Hope and Self-esteem in Childhood
and Suicidal Thoughts in Early Adulthood
Rob McGee, Sheila Williams and Shyamala Nada-Raja
Department of Preventive and Social Medicine, University of Otago Medical School,
Dunedin
Summary
We examined the longitudinal relationship between family characteristics in early
childhood, feelings of hopelessness, low self-esteem and thoughts of self-harm in the midchildhood years, and suicidal ideation at ages 18 and 21 years. Our findings suggested quite
different pathways to later suicidal thoughts among boys and girls. For boys, these thoughts
seemed to have stronger roots in childhood with significant paths from hopelessness and low
self-esteem to early thoughts of self-harm and from there, to later thoughts of suicide. For
girls, low self-esteem had a small but significant path to later suicidal ideation. Individual
characteristics such as feelings of hopelessness and low self-esteem might act as “generative
mechanisms” linking early childhood family characteristics to later suicidal thoughts in early
adulthood. These findings were independent of depression in childhood, and suggest that
hopelessness is a topic deserving more attention among young children.
Introduction
Risk factors for suicidal behaviours among young people may be separated into those
that are close to the behaviour in time (such as depressed mood) and those that are more
distant (Moscicki, 1995). These more remote risk factors could be regarded as laying the
foundations upon which later suicidal thoughts and behaviours are built. These might include
childhood characteristics and family processes which lead to later vulnerability in
adolescence. In this presentation we examine two such factors, namely hopelessness and selfesteem.
The philosopher Immanuel Kant proposed that his philosophical investigations
centered around three questions: What can we know? What ought we do? What can we hope
for? These are questions that we as parents, teachers, health professionals or otherwise
interested adults might help young people answer for their own lives. Sadly, many young
people in New Zealand may not have a sense of hope about the future. We report on the role
that having a sense of hope about the future plays in predicting thoughts of self-harm in
childhood and early adult years. A related notion to hope is having a sense of identity, a
sense of self-respect and feelings of being valued and worthwhile. These related ideas are
sometimes encapsulated under the concept of self-esteem. Self-esteem has had a somewhat
shaky career in Developmental Psychology. In an article well-worth reading, Kahne (1996)
has differentiates among three models of self-esteem. In the first, self-esteem is conceived as
a kind of yardstick against which a child can measure themselves against others (social
comparison model); the emphasis here is on differentiating characteristics (e.g. I’m good at
swimming) and a practical implication is to enhance the range of possible evaluations which
young people can make. The second model emphasizes self-esteem as personal responsibility
(problem-solving model) with the practical implication that by raising self-esteem it is
possible to inoculate young people against society’s ills such as drug use. The third models
derives from a child’s entitlement to self-respect (social justice model) with a practical
implication that we need to enhance the foundations of self-respect. In this paper we endorse
this third model and examine the extent to which self-respect in childhood protects against
later thoughts of self-harm. We use the term “self-esteem” hereafter, in line with previous
research.
There is evidence that young people thinking about suicide have low feelings of low
self-worth (Fergusson & Lynskey, 1995) as well as feelings of hopelessness about the future
(Roberts et al., 1998). Family characteristics might also lead to such thoughts, and follow-up
studies indicate that family cohesion plays a protective role (Garber et al., & Weaver, 1998),
especially so for boys (Juon & Ensminger, 1997). Levy et al. (1995) have put forward the
idea that hopelessness is a “generative mechanism” through which family characteristics such
as socio-economic disadvantage and poor family functioning may increase a young person’s
sense of hope and self-respect, which in turn increases the individual’s protection against
suicidal thoughts. We present evidence for a model that suggests that self-esteem and
hopelessness are “generative mechanisms” which form an intermediate pathway between
family characteristics in early childhood and suicidal thoughts in early adulthood.
About the Dunedin Multidisciplinary Health and Development Study
Participants
The participants belonged to Dunedin Multidisciplinary Health and Development
Study or DMHDS. These people were born between 1 April 1972 and 31 March 1973 (see
Silva & McCann, 1996 for a fuller description of the DMHDS), and were first enrolled at age
3 years; 1037 of the 1139 eligible children were assessed. Subsequently they have been seen
at ages 5, 7, 9, 11, 13 and 15 years and then at ages 18, 21, 26 and most recently 32 years
(2003-2005). The sample is slightly socio-economically advantaged when compared with
the remainder of New Zealand, and it is under-representative of Maori and Pacific Islands
people.
