because the items were worded negatively (1 = strongly agree, 2 = agree; 3 = disagree; 4 = strongly disagree) including: "At times, I think I am no good at all," "I feel I do not have much to be proud of," "I certainly feel useless at times," "I wish I could have more respect for myself," and "All in all, I am inclined to feel that I am a failure."

To assess mental health, the CDC's HRQOL consisted of four items called the "Healthy Days Measures" that required students to rate their overall general health. A question included in the following study is "Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health not good?" Students were required to write down how many days their mental health was not good. The personal and family information section required students to identify their gender, grade level, race/ethnicity, family income level, and if they had any health or mental health problems that have been clinically diagnosed and to list the problems.

These instruments have been tested for validity and reliability. The MSPSS have been confirmed in subsequent studies to have good psychometric properties (Bruwer, Emsley, Kidd, Lochner, & Seedat, 2008; Canty-Mitchell & Zimet, 2000; Zimet, Powell, Farley, Wekman, & Berkoff, 1990). The SEM is a widely known important tool for assessing self-esteem and has a reported internal consistency of .78 (Rosenberg, 1965). The CDC HRQOL has been part of the state-based Behavioral Risk Factor Surveillance System (BRFSS) since 1993 and has been added to the National Health and Nutrition Examination Survey since 2000 (Centers for Disease Control and Prevention, 2011). It has been shown to have good psychometric properties (Andreson, Catlin, Wyrwich, & Jackson-Thompson; Andreson, Fitch, McLendon, & Meyers, 2000; Beatty, Schecter, & Whitaker, 1996; Hennessy, Moriarty, Zack, Scherr, & Brackbill, 1994).

Measures and Procedures

This study is a part of a larger ongoing study to examine college students' overall health and quality of life for students with and without chronic illnesses (Nabors et al., 2012). Research assistants administered the questionnaires on an individual basis or in small groups. Prior to survey distribution, research assistants informed students about the purpose of the survey, the confidentiality and voluntary nature of the survey, and the importance of offering honest and accurate answers. Students were instructed to skip any questions they did not wish to answer and that they could stop participating at any time. Students turned in completed surveys to the researchers.

Data Analysis

The SPSS statistical software package was used to analyze all data. Frequency distributions (ranges, means, and standard deviations) were performed to describe demographic and background characteristics, perceived social support, self-esteem, and the number of days that participants' self-described mental health was not good. Linear regression analyses were conducted to examine if college students' perceptions of the number of days in the last month they experienced problems with mental health differed significantly based on perceived social support and perceived self-esteem. Additional analyses were conducted to determine if students' perception of the number of days in the last month they experienced problems with their mental health differed significantly based on gender, ethnicity, grade level, and chronic illness diagnosis. The alpha level was set at .05.

RESULTS

Demographic Information

A total of 238 students completed surveys (100% response rate). Two-thirds (66.4%) of the participants were females and one-third (33.6%) were males (Table 1). Most of the participants were Whites (80.2%), 14% were African Americans, 1.6% Hispanics, 1.6% Asians, and 2.7% identified themselves as Other. The mean age of participants was 19.07 years (SD = 19.0739). More than half of the students were freshman (58.9%), 23.3% were sophomores, 13.2% were juniors, and 4.7% were seniors. Regarding chronic health conditions, more than one-third (36.1%) had been clinically diagnosed with a chronic illness and of those chronic illnesses, 16% of students reported a mental health diagnosis. The top three chronic illnesses identified by participants included vision problems (37.6%), asthma (17.1%), and mental health problems (16.1%). The number of days in the last month where students experienced mental health problems ranged from 0-30 (M = 6.4, SD = 7).

Predictor Variables of College Students' Perceptions of Mental Health Problems

A linear regression analysis was conducted to examine the influence of self-esteem, social support, and demographic variables on college students' perceptions of the number of days in the past month they experienced problems with their mental health. Predictor variables in the best fit model included student reports of self-esteem, whether or not they had a mental health problem or chronic illness, and reports of social support from family, friends, and significant others. Students' mean ratings for self-esteem is 3.50 (SD = 0.49). Students' mean ratings for the social support felt from family was 5.90 (SD = 0.52), social support felt from significant others was 5.88 (SD = 0.57), and social support felt by friends was 5.70 (SD = 0.48) (Table 2). This model was significant F(7, 237) = 6.86, p < .001. The model predicted 17% of the variance in the outcome variable, which was the number of days in the past month students experienced mental health problems (Table 3).

