Heliyon 9 (2023) e21459

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Heliyon
journal homepage: www.cell.com/heliyon

Investigating associations between emotional and behavioral

problems, self-esteem, and parental attachment among
adolescents: A cross-sectional study in Indonesia
Rika Sarfika a, *, I Made Moh Yanuar Saifudin b, Ira Mulya Sari c, Dewi Murni d,
Hema Malini e, Khatijah Lim Abdullah f
a
Department of Mental Health and Community, Faculty of Nursing, Universitas Andalas, Padang, Indonesia
b
Doctoral Student, Doctor of Medicine and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta,
Indonesia
c
Department of Maternity and Child, Faculty of Nursing, Universitas Andalas, Padang, Indonesia
d
Department of Basic Nursing, Faculty of Nursing, Universitas Andalas, Padang, Indonesia
e
Department of Medical Surgical, Faculty of Nursing, Universitas Andalas, Padang, Indonesia
f
Department of Nursing, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Emotional and Behavioral Problems (EBPs) are prevalent among adolescents, and
Adolescents adolescents’ capacity for adaptation can be influenced by their interactions with their parents,
Emotional and behavioral problems environment, and self-esteem. This link has not been systematically examined among adolescents
Parental attachment
in West Sumatra, Indonesia. This study aimed to assess the association of parental attachment and
Self-esteem
self-esteem with EBPs in adolescents.
Methods: A cross-sectional study was conducted from July to November 2022 in Padang West
Sumatra, Indonesia. In total, 854 students from public senior high school 4 Padang were involved
in this study and completed questionnaires on demographics, EBPs, parental attachment, and self-
esteem. There was a total of five subscales for EBPs, which included emotional problems, conduct
problems, hyperactivity, peer problems and prosocial. Additionally, there were three subscales for
parental attachment, which included the mother’s attachment, father’s attachment, and peer
attachment. Spearman’s correlation, independent-sample t-tests, ANOVA and multiple linear
regression analysis were employed to examine factors associated with EBPs.
Results: This study showed that father’s attachment (r = −0.191, p < 0.001), mother’s attachment
(r = −0.241, p < 0.001), and self-esteem (r = −0.437, p < 0.001) were negatively correlated with
EBPs. The linear regression analysis showed EBPs was associated with father’s education, father’s
communication, father’s alienation, mother’s alienation, and self-esteem. All predictors of overall
EBPs among adolescents were able to explain 31 % of the variance in EBPs.
Conclusion: High self-esteem and a strong parental attachment have positive outcomes in terms of
mental health in adolescents. Thus, increasing adolescent self-esteem and establishing a warm
parent attachment can be the main target in providing interventions for Indonesian adolescents
with EBPs.

* Corresponding author. Department of Mental Health and Community, Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, 25163,
Indonesia.
E-mail address: rikasarfika@nrs.unand.ac.id (R. Sarfika).

https://doi.org/10.1016/j.heliyon.2023.e21459
Received 5 May 2023; Received in revised form 28 September 2023; Accepted 21 October 2023
Available online 30 October 2023
2405-8440/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
R. Sarfika et al. Heliyon 9 (2023) e21459

1. Background

Adolescence frequently witnesses the occurrence of mental health challenges, encompassing various emotional and behavioral
disorders such as disruptive behavior, depression, anxiety, and pervasive developmental disorders like autism. In Indonesia, the
prevalence of Emotional and Behavioral Problems (EBPs) among adolescents aged 12 to 18 in Indonesia stands at 28.4 %. These
problems encompass emotional issues (29.2 %), hyperactivity (8.4 %), conduct disorders (32.9 %), and peer-related problems (13.1 %)
[1]. These disorders are often categorized as either internalizing or externalizing problems [2]. Previous research studies have reported
that the prevalence of these Emotional and Behavioral Problems (EBPs) globally among children and adolescents falls within the range
of 9.3 %–28.4 % [3–7]. It was found that higher levels of overall stress, particularly stress related to school and future prospects, were
linked to a greater occurrence of emotional and behavioral problems [8].
Persistent Emotional and Behavioral Problems (EBPs) pose an elevated risk of causing both societal and individual challenges [3].
In adolescents, these EBPs have significant adverse impacts on society, resulting in direct behavioral consequences and associated
costs. Moreover, they adversely affect the affected adolescents themselves, leading to difficulties in academic performance, occupa-
tional prospects, and psychosocial functioning. Families of these adolescents are also impacted [2,9].
EBPs often come with a high level of co-occurring conditions, hindered development of social skills, an increased likelihood of
involvement in criminal activities, and a heightened risk of suicide. To mitigate these issues, it is imperative to gain a comprehensive
understanding of the factors that contribute to the development of these problems [10,11].
The adaptability of adolescents is closely linked to their interactions with their parents, the actions of their parents, and the
environment they are in Ref. [12]. The emotional development and mental well-being of adolescents are directly shaped by their
parents’ influence [13,14]. Furthermore, the attitudes of parents and their manner of interacting with adolescents play a significant
role in determining how effectively they function. This, in turn, indirectly impacts their ability to adapt [15,16].
Various factors can influence parents’ reports on Emotional and Behavioral Problems (EBPs), including age, gender, parental
education, socioeconomic status, the level of support from parents, and the quality of the parent-child relationship [17,18]. Research
has also demonstrated differences in reports between parents and children at different ages [19], between reports from fathers and
mothers [20], and between reports from teachers and parents [21]. Many of the reasons for these disparities in reporting seem to be
linked to environmental and external factors [22,23].
Additionally, self-esteem and resilience are crucial components of good mental health [24–26]. Moreover, happiness is recognized
as a key measure of a person’s hedonistic perspective or emotional well-being, encompassing positive affectivity and life satisfaction
[27–29].
Building upon the aforementioned findings, the primary aim of this study was to examine the connection between parent-
adolescent relationships and self-esteem concerning emotional and behavioral problems in adolescents. The principal contribution
of this research lies in its exploration of parent-adolescent relationships and self-esteem as potential protective factors that could help
alleviate the effects of mental health difficulties among adolescents. Importantly, these factors are dynamic and subject to change,
especially during the adolescent years, which underscores their potential relevance in the design of prevention and intervention
programs aimed at addressing mental health issues among adolescents.

