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Keywords:

  • adverse childhood experiences;
  • aggression;
  • depression;
  • female correctional facility;
  • self-esteem

Abstract

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

Aim:  The purpose of this study was to examine the following hypothesis: (i) Self-esteem and aggressiveness, adverse childhood experiences (ACE), and a depressive tendency interact with each other. (ii) The subjects show a strong depressive tendency, and each of the other factors exerts a main effect on, and interacts with, the depressive tendency.

Method:  The subjects were 91 juveniles (all female) admitted to a female juvenile correctional facility between November 2005 and December 2006. They were aged 15–19 years, with a mean age of 17.0 (SD = 1.18) years. Self-esteem scale, aggression scale, ACE questionnaire, and depression scale were conducted.

Results:  Significant main effects (R2 = 0.50, P < 0.001) on the depression score were observed in self-esteem (β = −0.41, P < 0.001) and aggression (β = 0.21, P < 0.05). Self-esteem, aggression, ACE, and depression were found to be interrelated.

Conclusion:  Low self-esteem was also shown to exert marked effects on various factors. About half of the inmates of the facility were depressed, and the main effects of self-esteem, aggression, and the ACE score were shown to influence the depression score.

THERE HAVE BEEN a number of studies on the correlations between self-esteem and antisocial behavior.1–3 Donnellan et al.2 reported that low self-esteem in adolescence exerts negative effects on behavior. In contrast, Baumeister et al.4 argued that unrealistically high levels of self-esteem reflect narcissism and lead to social maladaptation. Such exaggerated self-esteem reportedly leads to aggressiveness and antisocial behavior in some adolescents.5 Thus, whether low self-esteem is related to antisocial behavior or overly high self-esteem promotes problematic behavior is presently unclear.

Much research has been conducted on self-esteem of juvenile delinquents.6–8 Research concerning the low self-esteem hypothesis, in which low self-esteem is related to external problematic behavior, can be classified into three major categories.2 Rosenberg suggested that low self-esteem weakens ties with society, and, consequently, promotes social maladaptation and delinquency. Hirschi9 also presented a similar opinion by emphasizing social ties. Rogers explained the mechanism of the appearance of problematic behavior as follows: ‘Failure to develop positive self-esteem leads to psychological problems and induces aggressive behavior’.10 Horney, who is considered to be a Neo-Freudian psychologist, asserted that an inferiority complex and a sense of humiliation (including low self-esteem) enhance aggressiveness and lead people toward antisocial behavior.11 While the low self-esteem hypothesis is widely accepted, its interpretation varies, and the direction of the cause–effect relationship lacks sound evidence.1

There are also reports that the self-esteem of juvenile delinquents is not low, and that the low self-esteem hypothesis, the controversy over which still remains, is still unable to explain delinquency or aggressive behavior. It has been supported, but at the same time has been suggested to lack scientific evidence.2

Matsuura et al., who investigated juvenile correctional facilities in Japan, compared the inmates with age- and gender-matched controls, and demonstrated the very low self-esteem of inmates.12 They simultaneously disclosed some common features and characteristics in inmates through the investigation of multiple facilities. They included developmental problems such as hyperactivity and impulsiveness, adverse childhood experiences (abuse and inappropriate child-raising), and moderate aggressiveness.13–15 Their studies also revealed marked internal problems such as anxiety, depression, and social withdrawal, as well as external behavioral problems such as aggressive behavior and delinquency.16

There is also extensive literature concerning the relationship between delinquency and inappropriate child-raising (including abuse).17–19 Abuse is considered to have particularly strong effects on the occurrence of aggressive behavior, and the concurrence of serious abuse and inappropriate child-raising has been shown to increase the seriousness of behavioral and emotional problems.20,21 The Adverse Childhood Experiences study (ACE study) by Felliti et al.22 is particularly informative. Anda et al.23 reported that ACE such as child abuse and the inadequacy of the child-raising function of the family lead to various health-related problems in adulthood. These ACE studies were planned primarily by the Centers for Disease Control and Prevention (CDC) and were conducted with regard to the relationship between past ACE and the present state of health in more than 17 000 adults. New findings that ACE enhance delinquency and dangerous behavior such as crime and drug abuse have also been reported.24–26 A clear quantitative relationship between ACE and external problems as well as their relationships with self-esteem and depression have also been clarified.22,27 Thus, it has been shown with scientific evidence that children exposed to an adverse environment are more likely to exhibit problems such as depression and suicide attempts during and after adolescence. In girls, particularly, it has been reported that more than 50% of those who experienced four or more ACE developed depression, and that about 20% attempted suicide.28

