behavioral
sciences
Systematic Review
Self-Esteem and Risk Behaviours in Adolescents:
A Systematic Review
Elena Martínez-Casanova * , María del Mar Molero-Jurado
Citation: Martínez-Casanova, E.;
Molero-Jurado, M.d.M.;
Pérez-Fuentes, M.d.C. Self-Esteem
and Risk Behaviours in Adolescents:
A Systematic Review. Behav. Sci. 2024,
14, 432. https://doi.org/10.3390/
bs14060432
Academic Editor: Dario Bacchini
Received: 26 April 2024
Revised: 17 May 2024
Accepted: 20 May 2024
Published: 22 May 2024
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Behav. Sci. 2024, 14, 432. https://doi.org/10.3390/bs14060432
and María del Carmen Pérez-Fuentes
Department of Psychology, University of Almería, 04120 Almería, Spain; mmj130@ual.es (M.d.M.M.-J.);
mpf421@ual.es (M.d.C.P.-F.)
* Correspondence: emc542@ual.es
Abstract: Adolescence is recognised as a notoriously vulnerable period in the human life cycle.
Influenced by a complex interplay of biological, psychological and social factors, adolescents show
a marked propensity to engage in risk behaviours. A systematic review was conducted of studies
published in the Web of Science, PsycInfo and MEDLINE databases over the last decade, with the
aim of collecting studies on the relationship between self-esteem and risk behaviour in individuals
aged 12–18 years. The aim was to confirm the role of high self-esteem as a consistent protective factor
against risk behaviour. The results show that self-esteem is negatively related to risk behaviour. Our
results also reflect the need for further research on how sociodemographic factors, among others,
affect the relationship between self-esteem and risk behaviours. This review highlights the relevance
of implementing specific educational interventions to strengthen self-esteem in adolescents, with
the aim of preventing various risk behaviours that may emerge during adolescence and persist
throughout life if not addressed early.
Keywords: self-esteem; risk behaviours; systematic review; cross-sectional studies
1. Introduction
Adolescence is a stage of vulnerability to risk behaviours, due to a complex interaction
of biological, psychological and social factors, including the brain’s sensitivity to emotions
generated by rewarding experiences, the search for identity and the desire for independence,
the lack of tools to manage different emotions and, finally, the adolescent’s permeability
to the example offered by their primary caregiver [1,2]. These factors can be defined as
risk factors, understood as individual attributes and/or characteristics, conditions and/or
environmental contexts that increase the likelihood of developing risk behaviours [3].
Risky behaviours encompass any action that threatens biological, psychological or
social development [4], with an immediate effect that may be pleasant but with harmful
long-term consequences, as they are linked to high morbidity and mortality [5]. This is
clearly exemplified in the case of tobacco and alcohol use, which have caused more than
8 million and 3 million deaths, respectively [6,7]. Around 90% of adult smokers admit to
having started smoking during adolescence [8], underlining the need for early interventions.
In addition, risk behaviours are often associated with each other. For example, drug use
is associated with risky sexual relationships [4] or with antisocial behaviour [9]. Another
relevant aspect is the connection between eating disorders, which often occur during
adolescence [10], and suicide [11].
In order to address risky behaviours, research on protective factors or, in other words,
personal or social resources that reduce the tendency to develop risky behaviours and,
consequently, health problems, is crucial [3].
Self-esteem, defined as the global evaluation of oneself [12], has traditionally been
considered a protective factor against various risk behaviours. It has been linked to a
decrease in the consumption of substances such as alcohol, tobacco [13] and illicit drugs, as
https://www.mdpi.com/journal/behavsci
Behav. Sci. 2024, 14, 432 2 of 17

well as to a lower risk of eating disorders (EA) [14], self-harm, suicidal behaviour [15,16],
sexual risk behaviours [17], harmful media use [18,19] and antisocial behaviours such as
aggression, delinquency, bullying, cyberbullying and sexting [20–26]. In addition, some
studies report a mediating role of self-esteem, for example, between strict parenting and
suicidal ideation [27] or between depression and suicidal ideation [28].
However, recent research has challenged this perspective. Some have found no
significant relationship [29–32] and others have even found a positive relationship [33,34].
In addition, it is important to consider possible variations in the relationship between
self-esteem and risk behaviours by gender. Self-reports suggest that women tend to report
lower levels of self-esteem compared to men, which may influence how these behaviours
manifest themselves in each group [35].
Thus, new research is needed to provide a clear and updated perspective on the
subject, in order to determine whether self-esteem is a relevant individual variable for the
reduction of risk behaviours in adolescence. The present review aims to find out whether
high self-esteem functions as a protective or risk factor by analysing the scientific literature
of the last decade, in Spanish and English.

2. Materials and Methods

This review has been conducted in accordance with the PRISMA 2020 guidelines for
systematic reviews [36].

2.1. Data Sources and Search Strategy

The search for publications was conducted between November 2023 and February
2024. Due to the multidisciplinary approach of the review, MEDLINE, Web of Science
and PsycInfo databases were consulted. In all three databases, the terms “self-esteem”,
“risk behaviours” and “adolescents” were used in English and Spanish. To find documents
that included the above terms, the Boolean operators “AND” and “OR” were used. Thus,
the search strategy was (autoestima OR self-esteem) AND (conductas de riesgo OR risk
behaviors) AND (adolescentes OR adolescents). A total of 7189 citations were identified
in the three databases searched. The search was limited to open access journal articles
published in English or Spanish between 2013 and 2023, which reduced the number of
citations to 1984. Table 1 shows the search strategy and the terms included.

Table 1. Results obtained in each database.

No. of Initial No. of Results after

Database Language Search Strategy
Results Applying Filters
(autoestima OR self-esteem) AND
Spanish
Web of Science (conductas de riesgo OR risk behaviors) 4542 1167
English
AND (adolescentes OR adolescents)
(autoestima OR self-esteem) AND
Spanish
PsycInfo (conductas de riesgo OR risk behaviors) 2217 767
English
AND (adolescentes OR adolescents)
(autoestima OR self-esteem) AND
Spanish
MEDLINE (conductas de riesgo OR risk behaviors) 429 50
English
AND (adolescentes OR adolescents)
Total 7189 1984