2. Methods

2.1. Study design

The correlative descriptive study with cross-sectional design was used.

2.2. Participants

The data for this study were gathered from members of the Minangkabau ethnic group attending Public Senior High School (PSHS)
4 in Padang, located in West Sumatra, Indonesia. The participants were recruited in collaboration with the school. To be eligible for the
initial study, students needed to meet the following criteria: be between the ages of 12–20 years old, be in grades 10th through 12th,
and express a willingness to participate. Those who had significant difficulties in completing the questionnaire due to physical or
psychological issues during the study were excluded. Consecutive sampling method was use to collect the data. The sample size was
determined using G*Power 3.1, which suggested that 822 participants are needed for multiple linear regression with twelve inde-
pendent variables, assuming an effect size of 0.05, an alpha level of 0.01, and 99 % power, however, we collected responses from 854
individuals who completed the survey comprehensively. Ultimately, no missing data were found in the final analysis.

2.3. Measures

In this research, four instruments were employed. The initial instrument comprised demographic variables, including gender, age,
grade level, residential status, parental education, parental occupation, and family income. The other instruments used in the study
were the Strengths and Difficulties Questionnaire (SDQ), the Inventory of Parent and Peer Attachment (IPPA), and the Rosenberg Self-
Esteem Scale (RSES). Furthermore, the researchers obtained permission from the developer of the Indonesian version of these ques-
tionnaires to utilize them in this study. A description of each instrument is provided below.

2
R. Sarfika et al. Heliyon 9 (2023) e21459

1) Emotional and Behavioral Problems (EBPs)

To measure emotional and behavioral problems, the Strengths and Difficulties Questionnaire (SDQ) developed by Ref. [30] was
used. This questionnaire has been adapted into Indonesian by Refs. [31,32] and has subsequently been established by the Ministry of
Health, Republic of Indonesia to screen for EBPs among Indonesian adolescents. This instrument comprises 25 items designed to assess
five different subscales related to EBPs. These subscales include emotional problems (e.g., “Often complains of headaches”), conduct
problems (e.g., “Often has temper tantrums or hot tempers”), hyperactivity (e.g., “Constantly fidgeting or squirming”), peer problems
(e.g., “Rather solitary, tends to play alone”), and prosocial behavior (e.g., “Considerate of other people’s feelings”). Each response is
rated on a three-point scale (0 = not true, 1 = somewhat true, and 2 = extremely true). To calculate the overall score for each subscale,
one can add up the scores from all relevant items. Each subscale has a possible maximum score of 10 and a minimum score of 0. The
instrument demonstrated strong overall item reliability with a high Cronbach’s α score of 0.863. Furthermore, each individual scale
within the instrument also exhibited satisfactory Cronbach’s α scores, including emotional problems (0.804), conduct problems
(0.486), hyperactivity (0.753), peer problems (0.513), and prosocial (0.852).

2) Parental Attachment

The Inventory of Parent and Peer Attachment (IPPA) was used to assess parental attachment. The questionnaire was developed by
Ref. [33]. Indonesian version of this instrument was adopted by previous study [34,35]. The measurement is divided into three
subscales, namely, 25 items for the mother’s attachment subscale, 25 for the father’s attachment subscale, and another 25 for the peer
attachment subscale. In this study, we were only interested in the parental attachment subscales (father’s and mother’s attachment).
The respondents were required to indicate the extent to which each item was true for them on a five-point scale (1 = never true; 5 =
always true). The items on scales for mother and father are clustered into three factors (trust, communication, and alienation) by
principal components analysis. Trust refers to mutual trust and respect for each other’s needs and desires (e.g., My father accept me as I
am). Communication refers to the perceived quality of involvement, responsiveness, and verbal communication related to an ado-
lescent’s emotional states (e.g., My father can tell when I’m upset about something). Alienation involves feeling socially isolated,
angry, and detached from a parent, but at the same time feeling the need to be closer to them (e.g., I feel alone or apart when I am with
my father). The Cronbach’s alpha score for father’s attachment was 0.890 and for mother’s attachments was 0.870.