In Japan, Matsuura performed a questionnaire survey in inmates of juvenile correctional facilities and a control group using the Japanese translation of a simplified version of the ACE questionnaire, and compared their responses. As expected, sharp differences were observed, suggesting the seriousness of ACE that inmates had. Furthermore, a survey at multiple facilities in Japan revealed common features of ACE in inmates.14

It has also been suggested by many studies that juvenile delinquents often suffer from symptoms of anxiety and depression. Depression and behavioral disorders are more concurrent than expected, and their relationship is so strong that it must not be overlooked.29–31 Angold et al. performed meta-analysis concerning the concurrence of depression and behavioral disorders in community samples of average children, and showed that the risk of the occurrence of psychiatric problems in adolescence was about 6.6 times higher (95%CI: 4.4–11.0) in those who had both conditions than in those who did not.32 As behavioral and depressive disorders innately tend to concur, some researchers have suggested that it may be more reasonable to regard the concurrence of both symptoms as a single diagnostic category.32

In a survey of male inmates of juvenile correctional facilities in Japan, marked depression was also noted in about 50% of the inmates.16 While characteristics among the inmates such as low self-esteem, increased aggressive behavior and serious ACE have thus been disclosed gradually, evaluation of their correlation remains insufficient. Although many factors are considered to interact in a complex way to induce psychiatric disorders, investigations themselves have been limited in Japan, and a standardized questionnaire has not been developed, hampering a clear understanding or analysis of the situation.

However, scientific studies to date have suggested that inmates of juvenile correctional facilities exhibit serious internal as well as external problems. In particular, close correlations are considered to be present between self-esteem and aggressive behavior and between abusive experience and a depressive tendency. Girls have been reported to respond more sensitively to stressful life events and to be more likely to exhibit a depressive tendency.33 In this study, we conducted a questionnaire survey in female inmates of juvenile correctional facilities, and examined the following hypothesis:

(i) self-esteem and aggressiveness, ACE, and a depressive tendency interact with each other; and (ii) the subjects show a strong depressive tendency, and each of the other factors exerts a main effect on, and interacts with, the depressive tendency.

METHODS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

Subjects

The subjects were 91 juveniles (all female) admitted to a female juvenile correctional facility between November 2005 and December 2006. They were aged 15–19 years, with a mean age of 17.0 (SD = 1.18) years. At this facility, the following questionnaire was completed by all inmates. Eighty-one inmates (89.0%) provided analyzable answers to all the questions and were included in the analysis.

The percent distribution of delinquency type committed by juveniles admitted to this facility was as follows: drug-related crime (41.7%), larceny (15.4%), injury/violence (10.0%), others (31.9). The juveniles admitted to Japanese correctional facilities are considered to correspond to ‘severe juvenile delinquents’ or ‘serious juvenile offenders’ rather than ‘delinquents’ in Western research papers.

Questionnaire

Rosenberg Self-Esteem Scale

The 10-item self-esteem scale prepared by Rosenberg34 and translated into Japanese by Yamamoto et al.35 was used. Rosenberg considered self-respect and positive evaluation of the self rather than a feeling of superiority or inferiority in comparison with others to be self-esteem. He also considered that one has high self-esteem when one feels oneself ‘good enough’ rather than ‘very good’. Low self-esteem means self-rejection, lack of self-approval, self-contempt, and the absence of self-respect. In this study, we used the term ‘self-esteem’ in such a sense. Answers to questions were obtained using a 5-point scale of: ‘true’ (5 points), ‘more true than false’ (4), ‘neither true nor false’ (3), ‘more false than true’ (2), and ‘false’ (1). The mean score in our subjects was 27.9 (SD = 6.82), and α = 0.79.