2.2. Elegibility Criteria

Articles were included if they (1) had adolescent participants (12–18 years); (2) were
quantitative and cross-sectional; (3) were in English or Spanish; (4) treated self-esteem as a
unidimensional concept; (5) and addressed a specific risk behaviour.
Articles were excluded if they (1) did not provide clear data on the age of partici-
pants or if ages were below 12 years or above 18 years; (2) had gender bias in the sample;
 Articles were excluded if they (1) did not provide clear data on the age of participants
or if ages were below 12 years or above 18 years; (2) had gender bias in the sample; (3)
included participants with physical, psychological or social particularities; (4) considered
Behav. Sci. 2024, 14, 432 3 of 17
terms such as “self-concept” or “self-image” as synonymous with self-esteem; (5)
superficially addressed risk behaviours; (6) focused on the creation, validation or
adaptation of scales and questionnaires; (7) evaluated the effectiveness of intervention
(3) included participants with physical, psychological or social particularities; (4) con-
programmes; (8) and/or were limited in their accessibility.
sidered terms such as “self-concept” or “self-image” as synonymous with self-esteem;
(5)
2.3.superficially addressed risk behaviours; (6) focused on the creation, validation or adap-
Quality of Manuscripts
tation of scales and questionnaires; (7) evaluated the effectiveness of intervention pro-
Two reviewers
grammes; (8) and/orindependently
were limited inrated
theirthe quality of the selected full-text articles using
accessibility.
the Newcastle–Ottawa Scale (NOS) tool adapted for cross-sectional studies by Herzog et
al. [37].
2.3. A minimum
Quality score of 5 out of 10 was set for this review to be selected.
of Manuscripts
Two reviewers independently rated the quality of the selected full-text articles using
2.4. Data
the Extraction
Newcastle–Ottawa Scale (NOS) tool adapted for cross-sectional studies by
HerzogStudies
et al. were selected
[37]. A minimum following
score ofa two-stage
5 out of 10process,
was set as
forshown in Figure
this review to be1selected.
(PRISMA
flowchart): (1) screening of the titles and abstracts of potentially eligible studies followed
2.4. Data
by (2) Extraction
screening of the full texts of the preliminarily selected articles. The assessment of
eachStudies
record was performed by two reviewers.
were selected following a two-stage process, as shown in Figure 1 (PRISMA
A total(1)
flowchart): ofscreening
1737 articles were
of the identified
titles as eligible;
and abstracts however,
of potentially after full-text
eligible analysis,
studies followed
only
by (2)48screening
articles remained
of the fulland were
texts included
of the in this review.
preliminarily selected articles. The assessment of
each record was performed by two reviewers.

Figure 1. Flowchart of the document selection process.

A total of 1737 articles were identified as eligible; however, after full-text analysis, only
48 articles remained and were included in this review.
Behav. Sci. 2024, 14, 432 4 of 17