3) Self-esteem

Self-esteem was measured with a short version of the Rosenberg Self-Esteem Scale (RSES) [36]. The Indonesian version of RSES was
adapted by previous study [37]. The RSES is a self-rating scale comprising five negative and five positive items. The respondents
answered on a four-point scale ranging from “I totally agree” (1) to “I totally disagree” (4). High scores correspond to high self-esteem
[38]. The Cronbach’s alpha score of this instrument was 0.899.

2.4. Ethical considerations

Ethical approval for the study was obtained from the Research Ethics Committee of the Faculty of Medicine at Universitas Andalas,
Padang, Indonesia (Approval number: 847/UN.16.2/KEP-FK/2022). Furthermore, the school approved to conduct the study, and the
parents gave the student’s consent through the guidance counselor’s assistance. All the participants were fully informed about the aim
of the study and how the data was used and stored, besides confirming that the researcher complied with all relevant ethical regu-
lations to maintain the confidentiality of the participants’ information. All participants provided informed consent before filling out
the instruments. Additionally, anonymization was performed in data collection.

2.5. Statistical analyses

All statistical analyses were conducted using IBM SPSS version 22 (IBM Corp., Armonk, N⋅Y., USA). Demographic variables such as
gender, age, grade level, residential status, parental education, parental occupation, and family income were expressed as percentages,
means, and standard deviations. To assess the normality of continuous variables, the Kolmogorov-Smirnov test was employed. Group
comparisons were made using independent-sample t-tests and ANOVA. The relationships between research variables were explored
through Spearman’s correlations. Statistical significance was considered when p-values were <0.05 (two-sided). Furthermore, mul-
tiple linear regression analysis was employed to identify the factors that influenced Emotional Behavioral Problems (EBPs).

3. Results

3.1. Characteristics of the participants and study variables

Table 1 presents the socio-demographics of the respondents. This study included 854 adolescents, consisting of 380 males
(44.5 %) and 474 females (55.5 %). Most respondents were middle adolescents (61.4 %), and about 39.0 % were in grade 10.
Almost all participants lived with their parents (94.3 %). Most parents completed senior high school education (father = 519
[60.8 %], mother = 486 [56.9 %]). The majority of mothers were unemployed (71.3 %). Most of the participants lived with a

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R. Sarfika et al. Heliyon 9 (2023) e21459

Table 1
Characteristic of participants (n = 854).
Variables f %

Gender
Male 380 44.5
Female 474 55.5
Age (year)
Early adolescent (12–14) 13 1.5
Middle adolescent (15–17) 524 61.4
Late adolescent (18–20) 317 37.1
Class level
Grades 10 333 39.0
Grades 11 281 32.9
Grades 12 240 28.1
Residence status
With parents 805 94.3
With stepparents 5 0.6
With other family 40 4.7
Living alone 4 0.5
Father’s Education
No formal education 13 1.5
Primary School 57 6.7
Junior high school 116 13.6
Senior high school 519 60.8
College 149 17.4
Mother’s Education
No formal education 15 1.8
Primary School 65 7.6
Junior high school 101 11.8
Senior high school 486 56.9
College 187 21.9
Father’s Occupational
Civil servant 97 11.4
State employee 14 1.6
Private employees 85 10.0
Self-employed 245 28.7
Outsourcing 16 1.9
Retiring 31 3.6
Unemployment 38 4.4
Others 328 38.4
Mother’s Occupational
Civil servant 81 9.5
State employee 2 0.2
Private employees 23 2.7
Self-employed 100 11.7
Outsourcing 10 1.2
Retiring 9 1.1
Unemployment 609 71.3
Others 20 2.3
Family Income
< Regional minimum wage 539 63.1
> Regional minimum wage 315 36.9

household income under the regional minimum wage (63.1 %).

