Women's Mental Health Across the Lifespan

Challenges, Vulnerabilities, and Strengths

Kathleen A. Kendall-Tackett, Lesia M. Ruglass, Kathleen A. Kendall-Tackett, Lesia M. Ruglass

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138182738
• eBook ISBN: 9781317281467
• Topic: Medicine
• Subtopic: Health Care Delivery

Women's Mental Health Across the Lifespan examines women's mental health from a developmental perspective, looking at key stressors and strengths from adolescence to old age. Chapters focus in detail on specific stressors and challenges that can impact women's mental health, such as trauma, addictions, and mood and anxiety disorders. This book also examines racial and ethnic disparities in women's physical and mental health, mental health of sexual minorities and women with disabilities, and women in the military, and includes valuable suggestions for putting knowledge into practice.

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Part I

Women’s Mental Health in Lifespan Perspective

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Chapter One

Mental Health of Women: A Focus on Adolescent Girls

Tia R. Dole

A common refrain that is often heard when adults refer to adolescence is, “I wouldn’t want to be a teenager nowadays!” There is a perception that the issues that young people face, especially young girls, are much more challenging in today’s world than in previous generations. Whether this perception is true remains to be seen. However, for adolescent girls in our society, there are a whole host of factors that affect development and mental health. Some of these factors are relatively new (e.g., social media), and some have been a part of modern society for a long time (e.g., depression, body image, or serious mental health conditions). Adolescent girls in the United States face challenges that are both unique to their culture and common across different types of societies. For the purposes of brevity, most of the research presented in this chapter is focused on adolescent girls from a Western perspective. However, it will include the different diasporas that exist within Western society. Nonetheless, many of the themes could be generalized to other cultures.

This chapter will focus on salient topics related to mental health issues for adolescent girls. These topics include self-esteem, depressive symptoms, disordered eating behaviors, and social media. However, in exploring these topics, one will note that the underlying theme linking them is self-esteem. The interrelatedness of self-esteem and mental health in adolescent girls cannot be overstated. In essence, how an adolescent girl perceives herself has an untold impact on how she dates, how she eats, her mood, drug use, sexual behavior, and most importantly, her resilience. Hence, I will start this chapter with a discussion of self-esteem, how it has been examined, and its impact on girls. In the following sections, we will see how this construct plays a significant role in the mental health of adolescent girls overall, and how interventions that are based on improving self-esteem, or a sense of self-efficacy, can have a significant impact on the way that a girl develops into an adult.

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Self-Esteem

Self-esteem, or the positive or negative evaluation of oneself (Rosenberg, 1986), is a concept that is often examined with regard to adolescent girls. How a young girl perceives herself can have far-reaching consequences on her behavior and outcomes, including physical health and criminal behavior (Trzesniewski et al., 2006). Self-esteem is typically measured using tools such as the Rosenberg Self-Esteem Scale (Rosenberg, 1986). Initially it was thought to measure a single construct called “self-esteem.” However, over time this measure has been found to have two subscales that are related, but separate (Farruggia, Chen, Greenberger, Dmitrieva, & Macek, 2004; Martin, Thompson, & Chan, 2006; Owens, 1994). These constructs are “Self-Worth” (one’s evaluation of oneself), and “Self-Deprecation” (the degree to which an individual denigrates one’s self-worth, abilities, or usefulness). Recent research has found that, for girls progressing through adolescence, self-esteem is not a static construct; it is dynamic. In fact, Baldwin and Hoffmann (2002) found a curvilinear relationship between self-esteem and time. Starting from age 12, some girls experience a drop in self-esteem that starts to recover around the age of 17, with negative life events having a significant impact on an adolescents’ self-esteem. Interestingly, for boys, self-esteem increased through the age of 14, decreased to age 16, and then increased through early adulthood. In essence, girls struggle with maintaining a positive image of themselves throughout adolescence in ways that boys do not seem challenged. Race and culture also impact the complicated trajectory of self-esteem in adolescent girls (Twenge & Crocker, 2002).