3. Results
Self-esteem’s impact on identity and behaviour is widely studied. This systematic
review examines the available evidence on the interaction between self-esteem and risk
behaviours in adolescents, providing a comprehensive overview of how self-perception
may influence participation in activities that carry potential negative consequences for
health and well-being. The salient features of the studies included in the current review are
summarised in Table 2.
Six main categories of risk behaviours have been identified: (1) substance abuse,
(2) eating disorders, (3) suicide and self-harm, (4) risky sexual practices, (5) harmful use of
media and (6) antisocial behaviour. According to our inclusion and exclusion criteria, the
most researched category was “suicide and self-harm”, while the least studied categories
were “risky sexual practices” and “antisocial behaviour”.
In terms of the year of publication, 2022 stands out as the year with the highest number
of publications, coinciding with the return to normality after the COVID-19 pandemic. It is
notable that in 2021, during the height of the pandemic, research experienced a significant
decrease. There is a notable increase in the number of publications from 2021 to 2022,
followed by a similar transition between 2016 and 2017.
With regard to the country of publication, there is evidence of international interest
in the subject. However, Spain stands out as the country with the highest number of
publications related to self-esteem and risk behaviours.
As for the sample sizes of the studies analysed, there is considerable disparity, ranging
from a minimum of 100 to a maximum of 57,767 subjects. As for the age of the subjects,
they ranged from 12 to 18 years of age, with 15 and 16 years of age standing out, present in
more than 40 of the 48 studies included.
 review
3. examines the available evidence on the interaction between self-esteem and risk
Results
Figure 1. Flowchart of the document selection process.
behaviours in adolescents, providing a comprehensive overview of how self-perception
Self-esteem’s impact on identity and behaviour is widely studied. This systematic
may influence participation in activities that carry potential negative consequences for
review3. examines
Results the available evidence on the interaction between self-esteem and risk
health and well-being. The salient features of the studies included in the current review
Behav. Sci. 2024, 14, 432 behavioursSelf-esteem’s
in adolescents, providing
impact a comprehensive
on identity overview
and behaviour of how
is widely self-perception
studied. This systematic
5 of 17
are summarised in Table 2.
may influence participation
review examines in activities
the available that carry
evidence on thepotential negative
interaction betweenconsequences
self-esteem for
and risk
health2.and well-being.
Table behaviours ofThe salient
in adolescents,
Characteristics the studies features of
providing
included. the studies included
a comprehensive in the
overview of current review
how self-perception
Table 2. Characteristics of the studies included. are summarised
may influencein Table 2.
participation in activities that carry potential negative consequences for
health and well-being. Objectives.
The salient features of the studies included in the current review
Risk TableObjectives.
2. Analyse
Characteristics the Relationship Measuring
Risk Author summarised in Table 2. included.
Sample are Country
of the studies
Results
Author SampleBehaviourCountry Analyse the Relationship between Measuring Instrument
between Self-Esteem Instrument Results
Behaviour Objectives.
Self-Esteem and . . . and...
Risk Table 2. Characteristics
Analyse of thethe studies included.
Relationship Measuring
3882 Rial et al.
Author 3882
Sample Country cannabis use and self- Results
Rial et al. [38] BehaviourSpain Spain
cannabis use and self-esteem between Self-Esteem
Objectives. RSES
RSES Instrument Cannabis⤄SE
Cannabis SE
(12–18) [38] (12–18) esteem
Risk Anbarlouei and...the Relationship
Analyse Measuring
1282 Author 38821282Sample Country smoking (cigarettes and Tobacco⟺SE
Tobacco⇔SE ((−)
−)
Results
Anbarlouei et al. [39] Iran Rial
Behaviour et al. smoking (cigarettesIran
and cannabis
hookahs) use and
between self-
RSES
Self-Esteem RSES
Instrument
(14–17) et al. [39] (14–17) Spain hookahs) RSES Hookahs⤄SE
Cannabis⤄SE
Hookahs SE
[38] (12–18) esteem
Jongenelis et 1661 expenditure onand... alcohol, Alcohol⟺SE (−)
1661 Anbarlouei expenditure
1282 on alcohol,
Australia
Rial et al.(15–17) 3882 Iran tobacco and
smoking (cigarettes
cannabis useand
and ASQ
self- RSES Alcohol⇔SE ((−)
Tobacco⟺SE −)
Jongenelis et al. [40] Australia al. [40] tobacco and cannabis ASQ Tobacco andCannabis⤄SE
cannabis⤄SE
(15–17) et al. [39][38] (14–17)(12–18) cannabis Spain hookahs) RSES Tobacco and
Hookahs⤄SEcannabis SE
Pérez- esteem
1287 Jongenelis 1287 1282 perceived pressure to
Pérez-Fuentes et al. [41] Spain Fuentes etet
Anbarlouei 1661
perceived pressure Spain
to drink
Australia
expenditure
Iranalcohol
smoking on (cigarettes
alcohol,
RSESand RSES
Alcohol⟺SE
Pressure
ASQ RSES Pressure toTobacco⟺SE
to drink⟺SE
drink
(−)
⇔SE ((−) −(−)
)
(14–18) al. [40]
et al. [39](14–18)
(15–17) (14–17) drink
tobacco and alcohol
cannabis
hookahs) Tobacco and cannabis⤄SE
Hookahs⤄SE
al. [41]
870 Pérez-
Jongenelis et
Drug Baheiraei et al. [42] Drug Iran Baheiraei et tobacco870and1661
1287 alcohol
expenditure
tobacco
perceived and ontoalcohol,
alcohol
pressure Alcohol⟺SE (−)
⇔SE ((−)−)
(15–18) Fuentes al.et [40] (15–17) Iranexpenditure
Spain Australia
tobacco and
CTC-YS CTC-YSASQ
cannabis RSES
Tobacco
Tobacco⟺SE
Pressure to drink⟺SE
Tobacco (−)
and cannabis⤄SE
abuse abuse al. [42] (15–18)
(14–18) expenditure
drink alcohol
57,767 al. [41] Pérez-
Chen et al. [43] Chen et al. marijuana
United States 57,767 1287use United
by age andmarijuana
sex useAgreement
perceived by age and Statement
pressure to Agreement Marijuana ⇔SE ((−) −)
(13–16) Drug Baheiraei et 870 tobacco and alcohol Marijuana⟺SE
[43]Fuentes et Iran Spain
(13–16)(14–18)States sex
drink alcohol CTC-YSRSES
Statement Pressure to drink⟺SE
Tobacco⟺SE (−) (−)
abuse al. [42]al. [41] (15–18) expenditure
2636 Mehanović 2636 EU-Dap Alcohol⟺SE
Alcohol ⇔SE ((−) −)
Mehanović et al. [44] Slovenia
Drug Chen et al. etalcohol
57,767 Slovenia
consumption
United alcoholtobacco
marijuana consumption
useEU-Dap
by and questionnaire
age and Agreement
(12–14) et al. Baheiraei
[44] (12–14) 870 alcohol questionnaire in socioeconomic
in⬆socioeconomic
Marijuana⟺SE status(−)
status
(−)
[43] al. [42] (13–16)(15–18)States Iran
abuse Ninkron sexexpenditure
CTC-YS
Statement Tobacco⟺SE
624 et 624 Validated
Ninkron et al. [45] ThailandMehanovićChen et al. Thailand
2636substance
57,767 abuse substance
United alcohol marijuana abuse
Validated
use by age EU-Dap
instrument
and Substance
Agreement Substance abuse⟺SE
Alcohol⟺SE
abuse ⇔(−)SE ((−)−)
(12–18) al. [45] (12-18) Slovenia consumption instrument Marijuana⟺SE (−)
et al. [44][43] (12–14)(13–16) States sex questionnaire
Statement in⬆socioeconomic status
1287 Pérez- Anxiety Anxiety
and expectatives ⇔SE⇔Pressure
Spain Ninkron et
Mehanović 1287
624to pressure to drink resistance
2636Thailand alcohol to pressure to Validated and expectatives
Pérez-Fuentes et al. [46]
(14–18) Fuentes resistance
et Spain Slovenia substance alcohol abuse RSES RSESEU-Dap Substance
consumption instrument
Alcohol⟺SE
abuse⟺SE
to drink −)drink
(to (−)(−)
al. [45]
et al. [44](14–18)
(12-18) (12–14) drink alcohol ⟺SE⟺Pressure
questionnaire in⬆socioeconomic(−) status
al. [46]
448 Pérez-Ninkron et 624 Validated
Gutiérrez et al. [47] SpainGutiérrez et 448eating disorders
1287 Thailand to pressure RSES
resistance substance to EatingSubstance
Anxiety disorders ⇔ SE (−) (−)
and expectatives
(12–15) Fuentes al.et Spain eating disorders abuse RSES Eating disorders⟺SE abuse⟺SE (−)
al. [47] [45] (14–18)
(12–15)(12-18) drink alcohol instrument⟺SE⟺Pressure to drink (−)
356 al. [46]Pérez-
Ying et al. [48] MalaysiaYing et al. 356 binge eating RSES to RSES Binge eating ⇔ −)
SEexpectatives
((−)
(13–16) Gutiérrez et 448 1287Malaysia resistance
binge eatingto pressure Anxiety
Binge eating⟺SEand
[48]Fuentes et (13–16)(14–18)Spain Spain eating disorders drink alcohol RSES RSES Eating disorders⟺SE
⟺SE⟺Pressure to (−)drink (−)
Eating 100 al. [47]al. [46] (12–15)
Gomez-Sanchez et al. [49] Gomez-
Peru Ying et al. anorexia and bulimia FRAB Anorexia and bulimia ⇔SE (−)
disorders (13–16) Gutiérrez 100
et356 448Malaysia Anorexia and bulimia⟺SE
Sanchez et Peru Spain anorexia binge and
eating bulimia
eating disorders FRAB
RSES RSES Binge eating⟺SE
Eating (−)
disorders⟺SE (−)
[48] (13–16)
(13–16)(12–15) (−)
593 al. [49]al. [47]
Zhao et al. [50] China Gomez- Ying food addiction RSES Food addiction⇔SE (−)
(13–17) Zhao et al. et al. 100
593 356 Malaysiaanorexia binge eating RSES Anorexia and bulimia⟺SE
Binge eating⟺SE
Sanchez et[48] China
Peru food addiction
and bulimia RSES
FRAB Food addiction⟺SE (−) (−)
579 [50] (13–17)(13–16)
(13–16) (−)
Mora et al. [51] EatingSpain al. [49]Gomez- risk of eating disorders RSES Eating disorders⇔SE (−)
(12–16) Mora et al. 579 100 Anorexia and bulimia⟺SE
disorders Zhao et al. 593 Spain risk of eating disorders RSES Eating disorders⟺SE (−)
[51]Sanchez et (12–16)(13–16)China Peru foodanorexia
addiction and bulimia RSES FRAB Food addiction⟺SE (−) (−)
[50] al. [49] (13–17)
Eating Pamies-
Mora et al. et al.1630
Zhao 579 593 Spain RSES RSES Eating
Eating Food
disorders⟺SE (−) (−)
disorders Aubalat et Spain Chinariskeating of eating disorders
fooddisorders
addiction RSES disorders⟺SE
addiction⟺SE (−)
(12–18)(13–17)
[51] [50] (12–16)
al. [52]
Eating Pamies-
Cella etMora
al. et al.1630
973 579 Parental bonding
disorders
Aubalat et[51] Italy Spain eating
Spain risk disorders
binge ofeating
eating disorders RSES RSES Eating Eating disorders⟺SE
disorders⟺SE (−) (−)
[53] (12–16)(12–16)
(12–18) ⟺SE⟺Binge eating (−)
al. [52]
 Behav. Sci. 2024, 14, x FOR PEER REVIEW 4 of 16