Self-esteem, Social Support, and Demographic Variables

Significant predictors were gender and self-esteem. Regarding gender, females reported more days with mental health problems per month than did males (Table 3). A median split was used to divide self-esteem into higher and lower levels of self-esteem. Those with higher levels of self-esteem reported fewer days of mental health problems per month than those with lower self-esteem. There was a trend for family support, with those with higher levels of family support reporting fewer days of mental health problems per month. Two-and three-way interaction terms were examined and were not significant, and their inclusion in the model did not predict significantly more variance in the outcome variable; thus, they were not included in the final model.

Discussion

This study found that students experienced mental health problems more than six days on average in the month prior to completing the survey. Based on these findings alone, the deleterious effects of mental health issues are imperative to study among college students especially because they tend to have higher stigmatizing viewpoints of mental health problems than the older adult population (Ojeda & Bergstresser, 2008). Regarding chronic mental illnesses, only 15 of the 238 total participants reported they had been diagnosed with a mental illness. Such rates are alarming because only 6 of 10 Americans seek mental illness treatments a year (SAMHSA, 2010). Such findings suggest that college health professionals should work toward increasing student awareness of mental health resources on campus.

Gender was a specific predictor of mental health problems among college students in the present study. More specifically, females reported more days with mental health problems per month compared to their male counterparts. This is not surprising inasmuch as gender is a critical determinant of mental health issues (Rickwood, Deane, Wilson, & Ciarrochi, 2005). Biological and psychosocial factors related to gender have been proposed to account for females having more mental health issues including greater rates of anxiety disorders and mood disorders than males (Grigoriadis & Robinson, 2007). It is important to note that there are striking differences between age of onset of symptoms, frequency and course of symptoms, as well as social adjustment and long term outcome that typically place women at higher risk of developing mental health illnesses (Essau, Lewinsohn, Seely, & Sasagawa, 2010). Concerning gender-specific social factors, the World Health Organization (2012) reported that gender discrimination, domestic violence, and sexual abuse place females at higher risk for developing mental health illnesses than males. Based on social risk factors, female college students tend to be affected by higher depression and lower self-esteem than male students (Dixon & Robinson-Kurpius, 2008). It is important to note that even though females are at higher risk of suffering from mental illnesses, males tend to report higher rates of externalizing and aggression disorders as well as substance abuse disorders than females (Nolen-Hoeksema & Hilt, 2006). Although this study did not assess the specific type of mental health problems experienced by students, research is clearly warranted to examine if differences based on type of diagnosis hold true among college students.

Self-esteem was also a significant predictor of poorer mental health in the past month. Specifically, those with higher levels of self-esteem reported fewer days of mental health problems per month than those with lower self-esteem. If students have low self-esteem, they may have lower performance rates and achievement goals (Shim, Ryan, & Cassady, 2012). In addition, students may have poorer grades, decreased emotional skills, social isolation, and financial issues (Megivern, Pellerito, & Mowbray, 2003). Such findings are important and lend themselves for serious consideration by college health professionals. Low self-esteem and mental health issues have significant influence on grade point average and on students' intent to drop out of college (Pritchard & Wilson, 2003). Efforts to enhance self-esteem should be undertaken as an intervention for college students with mental health disorders. Building school connectedness and social support can assist in improving feelings of self-worth, and thus, improve the mental health of college students.

In this study, social support derived from family played a more pronounced role with respect to occurrence of mental health problems than did peers and significant others. More specifically, students who felt higher levels of family social support reported fewer days of mental health problems per month. Increased parent-adolescent time spent together has been reported as protective factor against involvement in unhealthy and risky behaviors (King, Vidourek, Haag, & Merianos, 2012). Thus, parents play an important role in the prevention of mental health problems. Low levels of social support have been associated with social costs including poor academic performance and increased anxiety and depression among college students (Chao, 2012). Previous research also found that students acquire academic and mental health benefits including higher coping skills and college retention when parental support and campus support services are widely available (Grant-Vallone, Reid, Umali, & Pohlert, 2004). Gaps currently exist in the literature concerning the impact of social support felt from different support groups and its impact on the mental health of college students. Further research is warranted to examine the impact of various social support sources, including institutional support on college students' mental health.