Japanese standardized version of the Buss-Perry Aggression Questionnaire

A Japanese standardized version36 of the Buss-Perry Aggression Questionnaire (BAQ)37was used. This questionnaire consists of four scales of verbal aggression, physical aggression, hostility, and anger. There is no consensus as to a precise definition of the concept of aggression, but this questionnaire is considered to allow comparison of internal aggressiveness between subjects and controls.

Buss et al.37confirmed the high internal consistency and reliability of their Aggression Questionnaire. This questionnaire was converted by Ando et al. into scales with internal consistency and stability, and its validity has also been established.36 The mean score of the subjects using this scale was 79.2 (SD = 15.56), and Cronbach's α = 0.87.

Adverse Childhood Experiences questionnaire (ACE questionnaire)

The ACE Study was conducted primarily by the Health Insurance Union of the United States and the CDC on childhood abuse and state of health later in life based on answers to questionnaires by 17 737 affiliates to the above union.22

The ACE Study emphasizes the number rather than categories of ACE that one has been subjected to. The number of the nine items of ACE (Table 1) that one has undergone (0–9) is regarded as the ACE score. The mean ACE score in our subjects was 1.94 (SD = 1.96), and α = 0.69. The range was 0–9.

Table 1.  Adverse Childhood Experiences questionnaire items
Growing up (prior to age 18) in a household with:
1. Recurrent physical abuse, e.g. pushing, grabbing, slapping, kicking.
2. Recurrent emotional abuse, e.g. you were called things like ‘lazy’ or ‘ugly’.
3. Sexual abuse.
4. An alcohol or drug abuser.
5. Mother being treated violently.
6. Someone who is chronically depressed, suicidal, institutionalized or mentally ill.
7. One or no biological parents.
8. An incarcerated household member.
9. Neglected by parents, e.g. didn't have enough to eat, had to wear dirty clothes.
yes = 1, no = 0. The sum is the Adverse Childhood Experiences (ACE) score.
Japanese standardized version of the Birleson Depression Self-Rating Scale for Children (DSRS-C)

In this study, the Birleson Depression Self-Rating Scale for Children (DSRS-C)38was used. The DSRS-C consists of 18 questions for the evaluation of depression in children designed to be answered by children themselves about their state during the past week using a 3-point scale (2, 1, and 0), with a full score of 36. Its Japanese version prepared by Murata has been confirmed to be reliable and valid.39 Recently, Denda et al.40 performed a large-scale survey in elementary and junior high school children in Hokkaido using this questionnaire.

Birleson et al.41 determined the cut-off of the DSRS-C as 15, but Murata et al.39 reported that 16 was appropriate by applying the Japanese version of the DSRS-C to Japanese children and adolescents. They also set the cut-off as 16 in their recent study.40 Therefore, we also set it as 16, and classified the subjects with a DSRS-C score of ≥16 as a ‘being depressed’ group. Thus, DSRS-C was used as an assessment instrument for screening depression, because we did not evaluate the symptoms using a structured interview.

According to Birleson's report, the DSRS-C is designed to be applied to children aged 7–13 years,38 but the scale was subsequently reported to also be applicable to adolescents.42,43 We selected the DSRS-C because it is simple and easy to answer, and some of our subjects were junior high school students. The mean score of our subjects was 15.53 (SD = 6.57), and α = 0.77.

Informed consent

The juvenile correctional facility performs multiple questionnaires and screening tests in all inmates at the time of their admission in order to understand and evaluate their psychological, cognitive, and behavioral characteristics. The above questionnaires are some of them. The results are used for the planning of individual programs for correctional education (similar to ‘Individual Educational Plan’) and understanding of inmates. The implementation of effective correctional education on the basis of the understanding of inmates' characteristics and statistical analyses and use of the test results for research are sufficiently explained at parents' meetings. Also, at the administration of the tests, their objectives are explained to the inmates, and their consent is obtained.

In this study, tests or questionnaires other than the DSRS-C were performed within a few days after admission. The DSRS-C was conducted about 1 month after admission in consideration of the psychological effects of the decision to send the adolescents to juvenile correctional facilities. All questionnaires were handed to the inmates individually after explanation by an instructor at the facility and recovered after completion.

Statistical analyses

For statistical analyses, Pearson's correlation analysis, 2-factor anova, and multiple regression analysis were performed. The level of significance was <0.05. The statistical package, SPSS 13.0J for Windows, was used.