Behav. Sci. 2024, 14, 432 Figure 1. Flowchart of the document selection process. 6 of 17

3. Results
Table 2. Cont. Self-esteem’s impact on identity and behaviour is widely studied. This systematic
review examines the available evidence on the interaction between self-esteem and risk
Objectives.
Risk behaviours in adolescents, providing a comprehensive
Author Sample Country Analyse the Relationship between Measuring Instrumentoverview of how self-perception
Results
Behaviour may Self-Esteem
influence participation in activities that carry potential negative consequences for
and . . .
1630
health and well-being. The salient features of the studies included in the current review
Pamies-Aubalat et al. [52] Spain eating disorders
are summarised in Table 2. RSES Eating disorders⇔SE (−)
(12–18)
973
Behav. Sci. 2024,Italy
14, x FOR PEER REVIEW 4 of eating
16
Cella et al. [53] Table 2. Characteristics
binge eating of the studies included. RSES Parental bonding ⇔SE⇔Binge (−)
Eating (12–16)
disorders 721 diet, bulimia, preoccupation with food Objectives.
and
Frieiro et al. [54] Spain RSES Eating disorders⇔SE (−)
(12–18)Risk oral control Analyse the Relationship Measuring
Author Sample Country
Figure 1. Flowchart of the document selection process. Results
Behaviour between Self-Esteem Instrument
2509
Olsen et al. [55] Denmark binge eating disorder and... SISES Binge eating⇔SE (−)
(16) 3. Results
Rial et al. 3882 cannabis use and self-
2258 Republic of Spain RSES Cannabis⤄SE
Lee et al. [56] [38] Self-esteem’s
(12–18) suicidal impact on
behaviour identity and RSES
esteem behaviour is widely studied. This systematic
Suicidal behaviour ⇔SE (−)
(15–18) Korea
Anbarlouei review examines the
1282 available
smoking evidence
(cigarettes andon the interaction between self-esteem
Tobacco⟺SE (−)and risk
5879 Iran RSES
Huang et al. [57] Chinaet al. [39] behaviours
(14–17)
self-harm in adolescents,
and attempted suicide providing a comprehensive
hookahs) RSES overview
Self-harm ofHookahs⤄SE
how
and self-perception
attempted suicide⇔SE (−)
(15–17)
Jongenelis et may
1661 influence participation in activities
expenditure on alcohol, that carry potential negative consequences
Alcohol⟺SE (−) for
Australia ASQ
617 al. [40] health and
(15–17) well-being. The salient Suicide Orientation
features of the studies included
Tobaccoin thecannabis⤄SE
current review
Muñetón et al. [58] Colombia suicidal risk tobacco and cannabis and
Suicidal risk⇔SE (−)
(14–18) Pérez- are summarised in Table 2. Inventory ISO-30
1287 perceived pressure to
1060 Fuentes et Spain RSES Pressure to drink⟺SE (−)
Tang et al. [59] Taiwan (14–18) non-suicidal self-harm drink alcohol RSES Self-harm⇔SE (−)
(14–16) al. [41] Table 2. Characteristics of the studies included.
2552Drug Baheiraei et 870
Iran
tobacco and alcohol
Suicide and Delfabbro et al. [60] abuse Australia al. [42] (15–18) suicidal tendencies
Objectives.
expenditure RSESCTC-YS Tobacco⟺SE
Suicidal (−) ⇔SE (−)
tendencies
(14–16)
self-harm Risk Analyse the Relationship Measuring
ChenAuthor
et al. Sample
57,767 Country marijuana use by age and
United Agreement Results
1790
Behaviour Spain between Self-Esteem Instrument Marijuana⟺SE (−)⇔SE (−)
Fonseca-Pedrero et al. [61] [43] (13–16) suicidal behaviour
States sex RSESStatement Suicidal behaviour
(14–18) and...
Mehanović 2636 EU-Dap Alcohol⟺SE (−)
392 Rial et al. 3882 Slovenia cannabis
alcohol use and self-
consumption
Brausch and Decker [62] UnitedetStates
al. [44] (12–14) suicidal Spain
ideation RSES RSES
questionnaire SE Cannabis⤄SE
in⬆socioeconomic
: Depression status Ideation
Suicide
(14–16) [38] (12–18) esteem
Ninkron et 624 Validated
263 Anbarlouei 1282 Thailand smoking (cigarettes
substance abuse and SubstanceTobacco⟺SE
abuse⟺SE (−) (−)
Oktan [63] Turkey al. [45] (12-18)
self-harm Iranbody image
and RSES RSES
instrument Self-harm⇔SE (−)
(15–18) et al. [39] (14–17) hookahs) Hookahs⤄SE
Pérez-
Jongenelis et 1661
1287 expenditure
resistance on alcohol,
to pressure to Anxiety Alcohol⟺SE (−)
and expectatives
4013 Fuentes et Australia
Spain ASQ
Garbus et al. [64] Mexico al. [40] (15–17)
(14–18) suicidal behaviour tobaccodrink and cannabis
alcohol RSES RSES Suicidal
⟺SE⟺Pressure
Tobacco and behaviour ⇔(−)
cannabis⤄SE
to drink SE (−)
(12–15) al. [46]
Pérez-
222 Gutiérrez et 1287
448 perceived pressure to
Vawda [65] Fuentes et
South Africa suicidalSpain
behaviour eating disorders
Spain RSES
RSES RSES Pressure
Suicidal
Eating tobehaviour
drink⟺SE
disorders⟺SE ⇔ SE (−)
(−)(−)
(13–15) al. [47] (14–18)
(12–15) drink alcohol
al. [41]
Ying et al. 356
Drug Baheiraei et 870 Malaysia tobacco
binge and alcohol
eating RSES Binge eating⟺SE (−)
[48] (13–16) Iran CTC-YS Tobacco⟺SE (−)
abuse al. [42] (15–18) expenditure
Gomez-
Chen et al. 57,767
100 United marijuana use by age and Agreement Anorexia and bulimia⟺SE
Sanchez et Peru anorexia and bulimia FRAB Marijuana⟺SE (−)
[43] (13–16)
(13–16) States sex Statement (−)
al. [49]
Mehanović 2636 EU-Dap Alcohol⟺SE (−)
Zhao et al. 593 Slovenia alcohol consumption
et al. [44] (12–14) China food addiction questionnaire
RSES in⬆socioeconomic
Food addiction⟺SEstatus (−)
 Behav. Sci. 2024, 14, x FOR PEER REVIEW 4 of 16
Behav. Sci. 2024, 14, 432 7 of 17
Behav. Sci. 2024, 14, x FOR PEER REVIEW 4 of 16

Figure 1. Flowchart of the document selection process.