3.2. EBPs and their differences among socio-demographic groups

Table 2 provides an overview of the mean scores of the total and individual subscales of EBPs. The overall mean score of the total
EBPs among participants was 24.15 (SD = 5.82), with scores ranging from 0 (no or mild EBPs) to 50 (severe EBPs). For the emotional
problems subscale and the conduct problems subscale the mean scores were 5.28 (SD = 2.66), with scores ranging from 0 (no or mild
emotional symptoms) to 10 (severe emotional symptoms); and 3.33 (SD = 1.59), with scores ranging from 0 (no or mild conduct
problems) to 10 (severe conduct problems) respectively. For the hyperactivity-inattention subscale, the mean score was 4.20 (SD =
1.79), with scores ranging from 0 (no or mild hyperactivity-inattention problems) to 10 (severe hyperactivity-inattention problems),
while for the peer problems subscale, the mean score was 3.74 (SD = 1.82), with scores ranging from 0 (no or mild peer relationship
problems) to 10 (severe peer relationship problems). For the prosocial behavior subscale, the mean score was 7.62 (SD = 1.85), with
scores ranging from 0 (no or low prosocial behavior) to 10 (high prosocial behavior).
The differences in mean scores of EBPs according to the characteristic group can also be seen in Table 2. There were significant
differences in the mean scores of total EBPs among genders (p < 0.001), areas of residence (p = 0.004), and father’s occupations (p <

4
 Table 2

R. Sarfika et al.
Differences EBPs according to characteristic.
Variables EBPs Total EBPs Emotional Problems EBPs Conduct Problems EBPs Hyperactivity EBPs Peer Problems EBPs Prosocial

Mean t/F p value Mean t/F p value Mean t/F p value Mean t/F p Mean t/F p Mean t/F p
± SD ± SD ± SD ± SD value ± SD value ± SD value

Gendera

Male 23.01 −5.19 <.001*** 4.16 ± −11.99 <.001*** 3.56 ± 4.20 <.001*** 4.05 ± −2.20 .028* 3.77 ± 0.45 .652 7.47 ± −2.13 .033*
± 5.71 2.43 1.65 1.70 1.78 1.87
Female 25.06 6.18 ± 3.10 ± 4.32 ± 3.72 ± 7.74 ±
± 5.75 2.49 1.52 1.86 1.85 1.83
Ageb
Early adolescent 25.92 0.68 .509 6.00 ± 1.15 .316 3.08 ± 0.13 .877 4.38 ± 0.36 .699 5.23 ± 4.55 .011* 7.23 ± 1.93 .145
(12–14) ± 4.75 3.24 1.55 1.94 1.88 1.30
Middle adolescent 24.17 5.24 ± 3.31 ± 4.21 ± 3.71 ± 7.59 ±
(15–17) ± 5.88 2.62 1.61 1.79 1.81 1.85
Late adolescent 24.03 5.60 ± 3.31 ± 4.05 ± 3.81 ± 7.99 ±
(18–20) ± 5.77 2.96 1.49 1.78 1.88 1.91
Class levelb
Grades 10 23.93 0.53 .588 5.09 ± 1.44 .236 3.28 ± 1.36 .256 4.14 ± 0.86 .424 3.74 ± 2.14 .118 7.67 ± 0.96 .382
± 5.69 2.64 1.64 1.68 1.76 1.81
Grades 11 24.42 5.44 ± 3.42 ± 4.16 ± 3.89 ± 7.49 ±
± 6.17 2.73 1.62 1.88 1.86 1.91
Grades 12 24.13 5.35 ± 3.19 ± 4.33 ± 3.56 ± 7.70 ±
± 5.59 2.61 1.50 1.83 1.84 1.85
Residence statusb
5

With parents 24.06 4.39 .004** 5.24 ± 2.23 .083 3.30 ± 2.48 .060 4.21 ± 1.87 .132 3.70 ± 5.27 .001** 7.62 ± 0.97 .405
± 5.75 2.66 1.56 1.80 1.78 1.84
With stepparents 24.90 6.00 ± 3.28 ± 3.83 ± 4.20 ± 7.60 ±
± 6.08 2.58 2.09 1.55 2.24 2.02
With other family 33.20 7.40 ± 5.00 ± 5.60 ± 6.40 ± 8.80 ±
± 6.80 2.61 1.41 1.14 1.82 2.17
Living alone 23.50 4.50 ± 2.25 ± 5.00 ± 5.00 ± 6.75 ±
± 8.58 3.32 1.26 2.16 2.16 0.96
b
Father’s Education
No formal 25.62 1.04 .384 5.85 ± 0.91 .455 3.31 ± 2.33 .055 4.31 ± 0.32 .863 4.54 ± 1.14 .334 7.62 ± 0.59 .669
education ± 6.11 2.27 1.65 1.65 1.33 1.94
Primary School 24.44 4.93 ± 3.72 ± 4.42 ± 3.95 ± 7.42 ±
± 5.62 2.59 1.76 1.78 1.47 1.86
Junior high 24.91 5.55 ± 3.55 ± 4.23 ± 3.85 ± 7.72 ±
school ± 6.48 2.86 1.58 1.66 1.07 1.60
Senior high 24.04 5.30 ± 3.25 ± 4.16 ± 3.67 ± 7.66 ±
school ± 5.69 2.66 1.58 1.79 1.80 1.90
College 23.66 5.08 ± 3.11 ± 4.23 ± 3.77 ± 7.46 ±
± 5.78 2.56 1.56 1.90 1.83 1.86
Mother’s Educationb
Heliyon 9 (2023) e21459