RESULTS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

Results of the ACE questionnaire revealed that physical, psychological, and sexual abuse had been experienced by 27.2%, 23.8%, and 8.6% of the subjects, respectively. The inmates of the correctional facility were asked questions regarding their household environment: 17.3% of the inmates indicated that ‘there was alcohol abuse’; 22.2 % indicated that there was ‘someone who was chronically depressed, mentally ill, institutionalized, or suicidal’; and more than 45% indicated that ‘either or both of the parents were missing’. A total of 12.3% of the inmates indicated that ‘a family member was imprisoned’, and 9.9% stated ‘I was neglected by my parents (was not allowed to go to school, not given regular meals etc.)’. These results suggest that family functioning in their families had often disintegrated.

The ACE score was 4 or higher, indicating a serious condition, in 28.4% of the subjects.

The mean score of the DSRS-C was 15.5 (SD = 6.57), and the score was equal to or above the cut-off point (= 16) in 39 inmates (48.1%). Therefore, about half of the inmates were classified into the ‘being depressed’ group.

Table 2 shows the results of correlation analysis among various factors. Self-esteem assessed with the Rosenberg Self-Esteem Scale had significant negative correlations with aggression assessed with the BAQ, the ACE score and depression assessed with the DSRS-C. However, aggression had significant positive correlations with the ACE score and depression. The ACE score also had a significant positive correlation with depression.

Table 2.  Correlations among self-esteem, aggression, and depression
 1234
  • *

    P < 0.05;

  • **

    P < 0.01;

  • ***

    P < 0.001.

1 Self-esteem   
2 Aggression−0.291***  
3 Adverse Childhood Experiences score−0.240*0.353** 
4 Depression−0.469***0.329**0.271*

As correlation analysis identified significant correlations among factors, the main effect and interactions of each factor were evaluated to examine the hypothesis.

Table 3 shows the results of multiple regression analysis performed by selecting the depression score as the dependent variable and the other factors as independent variables. The main effects of self-esteem and aggression on the dependent variable were evaluated in the Main effect model (A). As a result, significant main effects on the depression score were observed in self-esteem and aggression.

Table 3.  Self-esteem, aggression, and ACE score as predictors of depression
 Main effect model (A)Main effect model (B)1-way interaction model
  • *

    P < 0.05;

  • **

    P < 0.01;

  • ***

    P < 0.001.

  • Standardized beta weights (β) are shown.

  • R2 = adjusted multiple correlation coefficient.

  • ACE, Adverse Childhood Experiences.

Self-esteem−0.41***−0.39***−0.37**
Aggression0.21*0.180.20
Adverse Childhood Experiences (ACE) score 0.12 
Self esteem × aggression  0.20
R20.51***0.59***0.50***

Next, the main effects of self-esteem, aggression, and the ACE score were evaluated using the Main effect model (B). As a result, self-esteem had a significant negative main effect on the depression score, but the other two factors showed no significant effect. The multiple regression coefficient of this model indicated its high-level validity.

Next, multiple regression analysis was performed by selecting self-esteem and aggression and their interaction as independent variables using a 1-way interaction model. In this model, a significant negative main effect was observed in self-esteem. The multiple regression coefficient of this model significantly indicated a goodness of fit.

DISCUSSION

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

Correlations among factors

As expected, self-esteem was negatively correlated with the other three factors (aggression, ACE score, and depression score). As self-esteem showed particularly strong correlations with aggression and the depression score, they are considered to be exerting direct effects with each other.

The ACE score was also suggested to significantly affect aggression rather than self-esteem or the depression score. This is considered to be in agreement with the findings of a previous study that abuse and inadequate child-raising promote aggressive behavior in children.44

Multiple regression analysis and evaluation of models

Multiple regression analysis revealed that each of the three models showed a strong goodness of fit. In particular, the coefficient of determination was highest for the Main effect model (B), showing that the main effects of self-esteem, aggression, and ACE score affect the depression score (interaction between self-esteem and aggression was eliminated). The coefficient of determination was also 0.50 when only self-esteem and aggression were used as independent variables. As it was also 0.50 in the 1-way interaction model in which the depression score was explained by self-esteem, aggression, and their interaction, self-esteem was suggested to be an important factor in the depressive tendency. Moreover, self-esteem was the factor that most affected the depressive tendency in all three models. Therefore, the low self-esteem in subjects of this study is considered to have exerted very serious effects on the depressive tendency.