Impett, Sorsoli, Schooler, Henson, and Tolman (2008), examining research literature from a feminist developmental perspective, suggest that the differences between boys and girls are derived from differences within the power hierarchy in our society, and girls’ focus on relationships. Traditionally, development is seen through the lens of male development, primarily focused on individuation and individualism (Erikson, 1968). This is in contrast to examining development from a feminist perspective, or an alternative perspective, in which relationships between individuals retain their importance over time. Consequently, with the value in our society on individualism, the way that girls grow and change is not as valued, and thus, the innate way that girls make sense of their world is not considered worthwhile. Girls have a strong emphasis on relationships and their esteem is based heavily on the way that they are relating to each other, and how others are relating to them. In fact, we find that how girls negotiate relationships and how they think about themselves have important implications for self-esteem. Consequently, perhaps one of the underlying factors impacting the precipitous drop in self-esteem for girls in mid-adolescence especially is related to the fact that the way girls gain confidence in themselves is undervalued in our society.

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Research by Impett et al. (2008) and Impett, Henson, Breines, Schooler, and Tolman (2011) suggests that girls who have higher relationship authenticity, meaning that a young girl’s behavior reflects what she thinks and feels, also have higher self-esteem. These findings suggest that teaching young women to be “true to themselves” in their interactions with others will increase their chances of feeling good about who they are as a person. These findings also suggest that girls may be at an inherent disadvantage in terms of acquiring a positive sense of self if they are not taught the value of being authentic in interpersonal relationships. In fact, some recent research has supported this hypothesis. It appears that authenticity in interpersonal relationships can serve as a mediator between childhood maltreatment and negative outcomes, such as depression, poor self-esteem, and trauma symptoms for college-aged women (Theran & Han, 2013). For adolescent girls, lack of authenticity with parents was related to depression (Theran, 2011). Thus, interventions focused on girls feeling more comfortable with who they are may be essential in improving functioning.

Race and ethnicity also play a role in the development and maintenance of self-esteem. Some research has shown that self-esteem manifests differently across cultures. In fact, some research has found that, for African American girls, the trajectory of plummeting self-esteem through adolescence was not found (Gray-Little & Hafdahl, 2000; Twenge & Crocker, 2002). Crocker and Major (1989) speculate that stigmatized groups (like African Americans) may attribute negative feedback from others as based in prejudice, or failures to perform as related to prejudice, even when they are not. Blacks may also be protected from poor self-esteem by in-group comparisons, in which people compare themselves to other similarly “disadvantaged” individuals. Thus, role failure is not perceived of as harshly. Other research has found that Blacks are less likely to base their esteem on the approval of others, and that basing one’s self-esteem on the approval of others mediated the relationships between self-esteem and race (Ziegler-Hill, 2007).

Some researchers suggest that, instead of employing methods to improve self-esteem overall (as one would do for White adolescent girls), for Black girls one should use the improvement of self-esteem as a way of decreasing risky sexual behaviors that may lead to increased risk of HIV infection (Adams, 2010). This study also found that for Black girls, in particular, social support led to decreased self-deprecation scores.

There have been several factors that mediate and moderate the development and maintenance of self-esteem in adolescent girls. One significant area of research has been in the role of sports participation and its association with better outcomes for girls, including improved self-esteem, self-worth, and a positive body image (Findlay & Coplan, 2008; Marsh & Jackson, 1986; Richman & Schaffer, 2000). Some research has found that these robust results are even more complex, with perceived peer acceptance mediating the relationship between sports participation and self-esteem (Daniels & Leaper, 2006). In fact, Adachi and Willoughby (2014) recently conducted a study in which high levels of self-esteem predicted greater involvement in sports, not the inverse. Their conclusions suggested that a young woman’s enjoyment of the sport is what impacted self-esteem, rather than simply participating in sports themselves.

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Predictors of Higher Self-Esteem

Much of the research on self-esteem tends to be focused on trends which predict negative outcomes. However, research has pointed to factors that are associated with higher self-esteem. A seminal study by Birndorf, Ryan, Auinger, and Aten (2005) using the National Education Longitudinal Study (Kaufman, Bradby, & National Center for Education Statistics, 1992) database found that some predictors of higher self-esteem were being African American or Latina, positive family communications, safety, and religious community.