No formal 23.87 1.01 .400 5.27 ± 1.16 .325 3.20 ± 2.15 .073 4.60 ± 0.36 .836 3.67 ± 0.627 .644 7.13 ± 0.95 .436
education ± 6.52 2.66 1.90 1.88 1.50 1.88
Primary School 25.46 5.60 ± 3.62 ± 4.31 ± 4.06 ± 7.88 ±
± 5.88 2.55 1.57 2.04 1.83 1.76
Junior high 23.98 4.95 ± 3.62 ± 4.21 ± 3.79 ± 7.41 ±
school ± 5.66 2.765 1.51 1.77 1.76 1.80
(continued on next page)
 R. Sarfika et al.
Table 2 (continued )
Variables EBPs Total EBPs Emotional Problems EBPs Conduct Problems EBPs Hyperactivity EBPs Peer Problems EBPs Prosocial

Mean t/F p value Mean t/F p value Mean t/F p value Mean t/F p Mean t/F p Mean t/F p
± SD ± SD ± SD ± SD value ± SD value ± SD value

Gendera

Senior high 24.14 5.39 ± 3.25 ± 4.15 ± 3.72 ± 7.62 ±

school ± 5.99 2.69 161 1.74 1.86 1.85
College 23.81 5.06 ± 3.17 ± 4.25 ± 3.66 ± 7.67 ±
± 5.35 .254 1.56 1.86 1.77 1.90
Father’s Occupationb
Civil servant 23.71 4.03 <.001*** 5.06 ± 3.53 .001** 3.21 ± 2.08 .043* 4.19 ± 0.63 .734 3.64 ± 2.38 .020* 7.62 ± 2.37 .021*
± 5.94 2.74 1.55 2.09 1.88 1.97
State employee 19.57 2.79 ± 2.71 ± 3.93 ± 2.86 ± 7.29 ±
± 533 2.08 1.38 1.77 1.87 1.98
Private 25.93 5.89 ± 3.51 ± 4.53 ± 4.26 ± 7.74 ±
employees ± 5.14 2.60 1.56 1.62 1.75 1.79
Self-employed 24.36 5.33 ± 3.40 ± 4.14 ± 3.88 ± 7.60 ±
± 5.80 2.63 1.58 1.78 1.88 1.83
Outsourcing 21.50 4.25 ± 2.19 ± 4.38 ± 3.00 ± 7.69 ±
± 5.38 2.77 1.27 2.06 2.06 1.81
Retiring 21.65 4.48 ± 3.26 ± 4.06 ± 3.48 ± 6.35 ±
± 5.73 2.10 1.77 1.75 1.78 1.92
Unemployment 25.08 5.79 ± 3.63 ± 4.39 ± 3.50 ± 7.76 ±
± 5.50 2.47 1.85 1.42 1.84 1.76
6

Others 24.11 5.32 ± 3.25 ± 4.16 ± 3.66 ± 7.72 ±

± 5.86 2.69 1.58 1.78 1.73 1.82
Mother’s Occupationb
Civil servant 23.68 0.85 .545 5.06 ± 2.17 .035* 3.20 ± 2.19 .033* 4.05 ± 0.41 .896 3.73 ± 0.69 .676 7.64 ± 1.99 .053
± 5.55 2.67 1.45 1.88 1.63 1.93
State employee 19.00 2.00 ± 5.00 ± 3.50 ± 2.50 ± 6.00 ±
± 4.24 0.00 1.41 2.12 2.12 1.41
Private 25.83 6.78 ± 3.83 ± 4.52 ± 3.65 ± 7.04 ±
employees ± 5.10 2.17 1.85 1.73 1.64 2.01
Self-employed 24.18 5.16 ± 3.48 ± 4.24 ± 3.84 ± 7.46 ±
± 5.85 2.53 1.54 1.74 1.87 1.95
Outsourcing 23.50 4.40 ± 2.50 ± 4.40 ± 3.80 ± 8.40 ±
± 4.72 2.59 1.90 1.26 1.55 1.51
Retiring 24.11 4.33 ± 4.44 ± 4.78 ± 4.56 ± 6.00 ±
± 6.47 2.83 2.24 1.30 1.67 2.12
Unemployment 24.11 5.29 ± 3.25 ± 4.19 ± 3.71 ± 7.68 ±
± 5.90 2.69 1.58 1.81 1.86 1.82
Others 25.90 6.05 ± 3,65 ± 4.35 ± 4.25 ± 7.60 ±
± 5.42 2.21 1.69 1.78 1.41 1.43
Heliyon 9 (2023) e21459