Suicidal thoughts
At ages 18 and 21 years, participants were asked four questions as part of an
interview on their mental health: “(during the last year) have you thought a lot about death
(your own, someone else’s or death in general);” “have you felt like you wanted to die;” have
you felt so low you thought about committing suicide;” and if yes “have you attempted
suicide.”
Family life
To summarise the family life of the participants in the DMHDS in childhood, we
developed three indices to describe the child’s home environment from age 3 to 9 years. We
called them “socio-economic disadvantage,” “poor family climate,” and “harsh parent-child
interaction.” Socio-economic disadvantage included low socioeconomic status indicated by
the child’s father having a semi skilled or unskilled job; the child’s mother being 20 years of
age or less at first pregnancy; the mother having no further education beyond high school
(about three-quarters of such women had a school qualification gained after three years of
high school only); and single parenting primarily by the mother.
Family climate captured the general level of mental health within the family. This
four point index included: low within family cohesion, expressiveness of feeling and
conflict; high levels of maternal depression; parental separation accompanied by adverse
consequences for the child up to age 9 years; and other adverse circumstances including
mental health problems among the fathers such as alcohol abuse and depression, and several
instances of family violence.
Parent-child interaction attempted to capture the way the parent(s) interacted with the
child. It included a measure of the mother’s expression of affection, encouragement, physical
handling, management, and general responsiveness to the child’s needs; parental reports of
low egalitarianism or high authoritarianism on a self-report measure of parenting attitudes;
and lax-inconsistent discipline based upon parental ratings of strictness and consistency of
discipline. For each index we simply summed the components resulting in a possible score
from 0 to 4 for each one.
Self-esteem, hopelessness and thoughts of self-harm in childhood
At ages 11 and 13 years, the children filled out the Rosenberg (1965) 10 item selfesteem scale, assessing global aspects of self-worth, confidence and self approval. Examples
of items include “I am able to do things as well as most people” and “I feel that I do not have
much to be proud of.” We than identified children with consistently low, medium and high
levels of self-esteem. We constructed a 5-item measure of hopelessness on the basis of
questions given to parents and children from ages 9 to 13 years. For example, at age 9 the
parents completed the item “child acts as if everything is hopeless” and the child - “I believe
things will go well for me.” At age 11 years, comparable items were “thinks that things are
not going to work out well and are hopeless” (parent), and “do you think the future will be
good?” (child). At age 13, parents were asked whether the child “feels he or she can’t
succeed.” Again we identified three levels corresponding to low, medium and high levels of
hopelessness.
A measure of thoughts of self-harm was constructed on the basis of parent and child
report from age 9 to 13 years. Parent items included “has talked about a wish to be dead or
that others would be better off if he/she dead” (ages 9 and 11 years). Child items included
“sometimes I think a lot about hurting myself on purpose” (age 9) and “thought about killing
yourself or tried to kill yourself” Low, medium and high levels of such thoughts were
identified.
What did we find?
Findings from childhood
In studies like this where data have been collected at different ages, missing
information means that results are not available for the total sample. Full data were available
for N = 732 participants (379 boys and 353 girls). This represents about 83% of those
participants who were asked about suicidal ideation at ages 18 and 21 years. Table 1 shows
the numbers of children identified according to levels of self-esteem,hopelessness and
thoughts of self-harm. There were no significant differences between boys and girls on any
of these three measures, so they are shown for the whole sample with available data. Nearly
17% of the children expressed some thoughts of hopelessness and nearly 7% expressed
thoughts of self-harm.
Table 1. Distribution of scores for low, medium and high levels of self-esteem,
hopelessness and thoughts of self-harm in childhood (9 to 13 years: N= 732).
Level
Measure
Low
Medium
High
____________________________________________________________
Self-esteem
17.6%
61.6%
20.8%
Hopelessness
83.1%
12.1%
4.8%
Thoughts of
93.2%
5.6%
1.2%
self-harm
____________________________________________________________
Suicidal thoughts at ages 18 and 21 years
By age 18 and 21 years, 17.3% had admitted to thoughts of suicide at either or both
ages, with 13.7% of the males and 21.2% of the females admitting to such thoughts. This
difference between males and females was significant. Of the group that reported suicidal
ideation at either age, about 1 in every 5 also reported a suicide attempt at either age.