Table 2. Cont.
Figure 1. Flowchart of the document selection process.
3. Results
Objectives.
Risk
Author Sample Country Analyse the Relationship between
3. Results
Self-esteem’s impact Measuring Instrument
on identity Results This systematic
and behaviour is widely studied.
Behaviour
Self-Esteem and . . .
review examines the available
Self-esteem’s impactevidence on the
on identity interaction
and behaviourbetween self-esteem
is widely and risk
studied. This systematic
5542 behaviours in adolescents, Covariatecomprehensive overview of how self-perception
Ybarra et al. [66] Behav. Sci. 2024,United States
14, x FOR review
PEER REVIEWbullying and suicidal examines theproviding
ideation available aevidence on the interaction between
4⇔
Suicidal ideation 16self-esteem
of SE (−) and risk
Suicide and (13–18) questionnaire
may influence participation in activities that carry potential negative consequences for
self-harm
behaviours in adolescents, providing a comprehensive overview of how self-perception
2170 healthself-harm
and
maywell-being. The salientRSES
features of thethat
studies
carryincluded in⇔the
Lin et al. [67] Taiwan non-suicidal influence participation in activities potential
Self-harm SE (current
negative review
−) consequences for
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Table 2.
health and The salient features of the studies included in the current review
Figure 1. Flowchart of the document selection process.
680 are summarised in Table 2.RSES
Kerpelman et al. [68] United States sexual risk behaviours Sexual risk behaviours⇔SE (−)
(15–18) Table 2. Characteristics of the studies included.
3. Results
771 problematic use of pornography Table 2. Characteristics
on the of the studies included.
Objectives.
Li et al. [69] China
Behav. Sci. 2024, 14, x FOR PEER REVIEW Self-esteem’s impact on identity and behaviour RSES Sexual risk
is widely studied. Thisbehaviours
systematic ⇔4SEof(−16)
(14–18) Risk Internet Analyse the Relationship Measuring
review examines
Author Sample the Country Objectives.
available evidence on the interaction between self-esteem and risk
Results
Risky sexual 1005 Behaviour Risk between Self-Esteem Sexual risk behaviours⇔SE (−) in women
Instrument
Ramiro et al. [70] Spain behaviourssexualin risk behaviours providing aAnalyse
adolescents, the Relationship
RSES
comprehensive overview Measuring
of how self-perception
practices (14–18) Author Sample Country and... and (+) in men Results
Behaviour may influence participation in activities between
that carry Self-Esteem
potential negativeInstrument
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296 Rial et Figure
al. 1. Flowchart
3882 of the document
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Ssewanyana et al. [71] Kenya sexual risk behaviour Spain and... RSES in Cannabis⤄SE
(12–17) health
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822 [38] 1282 (12–18) Iran
smoking (cigarettes and
esteem Tobacco⟺SE
RSESSexual risk behaviours⇔SE (−)
(−)
Thurston et al. [72] South Africa et al. [39] sexual risk behaviour
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(14–17) 1282 impact on identity hookahs) RSES
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Hookahs⤄SE
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and Spain
disruption
between
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The salient features RSES
Instrument
of the studiesRSES
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included in Pressure
gaming
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disruption
current ⇔
drink⟺SE
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review (−(−)
)
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perceived
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are summarised
et and...
in TableSpain
2. RSES Pressure to drink⟺SE (−)
4032 United
Druget al. Baheiraei3882 et (14–18) self- anddrink alcohol Time in networks⇔SE (−) in women and
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al. in 870
[41] cannabis use and
social networks Iran
tobacco alcohol
RSES CTC-YSCannabis⤄SE Tobacco⟺SE (−)
(13–15) Kingdom Spain RSES in men
of media abuse
[38] Drug(12–18) al. [42]Baheiraei
Table(15–18)
2. et
Characteristics
870 ofesteem
the studies expenditure
included.
tobacco and alcohol
3375 Anbarlouei Chen1282et al.al. [42] 57,767 United
smoking Iran
marijuana
(cigarettes anduse by age and Agreement CTC-YS
Tobacco⟺SE (−) Tobacco⟺SE (−)
Akbari et al. [76] Iran abuse problematic use of(15–18)
social media expenditure social media⇔(−) SE (−)
(13–18) [43]
Iran
(13–16) States Objectives.sex RSES RSES Problematic
Statement
use ofMarijuana⟺SE
et al. [39] (14–17)Chen et al. 57,767 hookahs)
United marijuana use by age and Hookahs⤄SE
Agreement
Risk Analyse the Relationship Measuring Marijuana⟺SE (−)
2170 Jongenelis et Mehanović
1661 Sample 2636 expenditure on alcohol, EU-Dap Alcohol⟺SE Alcohol⟺SE
(−) (−)
Lin et al. [77] Behaviour Taiwan Author [43]
Internet
Australia
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(13–16)
Slovenia
addiction States
between alcohol consumption
Self-Esteem RSES sex
ASQ Instrument Statement Results
Internet addiction ⇔SE (−)
(15–16) al. [40] et al. [44]
(15–17) Mehanović (12–14) 2636 tobacco and cannabis questionnaire
Tobacco in⬆socioeconomic
and cannabis⤄SE
EU-Dap status (−)
Alcohol⟺SE
Slovenia and... alcohol consumption
637 Pérez- Ninkron et et al. [44]624 (12–14) Validated
SE⇔Depression
questionnaire ⇔Use ( abuse⟺SE
in⬆socioeconomic
Li et al. [78] China Rial et al.al. 1287problematic
3882 Thailand
perceived
smartphone pressure
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use substance
use to self-
and abuse
RSES Substance interpersonal (−) status
(14–17) Fuentes et [45]Ninkron (12-18)
Spain Spain RSES RSESinstrument
Pressure to drink⟺SE
Cannabis⤄SE
trust= (−)
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[38] (14–18)(12–18) et 624 drink alcohol
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Anbarlouei 1282 1287 smoking resistance
(cigarettes to pressure
and to Anxiety and
Tobacco⟺SE (−)expectatives
Drug Baheiraei et Fuentes 870 etPérez- Spain and alcohol
Iran tobacco RSES RSES
et al. [39]al. [46](14–17) Iran(14–18) 1287 expenditure drink alcohol
hookahs)resistanceCTC-YS to pressure to Tobacco⟺SE⟺SE⟺Pressure
(−) Anxietytoand
Hookahs⤄SE drink (−)
expectatives
abuse al. [42] (15–18)Fuentes et Spain RSES
Jongenelis et 1661 (14–18) expenditure on alcohol, alcohol Alcohol⟺SE (−)
⟺SE⟺Pressure
Chen et al. Gutiérrez 57,767 et 448
United
al. [46] marijuana use by age and drink
Australia Agreement ASQ RSES to drink (−)
al. [40] al. [47](15–17) Spaintobacco and eating disorders
cannabis Marijuana⟺SE
Tobacco Eating
and (−)disorders⟺SE (−)
cannabis⤄SE
[43] (13–16) (12–15)
States sex Statement
Pérez-Ying etGutiérrez et 448
Spain eating disorders RSES
Mehanović al.
2636 1287[47] 356 perceived pressure to EU-Dap Alcohol⟺SE (−) Eating disorders⟺SE (−)
Fuentes et [48] al. Slovenia (13–16)
(12–15)
Spain Malaysia
alcohol consumption binge eating RSES RSES Pressure to Binge eating⟺SE
drink⟺SE (−) (−)
et al. [44] (12–14)(14–18)
Ying et al. 356 drink alcohol questionnaire in⬆socioeconomic status
al. [41] Malaysia binge eating RSES Binge eating⟺SE (−)
Ninkron et Gomez-
624 [48] Validated
Drug Baheiraei et 870 100 (13–16)substance
Thailand tobacco abuse
and alcohol Anorexia (−)
Substance abuse⟺SE and bulimia⟺SE
 Figure 1. Flowchart of the document selection process.