Family Incomea
< RMW 24.33 1.23 0.218 5.30 ± 0.33 .740 3.35 ± 1.07 .278 4.16 ± −0.85 .398 3.79 ± 1.01 0.315 7.73 ± 2.31 .025*
± 5.76 2.64 1.62 1.77 1.82 1.79
> RMW 23.83 5.24 ± 3.23 ± 4.27 ± 3.66 ± 7.43 ±
± 5.93 2.70 1.56 1.83 1.83 1.95

Note: aIndependent t-test was performed, bOne-way ANOVA was performed, RMW = Monthly Regional Minimum Wage, ***P < 0.001; **P < 0.01; *P < 0.05.
R. Sarfika et al. Heliyon 9 (2023) e21459

0.001). On the emotional problems subscale, there were significant differences among genders (p < 0.001), father’s occupational (p =
0.001), and mother’s occupations (p = 0.035). On the conduct problems subscale, significant differences were found among genders (p
< 0.001), father’s occupations (p = 0.043), and mother’s occupations (p = 0.033) too. On the hyperactivity-inattention subscale, a
significant difference was found only between genders (p = 0.028). On the peer problems subscale, significant differences were found
among age groups (p = 0.011), areas of residence (p = 0.001), and father’s occupations (p = 0.020). Finally, on the prosocial behavior
subscale, significant differences were found among genders (p = 0.033), father’s occupations (p = 0.021), and household income
groups (p = 0.025).

3.3. Correlations of EBPs with parental attachment and self-esteem

The mean scores of the father’s attachments (M = 82.86, SD = 11.03), mother’s attachment (M = 85.11, SD = 9.59), and self-
esteem (M = 28.24, SD = 4.18) are shown in Table 3. Table 3 also shows the results of the correlation test. EBPs were significantly
negatively related to father’s attachment (r = −0.191, p < 0.001), mother’s attachment (r = −0.241, p < 0.001), and self-esteem (r =
−0.437, p < 0.001). At the same time, parental attachment was positively related to self-esteem (father: r = 0.407, p < 0.001 and
mother: r = 0.406, p < 0.001).

4. Factors influencing EBPs among adolescents

Table 4 illustrates the factors affecting EBPs and all subscales. These results were obtained by linear regression analysis for each
characteristic and study variable. All predictors of overall EBPs among adolescents were able to explain 31 % of the variance in EBPs
according to regression analysis. Overall EBPs among adolescents were associated with father’s education (β = −0.08, p < 0.05),
father’s communication (β = 0.18, p < 0.01), father’s alienation (β = 0.27, p < 0.001), mother’s alienation (β = 0.18, p < 0.001), and
self-esteem (β = 0.27, p < 0.001). Emotional problems were associated with gender (β = 0.26, p < 0.001), father’s alienation (β = 0.19,
p < 0.01), mother’s alienation (β = 0.18, p < 0.001), and self-esteem (β = −0.29, p < 0.001). The conduct problems were associated
with gender (β = −0.20, p < 0.001), father’s alienation (β = 0.17, p < 0.001), mother’s trust (β = −0.15, p < 0.05), mother’s
communication (β = 0.15, p < 0.05), and mother’s alienation (β = 0.17, p < 0.01). Hyperactivity was associated with father’s
alienation (β = 0.20, p < 0.001), mother’s trust (β = −0.12, p < 0.05), and self-esteem (β = −0.21, p < 0.001). Peer problems were
associated with gender (β = −0.10, p < 0.01), class level (β = −0.11, p < 0.05), residence status (β = 0.08, p < 0.05), family income (β
= −0.08, p < 0.05), father’s alienation (β = 0.14, p < 0.01), and self-esteem (β = −0.21, p < 0.001). The prosocial was associated with
gender (β = 0.14, p < 0.001), residential status (β = 0.08, p < 0.05), family income (β = −0.10, p < 0.05), father’s alienation (β = 0.17,
p < 0.05), and mother’s trust (β = 0.17, p < 0.01).