Limitations

The methodological limitations of the present study should be noted. First, the sample population comprised students from one university, and therefore, results may not generalize to university students nationwide. Second, the monothematic survey format may have resulted in a response-set bias in some students. Third, the self-reported and sensitive nature of the survey may have caused some socially desirable responses. However, the survey was validated, shown to be reliable and these scales have been successfully used in previous studies. Fourth, because data were cross-sectional in nature, cause-and-effect relationships could not be determined.

Recommendations

Self-esteem and social support from family members are important factors involved in college students' perceptions of their mental health and should, therefore, be considered when designing campus programs or interventions to address mental health. To enhance the likelihood of success, campus health educators should seek to include building self-esteem and family support in prevention programs. Regarding social support, future research is warranted on the relationship between mental health problems and institutional support as the present study found students reported experiencing mental health problems on average of six days per month. Building school connectedness may assist in improving feelings of self-esteem, and thus, improve the mental health of college students. Case-control program evaluations are needed to identify effective school programs that increase students' self-esteem and awareness of mental health services on campus. Findings from such studies should be shared with the professional community as well as campus health educators nationwide.

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Ashley L. Merianos, MS, CHES

Laura A. Nabors, PhD

Rebecca A. Vidourek, PhD, CHES

Keith A. King, PhD, MCHES

Ashley L. Merianos, MS, CHES is a Graduate Assistant in the Health Promotion and Education Program, University of Cincinnati, Cincinnati, OH 45221-0068. Laura A. Nabors, PhD is an Associate Professor in the Health Promotion and Education Program, University of Cincinnati, Cincinnati, OH 45221-0068. Rebecca A. Vidourek, PhD, CHES is an Assistant Professor in the Health Promotion and Education Program, University of Cincinnati, Cincinnati, OH 45221-0068. Keith A. King, PhD, MCHES is a Professor and Graduate Program Director in the Health Promotion and Education Program, University of Cincinnati, Cincinnati, OH 45221-0068. Send correspondence to Ms. Merianos, Tel: 513-556-3859; Fax: 513-556-3898 merianal@mail.uc.edu.
Table 1. Demographic Characteristics

Item n %

Gender
 Female 168 66.4
 Male 85 33.6
Race
 White 207 80.2
 African American 36 14.0
 Hispanic 4 1.6
 Asian 4 1.6
 Other 7 2.7
Grade Level
 Freshman 152 58.9
 Sophomore 60 23.3
 Junior 34 13.2
 Senior 12 4.7
Chronic Illness
 Yes 163 63.9
 No 92 36.1
Clinically Diagnosed
Eye vision problems 35 37.6
Asthma 16 17.2
Emotional problems 15 16.1
Facture bone problems 8 8.6
Other 8 8.6
Arthritis 4 4.3
Walking problem 2 2.2
Hearing problem 2 2.2
Diabetes 1 1.1
Lung breathing problem 1 1.1
Heart problem 1 1.1

N = 238; Percents refer to valid percents; Missing values excluded

Table 2. Perceived Social Support felt by College Students

Variable M SD

Family Social Support 5.90 0.52
Significant Other Social Support 5.88 0.57
Friends Social Support 5.70 0.48

N = 238; Means based on a 7-point scale (1 = very strongly disagree;
7 = very strongly agree)

Table 3. Regression Coefficients for How Many Days during the Past 30
Days Was Your Mental Health Not Good?

Variable Unstandardized Standard Standardized
 Beta Error Beta

Self-esteem -3.933 0.940 -0.274
Gender -1.956 0.909 -0.131
Family Social Support -0.196 0.108 -0.147
Friends Social Support 0.034 0.113 0.023
Significant Other 0.035 0.095 0.029
 Social Support
Chronic Illness 1.297 1.068 0.089
Mental Health Problems -1.696 1.208 -0.104

Variable t P

Self-esteem -4.182 < .001
Gender -2.151 .032
Family Social Support -1.807 .052
Friends Social Support 0.301 .764
Significant Other 0.369 .712
 Social Support
Chronic Illness 1.214 .226
Mental Health Problems -1.403 .162

N = 231. This model predicted 17% of the variance in students'
perceptions of their mental health.
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Author:Merianos, Ashley L.; Nabors, Laura A.; Vidourek, Rebecca A.; King, Keith A.
Publication:American Journal of Health Studies
Date:Jan 1, 2013
Words:5193
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