3. Results
Behav. Sci. 2024, 14, 432 8 of 17
Self-esteem’s impact on identity and behaviour is widely studied. This systematic
review examines the available evidence on the interaction between self-esteem and risk
behaviours in adolescents, providing aBehav.
comprehensive overview
Sci. 2024, 14, x FOR of how self-perception
PEER REVIEW 4 of 16
Table 2. Cont.
may influence participation in activities that carry potential negative consequences for
health and well-being. The salient features of the studies included in the current review
Objectives.
Risk
are summarised in Table 2.
Author Sample Country Analyse the Relationship between Measuring Instrument Results
Behaviour Figure
Behav. Sci. 2024, 14, x FOR PEER1.REVIEW
Flowchart of the document selection process. 4 of 16
Self-Esteem and . . .
Table 2. Characteristics of the studies included.
960
Wang [79] China 3. Results
problematic Internet use CSES Parental bonding ⇔SE⇔Internet use (−)
Harmful use (13–16)
Objectives. Self-esteem’s impact on identity and behaviour is widely studied. This systematic
of media 1150 Figure 1. Flowchart of the document selection process.
k Tural and YeşilovaAnalyse
[80] the Relationship Measuring
Turkey review
Internet examines
addiction the available evidence CSEI on the interaction between ⇔SEand
self-esteem
Internet addiction (−) risk
Author Sample Country (15–18) Results
our between Self-Esteem Instrument
behaviours3.inResults adolescents, providing a comprehensive overview of how self-perception
and... Sexual experience abuse⇔SE⇔Crime (−)
8194 may influence participation in activities that carry potential
Self-description negative consequences for
Rial et al. 3882Gauthier-Duchesne et al. [81] use and self- Canada
cannabis crime by gender Self-esteem’s impact on identity and Not behaviour is widelyabuse:
sexual experience studied.
SE⇔This systematic
Crime
Spain (14–18) RSES health and well-being. The salientquestionnaire
Cannabis⤄SE features of the studies included in the current review
[38] (12–18) esteem review examines the available evidence on the interaction (+)
between self-esteem and risk
are summarised in Table 2.
Anbarlouei 1282 smoking (cigarettes
268 and Tobacco⟺SEbehaviours(−) in adolescents, providing a comprehensive overview of how self-perception
BASC-S3
Iran
Dosil et al. [82] SpainRSES dating violence Dating violence⇔SE (−)
et al. [39] (14–17) hookahs)
(12–17) Hookahs⤄SE may influence participation
Table 2. Characteristics of the studies included.
CDSin activities that carry potential negative consequences for
Antisocial
Jongenelis et 1661 expenditure 3772on alcohol, Alcohol⟺SEhealth (−) and well-being. The salient features of the studies included in the current review
Australia
Rial et al. [83] tobacco and cannabis SpainASQ problematic Internet use Problematic Internet use⇔SE(−)
behaviour(15–17)
al. [40] (12–17) Tobacco and cannabis⤄SE in Table 2.RSES
are summarisedObjectives.
Pérez- Risk Analyse the Relationship Measuring
1287 Garaigordobil [84] 3026
perceived pressure to Author Sample Country Results
Fuentes et Spain SpainRSES
Behaviour being atocyber
Pressure aggressor
drink⟺SETable (−)
2. between Self-Esteem
Characteristics of the RSES
studies Instrument
included. Cyber aggressor⇔SE (−)
(14–18) (12–18)
drink alcohol
al. [41] and...
Rial et al. 3882 cannabis Scales
use and ofObjectives.
the Battery of
self-
g Baheiraei et 870 tobacco and541 alcohol
R˛ebisz
Iranet al. [85] Poland
CTC-YS Risk Tobacco⟺SE Spain
cyberbullying (−) Social Functioning
Analyse the Relationship RSES Cannabis⤄SE
Cyberbullying
Measuring SE
e al. [42] (15–18) (14–15)
expenditure [38] (12–18)
Author Sample Country esteem Results
Behaviour questionnaires
between Self-Esteem Instrument
Chen et al. 57,767 United marijuana use by age and Anbarlouei
Agreement 1282 smoking (cigarettes and Tobacco⟺SE (−)
Marijuana⟺SE
SE: self-esteem. RSES: Rosenberg Self-Esteem Scale; ASQ: Adolescent Iran
Self-Esteem (−)Questionnaire; SISES: Single-Item and...
Self-EsteemRSES
Scale; MMPI-A: Minnesota Multiphasic Personality
[43] (13–16) States Inventory-Adolescent;sex BASC-S3: Behavior et al. [39]
Statement (14–17) hookahs) Hookahs⤄SE
Assessment System foret
Rial Children
al. and Adolescents; CDS: Children’s
3882 Depression
cannabis use andScale; CTC-YS: Communities of Concern Youth; FRAB: Risk
self-
Mehanović 2636 Jongenelis
EU-Dap
Factors Scale for Anorexia and Bulimia; CSES: et
Rosenberg Children’s 1661
Alcohol⟺SE expenditure
(−) CSEI: Spain
Self-Esteem Scale; on alcohol, Alcohol⟺SE
RSES are significantly
Coopersmith SE Inventory. QS: quality score. ⇔ (variables (−)
Cannabis⤄SE
related); (the
Slovenia alcohol consumption [38] Australia
(12–18) esteem ASQ
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questionnaire
relationship between the variables is weak [40] in⬆socioeconomic
significant); (15–17)
(high level). status tobacco and cannabis Tobacco and cannabis⤄SE
Anbarlouei 1282 smoking (cigarettes and Tobacco⟺SE (−)
Ninkron et 624 Validated Pérez- Iran RSES
Thailand substance abuse et al.1287
Substance [39] abuse⟺SE
(14–17)(−) perceived pressurehookahs)
to Hookahs⤄SE
al. [45] (12-18) Fuentes et
instrument Spain RSES Pressure to drink⟺SE (−)
(14–18)
Jongenelis et 1661 drink alcohol
expenditure on alcohol, Alcohol⟺SE (−)
Pérez- al. [41] Australia ASQ
1287 resistance to pressure to Anxiety
al. [40]and expectatives
(15–17) tobacco and cannabis Tobacco and cannabis⤄SE
Fuentes et Spain Drug RSES Baheiraei et 870 tobacco and alcohol
(14–18) drink alcohol ⟺SE⟺Pressure
Pérez- to Iran
drink (−) CTC-YS Tobacco⟺SE (−)
al. [46] abuse al. [42] (15–18) 1287 expenditure
perceived pressure to
Fuentes et Spain RSES Pressure to drink⟺SE (−)
Gutiérrez et 448 Chen et al. 57,767 United
(14–18) marijuana use by age drinkandalcoholAgreement
Spain eating disorders RSES Eating
al. [41]disorders⟺SE (−) Marijuana⟺SE (−)
al. [47] (12–15) [43] (13–16) States sex Statement
Drug Baheiraei et 870 tobacco and alcohol
Ying et al. 356 Mehanović 2636 Iran EU-Dap CTC-YS Alcohol⟺SE (−)
Tobacco⟺SE (−)
Malaysia binge eating RSES abuse Binge
al. [42]eating⟺SE Slovenia
(15–18)(−) alcohol consumption expenditure
[48] (13–16) et al. [44] (12–14) questionnaire in⬆socioeconomic status
Chen et al. 57,767 United marijuana use by age and Agreement
Gomez- Ninkron et 624 Validated Marijuana⟺SE (−)
100 Anorexia Thailand
[43] and bulimia⟺SE
(13–16) substance abuse sex
States Substance abuse⟺SE (−)
Statement
Sanchez et Peru anorexia and bulimia FRAB al. [45] (12-18) instrument
(13–16) Mehanović(−) 2636 EU-Dap Alcohol⟺SE (−)
al. [49] Pérez- Slovenia alcohol consumption
et al.1287
[44] (12–14) resistance to pressure to Anxiety andin⬆socioeconomic
questionnaire expectatives status
Zhao et al. 593 Fuentes et Spain RSES
China food addiction RSES Food(14–18)
addiction⟺SE
Ninkron et 624 (−) drink alcohol ⟺SE⟺Pressure
Validated to drink (−)
[50] (13–17) al. [46] Thailand substance abuse Substance abuse⟺SE (−)
ng al. [45] (12-18) instrument
Mora et al. 579 Gutiérrez et 448
ers Spain risk of eating disorders RSES Eating
Pérez- disorders⟺SESpain(−) eating disorders RSES Eating disorders⟺SE (−)
[51] (12–16) al. [47] (12–15) 1287 resistance to pressure to Anxiety and expectatives
Behav. Sci. 2024, 14, 432 9 of 17