Models of suicidal ideation at age 18 and 21 years
Full details concerning the way in which we derived our models are given in McGee
et al. (2001). To summarise, we used a statistical technique called path analysis that allows
an exploration of variables in a predictive framework. It is often difficult in these kinds of
models to say that “X causes Y”, but the longitudinal nature of our information supports the
idea of causal relationships between earlier and later measures. Our initial analyses also
strongly suggested that we needed to build separate models for boys and girls. The
relationships among some of the measures were so different between the sexes, that we could
not identify and overall model for the whole sample.
Figure 1 (see accompanying power point slides) shows the final model for boys and
all the pathways shown are statistically significant. What did the model suggest? First,
higher levels of socioeconomic disadvantage predicted lower levels of self-esteem and higher
levels of hopelessness, and harsh parent-child interaction predicted thoughts of self-harm in
childhood. The three strongest paths were from self-esteem and hopelessness to thoughts of
self-harm in childhood, and from these thoughts to suicidal ideation at ages 18 and 21 years.
The model for girls is shown in Figure 2. Once again higher levels of socioeconomic
disadvantage were related to lower levels of self-esteem, as was the case for boys. Family
climate was directly related to thoughts of self-harm in childhood, and parent-child
interaction was directly related to hopelessness. Hopelessness, in turn, strongly predicted
thoughts of self-harm in childhood as was the case with boys. Where the models for girls and
boys differed most strongly was the absence of a direct path between thoughts of self-harm
and later suicidal ideation in early adulthood for girls, and the presence of this pathway for
boys. There was, however, a direct path from self-esteem to later suicidal ideation, with
ideation predicted by lower levels of self-esteem in childhood.
Are these childhood measures simply reflecting the influence of something else in
childhood? Our best guess would be childhood depression. Among the 732 children, about
5% had current depression (major depressive episode or dysthymic disorder) between the
ages of 9 and 13 years. This is clearly less than the prevalence of low self-esteem (18%) and
hopelessness (17%). While depression was higher among children with low self-esteem and
among those expressing hopelessness or thoughts of self-harm, most of these children
expressing these thoughts were not depressed.
What do the findings show?
Our findings do support the idea (Levy et al., 1995) that characteristics such as low
self-esteem and hopelessness are “generative mechanisms” through which family
characteristics in childhood might operate to raise the risk of suicidal behaviours in early
adulthood. For boys, socioeconomic disadvantage was especially important in terms of lower
self-esteem and higher levels of hopelessness. Harsh parent-child interaction also predicted
early thoughts of self-harm. For girls, socioeconomic disadvantage predicted lower selfesteem while harsher parent child-interaction predicted hopelessness. Family climate also
predicted thoughts of self-harm among girls.
It was in the nature of the relationship between early thoughts of self-harm and later
suicidal ideation that boys and girls showed marked divergence. For boys, later suicidal
ideation reflected earlier thoughts of self-harm in childhood. This was not so for girls; rather,
there was a somewhat weaker pathway from low self-esteem in childhood to later suicidal
ideation. It seems as if boys “carry the baggage” of hopelessness, feelings of self-worth into
adulthood to a greater extent than girls (see also the findings of Juon & Ensminger, 1997, and
Leadbeater et al., 1999).
Family characteristics have the ability to set in motion chains of events in which
adversity compounds upon adversity. For boys in particular, the roots of suicidal ideation
may be found in early experiences within the family and the effects those experiences have on
their sense of self-worth and their expectations about the future. Raising childrens’ feelings
of self-respect and hopes are important in both the clinical setting and in the community at
large. Reducing sources of childhood family adversity through public health actions is one
way of helping to stop setting these chains of adverse events in motion.
Acknowledgements
The programme of research described in this report has been supported by the Health
Research Council of New Zealand. Collection of the mental health data was partially
supported by grants from the Antisocial and Violent Behaviour Branch of the US National
Institutes of Mental Health. Thanks are due to SPINZ for the opportunity to present this
research.. The authors are indebted to the many people who have contributed to this research
over the years, but our thanks go ultimately to the participants in the DMHDS and to their
parents for their long-term commitment to this important NZ research.
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