Trzesniewski et al.1 showed that low self-esteem develops into not only delinquency but also diverse problematic behavior and health problems during and after adolescence by a cohort study in Dunedin, New Zealand. They also considered that the low self-esteem hypothesis was partially, but not totally, supported by their results. We studied the effects of low self-esteem on depression, and the results supported the low self-esteem hypothesis. However, the correlation between self-esteem and deviance behaviors was complicated and intricate interactions among multiple factors were not fully evaluated.

On the basis of the data obtained in this study, we must continue to advance scientific research.

Characteristics of subjects and effects of ACE

The subjects were female inmates aged 14–20 years who were charged with delinquency and admitted to the juvenile correctional facility. Treatments of juvenile delinquents are determined through a few complicated processes. Juveniles who have eventually been sentenced by the family court to be admitted to a correctional facility are sent to various facilities depending on their age, level of criminal tendency, and physical and mental conditions. One out of about every 8000 girls of the same age is sent to a juvenile correctional facility;45 female minors who have committed relatively serious acts of delinquency and are in a grave situation are considered for admission to the facility.

According to a large-scale survey of those admitted to juvenile classification offices by Kondo et al., 56% exhibited behavioral disorders.46 Of the juveniles admitted to classification offices, those who have committed serious acts of delinquency or serious crime are sent to correctional facilities. Therefore, the percentage of those with behavioral disorders among those sent to correctional facilities is considerably high.47

There are also serious problems regarding the child-raising environment. In the subjects of this study, the result of the ACE questionnaire showed that 27.2%, 23.8%, and 8.6% had suffered physical, psychological, and sexual abuses, respectively. Matsuura et al. surveyed about 350 average high school students using a similar questionnaire, and reported that the percentages of those who had experienced these abuse types were 0–1.2%.14

Depression group

Denda et al. performed the DSRS-C in about 3300 elementary school children and junior high school students, and reported that 22.8% were depressed, with a cut-off of 16.40 They also reported significant increases in the score with age. The result of this study, that 48.1% of the subjects with a mean age of about 17 years were depressed, is considered to indicate their serious depressive tendency. Depression was shown to be very prevalent in female as well as male juvenile correctional facilities.48,49

Some epidemiological surveys have demonstrated that behavioral and depressive disorders are likely to concur,31 but their cause–effect relationship is unclear. The diagnosis of their concurrence with, and their differential diagnosis from, other diseases or disorders are considered to be difficult due to the diversity of the problems.30

Limitations

There were a few limitations and problems in this study. One was that all questionnaires performed were self-administered. Self-administered questionnaires have the disadvantage of a high possibility of bias but are reliable in that information known only to the respondents can be obtained, and information can be collected at a low cost.50–52 For the future, self-administered questionnaires should be combined with objective evaluations by a third party.

The second limitation was the sample size. In this study, the sample number was considerably deficient for statistical analyses. A sample number at least a few times larger would have been reasonable for the evaluation of multiple cause–effect models. While about 100 juveniles are admitted to the juvenile correctional facility every year, it is not easy to obtain several hundred samples. There are considerable barriers against investigations and research because of the nature of juvenile correctional facilities. These problems should be overcome one by one, and data should be collected and analyzed steadily.

The third limitation involved problems with the control group. However, characteristics of the subjects are considered to be revealed more clearly by performing the same questionnaires in a control group matched with regard to age, gender, and local characteristics, and comparing the results. Comparison with the results in male juvenile correctional facilities is also considered to make evaluation of the effects of gender possible.

Our hypotheses were examined and we summarized our results as follows: (i) self-esteem and aggressiveness, ACE, and a depressive tendency negatively interacted with each other strongly. (ii) The subjects showed a strong depressive tendency, and the main effect of low self-esteem on depressive tendency was confirmed significantly in all models in the multiple regression analysis.

Multiple regression analysis also indicated that some models show a strong goodness of fit. The findings of this study are expected to contribute to the future development of research in related fields.

REFERENCES

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES
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