Regarding the results, on the one hand, in those obtained in the category of sub-
stance abuse, a negative relationship prevails with alcohol consumption [40,41,45,46],
although one study highlights that this relationship is only significant in adolescents of
high socioeconomic status [44]. With regard to tobacco, the negative relationship also
predominates [42,45], although one study notes that this relationship is significant only
with cigarettes and not with hookah smoking [39] and another reports a non-significant
relationship [40]. For cannabis, two studies report no or a weak relationship [38,40], respec-
tively, and two others report a relationship [43,45], especially in older men [43], requiring
further research to provide clarity on the relationship between these two variables.
On the other hand, in the category of eating disorders, all studies recognise a negative
relationship between eating disorders and self-esteem [47–55]. Furthermore, a relevant
aspect of the role of self-esteem is highlighted in the study by Cella et al. [53] where self-
esteem is identified as a mediator in the relationship between parental bonding and the
incidence of binge eating, providing a more complete understanding of how self-esteem is
related to eating disorders.
Regarding the category of suicide and self-harm, all studies report a negative rela-
tionship between self-esteem and self-harm, both suicidal and non-suicidal [56–61,63–67].
Furthermore, Brausch and Decker’s [62] study broadens the understanding of how self-
esteem affects suicide by identifying a modulatory effect, revealing that the relationship
between depression and suicidal ideation is mainly manifested in individuals with low
levels of self-esteem.
With regard to sexual risk behaviour, the evidence shows that there is a predominantly
negative relationship between self-esteem and sexual risk behaviour [68,69,72]. One study
partially agrees with these results, maintaining a negative relationship in women, while
in men, the relationship is positive [70], and another disagrees completely, finding no
significant relationship [71].
In terms of harmful media use, evidence shows a negative relationship between self-
esteem and problematic information and communication technology (ICT)
use [73,74,76,77,80], although one study partially agrees with the results, finding no sig-
nificant relationships in men [75], and another finds that this relationship is mediated by
depression and that the influence of depression on the relationship between self-esteem
and problematic ICT use is moderated by interpersonal trust [78]. Wang’s [79] study
points to a mediating role between parent–child closeness, peer closeness and problematic
Internet use.
And finally, with regard to antisocial behaviour, the evidence collected points to a
negative relationship between self-esteem and antisocial behaviour, particularly in cases
of violence [82–84], in contrast to those studies that find no significant relationships [85].
Regarding delinquency, Gauthier-Duchesne et al. [81] recognise the mediating role of self-
esteem between the experience of sexual abuse and delinquency, as well as highlighting the
fact that it is men who have lower self-esteem and higher delinquent behaviour. However,
among those who have not experienced sexual abuse, boys typically display higher self-
esteem than girls. Interestingly, the data show that higher self-esteem correlates with
increased delinquent behaviour.