5. Discussion

In the present research, it was discovered that the bonds with both mothers and fathers had an adverse connection with EBPs while
exhibiting a positive correlation with self-esteem. A previous investigation reinforces our findings by demonstrating a harmful link
between parental attachment and mental health concerns [10]. Another study revealed that parental hostility was linked to heightened
hyperactivity difficulties and trauma symptoms, as well as increased behavioral problems, but only in adolescents who already had
significant baseline issues. Conversely, parental warmth was linked to reduced trauma symptoms [39,40]. In line with our current
study, research conducted previous study [41,42], similarly demonstrated a connection between limited parental connection and an
escalation in mental health problems, particularly in terms of overall difficulties.
Moreover, in line with the findings of the current study, another longitudinal investigation has demonstrated that lower perceived
attachment to both mothers and fathers during childhood predicts a greater severity of mental health problems [43–45]. The
perception of inadequate parental attachment during childhood may hinder the development of skills to nurture and resolve conflicts
within intimate relationships in a healthy and mature manner. Furthermore, a lower perceived childhood attachment to parents could
lead to a higher likelihood of misinterpreting the perceptions, emotions, and intentions of significant others, potentially resulting in
increased depressive symptoms in adulthood [46,47]. These findings have significant implications for the design of interventions and
treatment plans for individuals struggling with behavioral difficulties [48].
Although the present study uncovered a connection between parental attachment and self-esteem, a hierarchical regression
analysis demonstrated that father’s and mother’s attachment factors were individually linked to behavioral issues. This suggests that
while these processes are related, they remain distinct factors. Furthermore, the results of this study indicated that father’s attachment
did not exhibit a significant association with the SDQ (Strengths and Difficulties Questionnaire) among adolescents (β = −0.02, t =
−0.81, p = 0.41), despite a correlation between the two variables (r = −0.13, p < 0.001). This finding aligns with previous research
that has shown a negative correlation between father’s attachment and mental health problems in adolescents [49]. It’s important to
note that determining the direction of effects in this study is challenging due to its correlational approach.
According to the results of the linear regression analysis, self-esteem exhibited a stronger and more significant association with
mental health status and was better at explaining the variance in mental health scores. Self-esteem plays a pivotal role in the
development of various mental health conditions. In the context of adolescents, previous research has indicated that low self-esteem is
linked to depression during adolescence and young adulthood, whereas high self-esteem tends to be connected with greater well-being
and overall life satisfaction. Low self-esteem among adolescents has consistently been associated with mental health issues.
Furthermore, multiple prior studies have demonstrated the relationship between teenagers’ self-esteem and their mental health

7
 R. Sarfika et al.
Table 3
Descriptive statistics and correlations among study variables.
Variables Mean SD 1 2 3 4 5 6 7 8 9

1. EBPs Total 24.01 5.82 1

2. EBPs Emotional Problems 5.20 2.69 .838*** 1
3. EBPs Conduct Problems 3.29 1.60 .508*** .255*** 1
4. EBPs Hyperactivity 4.21 1.78 .647*** .461*** .327*** 1
5. EBPs Peer Problems 3.68 1.79 .620*** .402*** .352*** .284*** 1
6. EBPs Prosocial 7.62 1.86 .205*** .089** −.182*** −.145** −.123** 1
7. Father’s Attachment 82.97 11.03 −.191*** −.244*** −.147** −.216*** −.206*** .289*** 1
8. Father’s Trust 38.18 8.22 −.270*** −.296*** −.230*** −.256*** −.267*** .267*** .910*** 1
8

9. Father’s Communication 29.70 4.28 −.263*** −.320*** −.153*** −.265*** −.238*** .267*** .930*** .819*** 1
10. Father’s Alienation 15.09 7.12 .415*** .417*** .258*** .328*** .313*** −.148*** −.551*** −.704*** −.698*** 1
11. Mother’s Attachment 81.63 7.39 −.241*** −.258*** −.140*** −.282*** −.219*** .255*** .583*** .530* .540*** −.324*** 1
12. Mother’s Trust 38.44 4.54 −.337*** −.346*** −.230*** −.329*** −.291*** .259*** .548*** .582*** .517*** −.441*** .864*** 1
13. Mother’s Communication 29.28 5.42 −.345*** −.364*** 0.169*** −.349*** −.297*** .230*** .584*** .558*** .602*** −.469*** .868*** .762*** 1
14. Mother’s Alienation 13.91 5.94 .440*** .450*** .226*** .349*** .341*** −.131*** −.387*** −.484*** −.461*** .610*** −.412**** −.638*** −.694*** 1
15. Self-Esteem 28.25 4.12 −.437*** −.520*** −.134*** −.331*** −.320*** .171*** .407*** .377*** .472*** −.421*** .406*** .429*** .476*** −.449***

Note: Spearman’s correlation test was performed, ***P < 0.001; **P < 0.01; *P < 0.05. Bonferroni correction was performed.

Heliyon 9 (2023) e21459

 R. Sarfika et al.
Table 4
Predictors of EBPs.
Variables EBPs Total EBPs Emotional Problems EBPs Conduct Problems EBPs Hyperactivity EBPs Peer Problems EBPs Prosocial

B β B β B β B β B β B β
Gender .752 .064 1.436 .265*** −.669 −.209*** −.173 −.048 −.381 −.106** .539 .144***
Age .284 .048 −.017 −.006 .115 .071 −.076 −.042 .119 .065 .142 .075
Class level −.274 −.038 .081 .024 −.111 −.056 .130 .058 −.258 −.116* −.116 −.050
Residence Status 1.607 .059 .166 .013 −.070 −.009 .052 .006 .718 .086* .741 .086*
Father’s Education −.572 −.082* −.194 −.060 −.104 −.054 −.102 −.048 −.111 −.052 −.060 −.027
Mother’s Education .247 .037 .100 .032 −.043 −.024 .052 .025 .000 .000 .139 .066
Father’s Occupation −.120 −.052 −.004 −.004 −.022 −.034 −.016 −.023 −.505 −.069 −.028 −.037
Mother’s Occupation .008 .003 −.006 −.004 −.025 −.032 .038 .043 −.005 −.005 .005 .006
9