The importance of this type of research cannot be overstated. Examining why some girls are more resilient is essential to developing effective programs like Girls on the Run (Martin, Waldron, McCabe, & Choi, 2009) that help build self-esteem and a sense of efficacy. Some protective factors are somewhat dependent on self-esteem as well. Cooper (2009) found that for African American adolescent girls, self-esteem served as a mediating factor between father–daughter relationship quality and academic achievement. Girls who reported having a positive relationship with their father also reported higher self-esteem and higher academic performance. Other protective factors include being of Black or Latina descent (Bachman, O’Malley, Freedman-Doan, Trzesniewski, & Donnellan, 2011), a sense of self-efficacy or mastery (Lightsey, Burke, Ervin, Henderson, & Yee, 2006), being emotionally stable, extraverted, or conscientious (Erol & Orth, 2011).

Depression

The effects of depressive disorders for adolescent girls have untold consequences. In their seminal paper, “The Development of Depression in Children and Adolescents,” Cicchetti and Toth (1998) described what could be considered to be a condition that occurs with relative frequency, with between 15% and 20% of young people experiencing depression during their adolescence (Harrington, Rutter, & Fombonne, 1996). Cicchetti and Toth (1998) noted that the long-term consequences of depression are fairly far reaching, with a significantly increased risk for major depressive disorder in adulthood, and other comorbid conditions like anxiety disorders, conduct disorders, and substance abuse.

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In the United States, the rates of a major depressive episode for adolescent girls between the ages of 12 and 17 are 17.3% (11.4% for all adolescents in that same age range) (Center for Behavioral Health Statistics and Quality, 2015). Thus, nearly 20% of girls meet criteria for a depressive episode. This number is not inclusive of girls who have subthreshold depressive symptoms. These alarming numbers point to an urgent need for intervention in the United States. However, the etiology of depression in adolescent girls is fairly complicated: the intersection of genetics, negative life events, and environment can cause, or increase, vulnerability to depressive symptoms. Thompson, Parker, Hallmayer, Waugh, and Gotlib (2011) found that adolescent girls who experienced what they describe as “early adversity” (e.g., having a mother diagnosed with recurrent major depressive disorder), and who also had specific nucleotide polymorphism related to oxytocin, reported the highest levels of depression and anxiety. Thus, the effects of genetics and home environment can combine to impact a young girl’s functioning.

There appears to be a natural connection between self-esteem and depression in adolescents. Consequently, much of the research in these fields explicitly examines the relationships between them. For instance, rates of depression in adolescents are directly related to low self-esteem, with adolescents who experience low self-esteem subsequently experiencing higher rates of depression (Orth, Robins, Widaman, & Conger, 2014). As with self-esteem, depression in adolescence follows an inverted U-shaped curve, beginning in early adolescence and continuing until approximately age 17, when it begins to decrease (Rawana & Morgan, 2014). This same pattern is shown for adolescent boys, though boys have lower initial levels of depression (Rawana & Morgan, 2014).

Pubertal Timing

There are also factors that may influence rates of depression, such as pubertal timing, though some of this research is mixed (Ellis, 2004). The concept of pubertal timing affecting subsequent adolescent psychological well-being was originally called the Stage Termination Hypothesis (Peskin & Livson, 1972; Petersen & Taylor, 1980). This hypothesis posited that behavioral problems in adolescence occurred because early pubertal timing did not allow girls to complete essential developmental milestones in early to middle childhood. Keenan, Culbert, Grimm, Howell, and Stepp (2014) found an inverse relationship between pubertal timing and depression, with early-onset puberty being associated with increased depression. Overall, African American girls have a slightly earlier onset for puberty, and consequently reported higher rates of depression, thus race served as a moderating factor.

Markotte, Fortin, Potvin, and Papillon (2002) conducted a study that indicated that, for adolescents transitioning to high school, self-esteem, negative stressful life events, and body image mediated the relationship between pubertal status and depressive symptoms. In other words, g...

Table of contents

• Cover Page
• Women’s Mental Health Across the Lifespan
• Clinical Topics in Psychology and Psychiatry
• Title
• Copyright
• Contents
• Series Editor’s Foreword
• About the Editors
• Preface
• Introduction
• Author Biographies
• PART I Women’s Mental Health in Lifespan Perspective
• PART II Diversity Issues in Women’s Mental Health
• PART III Specific Disorders Related to Women’s Mental Health
• Index