Behavioral problem trajectories and self-esteem changes in relation with adolescent depressive symptoms: a longitudinal study

  • Cherry Y. Leung
  • Gabriel M. Leung
  • C. Mary SchoolingEmail author
Original Paper



Prospectively childhood behavioral problems and low self-esteem are associated with depression. However, these mental health changes over time have never been examined. This study assessed the association of childhood behavioral trajectories and self-esteem changes over time with adolescent depressive symptoms.


Parent-reported Rutter behavioral assessments and self-reported Culture-Free Self-Esteem Inventories (SEI) were obtained via record linkage from the Student Health Service, Department of Health (Hong Kong), and the Patient Health Questionnaire-9 (PHQ-9) depressive symptom scores were obtained via active follow-up of the Hong Kong’s Children of 1997” Chinese birth cohort. Partitional clustering was used to generate homogenous trajectories between ~ 7 and ~ 11 years for Rutter scores. Changes in low self-esteem between ~ 10 and ~ 12 years were obtained from the SEI. Multiple linear regression was used to estimate their associations with depressive symptom scores at ~ 13 years.


Four trajectories/groups (stable low, declining, rising, and stable high) of Rutter score and self-esteem groups were created. The stable low behavioral trajectory was associated with the fewest depressive symptoms while the stable high trajectory had 1.23 more depressive symptoms [95% confidence interval (CI) 0.84 to 1.61] than the stable low trajectory. Consistently low self-esteem (stable low) was associated with 2.96 more depressive symptoms (95% CI 2.35–3.57) compared to consistently high self-esteem (stable high).


Sustained or worsening childhood behavioral problems and low self-esteem were precursors of adolescent depressive symptoms, and as such could be an early indicator of the need for intervention.


Behavioral problem trajectories Self-esteem changes Depression Adolescent Cohort study 



The authors thank colleagues at the Student Health Service and Family Health Service of the Department of Health for their assistance and collaboration. They also thank the late Dr. Connie O for coordinating the project and all the fieldwork for the initial study in 1997-8. C. Leung additionally thanks the University Grants Committee for funding her research through the Hong Kong PhD Fellowship Scheme.


This work is a sub-study of the “Children of 1997” birth cohort which was initially supported by the Health Care and Promotion Fund, Health and Welfare Bureau, Government of the Hong Kong SAR (HCPF Grant #216106). Since 2005, the “Children of 1997” birth cohort has been funded by the Health and Health Services Research Fund (HHSRF Grant #03040771), Government of the Hong Kong SAR, the Research Fund for the Control of Infectious Diseases (RFCID Grants #04050172), Government of the Hong Kong SAR, the Health and Health Services Research Fund [HHSRF Grants # 07080751], Government of the Hong Kong SAR and the University Research Committee Strategic Research Theme (SRT) of Public Health, The University of Hong Kong.

Compliance with ethical standards

Conflict of interest

The author declares that there is no competing interest.

Supplementary material

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Supplementary material 3 (DOCX 15 KB)
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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Public Health, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongPeople’s Republic of China
  2. 2.Community Health Systems, School of NursingUCSFSan FranciscoUSA
  3. 3.CUNY School of Public Health and Health PolicyNew YorkUSA

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