Family Income −.896 −.075 −.056 −.010 −.164 −.050 .031 .008 −.303 −.082* −.404 −.105*
Father’s Trust .004 .005 .001 .003 −.023 −.101 .009 .036 −.006 −.026 .023 .088
Father’s Communication .145 .184** .042 .115 .025 .118 .018 .076 .014 .059 .045 .177*
Father’s Alienation .357 .278*** .114 .193*** .061 .174** .079 .202*** .058 .147** .044 .107
Mother’s Trust −.066 −.061 −.003 −.005 −.045 −.152* −.042 −.128* −.036 −.109 .059 .172**
Mother’s Communication −.009 −.009 −.016 −.036 .041 .153* −.026 −.088 .000 .000 −.007 −.023
Mother’s Alienation .259 .183*** .118 .181*** .070 .179** .029 .068 .043 .100 −.001 −.002
Self-Esteem −.370 .272*** −.189 −.299*** −.022 −.058 −.089 −.214*** −.090 −.215*** .019 .044
Constant 19.998 4.680 3.161 7.829 5.494 −1.165
R2 0.310 0.394 0.150 0.222 0.199 0.118
Cohen’s f 0.670 0.806 0.420 0.534 0.835 0.366

Note: ***P < 0.001; **P < 0.01; *P < 0.05. Bonferroni correction was performed.

Heliyon 9 (2023) e21459

R. Sarfika et al. Heliyon 9 (2023) e21459

[50–52]. In terms of mental health, self-esteem is a crucial factor and has been found to be associated with mental well-being [53–56].
This study confirms the widely held belief that adolescents who have stronger bonds with their parents and higher self-esteem tend
to experience fewer overall challenges and exhibit more positive prosocial behavior. However, it’s important to highlight that not all of
these variables exhibited direct connections with mental health outcomes when considered simultaneously in the same regression
model. The study underscores that not all aspects of parental attachment directly influence the mental health of adolescents, with
maternal attachment emerging as the primary influential factor.
The practical implications of this research are significant, especially for the development of interventions and treatment strategies
aimed at enhancing the mental well-being of adolescents. Recognizing the critical roles played by maternal attachment and self-esteem
can guide targeted interventions designed to bolster these factors, potentially leading to more favorable outcomes for adolescents in
terms of their behavior and emotional health.

5.1. Limitation

From a methodological point of view, attention should be called to the specifics of the sample. The data collection was only in one
school, located in the south of Padang City. It can be assumed that compared to other regions in Padang, this area, more adolescents
grew up in well-educated, better-off families. Sampling hence is likely to have contributed to our specific results. Further, the cross-
sectional design limited the ability to make causal inferences.

6. Conclusion

This study aimed to explore the association of parental attachment and self-esteem with mental health in adolescents. The study
showed that adolescents with more stable relationships with their parents and strong self-esteem had a number of positive mental
health outcomes. This study’s findings support the need to develop numerous attachments, secure attachments, and strong self-esteem
during adolescence. Although there was a correlation between variables, it is unclear whether lower adolescent attachment to their
parents was a precursor to whether individuals who exhibited poorer mental health had an incredible difficulty forming attachments.
Although long-term studies are needed to support this claim, some researchers have hypothesized that the links between attachment
security and mental health are reciprocal. The cross-sectional design limited the ability to draw causal conclusions.

Data availability statement

The data is not accessible to the public as it contains information that might compromise the confidentiality of the research par-
ticipants. Nevertheless, the data can be made available upon a reasonable request.

Funding

This study was supported by Research and Community Service Centre (Lembaga Penelitian dan Pengabdian Masyarakat) Fund of
the Universitas Andalas, Padang, Indonesia (Grant Number T/155/UN.16.17/PT.01.03/KO-RPT/2022).

CRediT authorship contribution statement

Rika Sarfika: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project
administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. I
Made Moh Yanuar Saifudin: Data curation, Formal analysis, Investigation, Software, Validation, Visualization, Writing – original
draft, Writing – review & editing. Ira Mulya Sari: Data curation, Project administration, Writing – original draft. Dewi Murni: Re-
sources, Writing – original draft. Hema Malini: Writing – review & editing, Formal analysis. Khatijah Lim Abdullah: Data curation,
Writing – review & editing.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to
influence the work reported in this paper.

Acknowledgement

The authors acknowledge Research and Community Service Centre (Lembaga Penelitian dan Pengabdian Masyarakat) Universitas
Andalas, which funded, supported and facilitated this reseach. The authors also thank to all respondents who participated in this study.

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