Quality of the Manuscripts

All articles used in this review scored well (Table 3) and were therefore considered to
be of good quality.
Behav. Sci. 2024, 14, 432
Table 3. Results of the assessment of the methodological quality of the included studies.
Author Total Score
Rial et al. [38]
Anbarlouei et al. [39]
Jongenelis et al. [40]
Pérez-Fuentes et al. [41]
Baheiraei et al. [42]
Chen et al. [43]
Mehanović et al. [44]
Ninkron et al. [45]
Pérez-Fuentes et al. [46]
Gutiérrez et al. [47]
Ying et al. [48]
Gomez-Sanchez et al. [49]
Zhao et al. [50]
Mora et al. [51]
Pamies-Aubalat et al. [52]
Cella et al. [53]
Frieiro et al. [54]
Olsen et al. [55]
Lee et al. [56]
Huang et al. [57]
Muñetón et al. [58]
Tang et al. [59]
Delfabbro et al. [60]
Fonseca-Pedrero et al. [61]
Brausch and Decker [62]
Oktan [63]
Garbus et al. [64]
Vawda [65]
Ybarra et al. [66]
Lin et al. [67]
Kerpelman et al. [68]
Li et al. [69]
Ramiro et al. [70]
10 of 17
Selection Comparability Result
Representativeness of Non- Design and Statistical
Sample Size Exposure Check Evaluation Results
Sample Respondent Analysis Test
7 * * ** * * *
8 * * * ** * * *
6 * * ** * *
6 * * ** * *
7 * * ** * * *
7 * * * ** * *
6 * * ** * *
6 * * ** * *
6 * * ** * *
6 * * ** * *
7 * * * ** * *
7 * * ** * * *
7 * * * ** * *
6 * * ** * *
6 * * ** * *
6 * * ** * *
6 * * ** * *
7 * * ** * * *
6 * * ** * *
8 * * * ** * * *
8 * * * ** * * *
8 * * * ** * * *
6 * * ** * *
6 * * ** * *
7 * * ** * * *
6 * * ** * *
7 * * ** * * *
6 * * ** * *
6 * * ** * *
8 * * * ** * * *
7 * * ** * * *
8 * * * ** * * *
6 * * ** * *
Behav. Sci. 2024, 14, 432 11 of 17

Table 3. Cont.

Selection Comparability Result

Author Total Score Representativeness of Non- Design and Statistical
Sample Size Exposure Check Evaluation Results
Sample Respondent Analysis Test
Ssewanyana et al. [71] 7 * * ** * * *
Thurston et al. [72] 6 * * ** * *
Munno et al. [73] 6 * * ** * *
Warburton et al. [74] 7 * * ** * * *
Barthorpe et al. [75] 7 * * ** * * *
Akbari et al. [76] 6 * * ** * *
Lin et al. [77] 7 * * * ** * *
Li et al. [78] 8 * * * ** * * *
Wang [79] 7 * * * ** * *
Tural and Yeşilova [80] 7 * * ** * * *
Gauthier-Duchesne et al. [81] 6 * * ** * *
Dosil et al. [82] 6 * * ** * *
Rial et al. [83] 7 * * ** * * *
Garaigordobil [84] 6 * * ** * *
Rebisz et al. [85] 7 * * * ** * *
SELECTION, maximum 5 asterisks. Representativeness of Sample: * random or non-random sampling. Sample Size: * justified. Non-Respondents: * comparability between respondent
and non-respondent characteristics is established and response rate is satisfactory. Exposure Check: ** validated measurement tool; * measurement tool not validated but described
or available. COMPARABILITY, maximum 2 asterisks. Design and Analysis: *study controls for the most important confounding factor; * study controls for any additional factors.
OUTCOME, maximum 3 asterisks. Evaluation Results: ** independent blinded assessment; ** record linkage; * self-reporting. Statistical Test: * the test used to analyse the data is
described and appropriate, and the measure of association, including confidence intervals and probability level (p-value), is presented.
Behav. Sci. 2024, 14, 432 12 of 17

4. Discussion
The aim of this study was to examine the relationship between self-esteem and risk be-
haviour in adolescents and to determine whether self-esteem, high or low, was a consistent
protective factor against risk behaviour. In exploring these dynamics, our results also un-
covered significant relationships between various risk behaviours, such as the association
between depression and suicidal ideation [62] or between substance use and problematic
Internet use [38], which not only bolsters the findings of prior research [4,9,11] but also
underscores the necessity and significance of investigating protective factors in contrast to
risk behaviours [3].
In regard to self-esteem as a protective factor, our results show a predominant and
negative relationship between self-esteem and all the risk behaviours analysed, including
tobacco and alcohol use, eating disorders, non-suicidal self-harm and suicide, sexual risk
behaviours, problematic ICT use and antisocial behaviour, and these results are supported
by the previous literature [14,15,17,18,20–22,24], with the exception of cannabis use, where
our findings are ambiguous due to us finding equality between studies supporting a
negative relationship and those finding no significant associations. There is no clear
trend of a negative relationship, as seen with the rest of the analysed risk behaviours,
nor a predominant relationship, even if not negative. The previous literature has already
identified this scenario, with some studies indicating a negative relationship between
cannabis use and self-esteem [14], while others found no significant relationship [29]. In
this context, our findings highlight the need for further research to clarify the relationship
between cannabis use and self-esteem. These results can be better understood by examining
the existing literature, which has traditionally focused more on substances like alcohol
or tobacco [6–8]. This historical preference for certain substances may have limited the
amount of research focused on cannabis and, therefore, could explain the scarcity of studies
dedicated to understanding its effects and associated risks.
Furthermore, our study provides further insight into the mechanisms underlying this
relationship by recording, on the one hand, the mediating role of self-esteem between
parental bonding and the incidence of binge eating [53], between the experience of sexual
abuse and involvement in delinquent activities [81], between adolescents’ closeness to
parents and friends and problematic Internet use [79] and, on the other hand, by recording
the modulating role of self-esteem in the relationship between depression and suicidal
ideation [62]. These results suggest that self-esteem is not only an important factor in its own
right but may also influence how other experiences and factors affect adolescents’ behaviour.
The previous literature also reported a mediating role of self-esteem, for example, between
strict parenting and suicidal ideation [27] or between depression and suicidal ideation [29].
This implies that high self-esteem is a protective factor and low self-esteem acts as a
risk factor. However, it is important to note that these significant relationships may vary
according to several factors, such as gender [70,75] or socioeconomic status [44]. With
regard to gender, our results show that women report lower self-esteem [75], in line with
the previous literature [35], and therefore, taking as a reference the results of our study that
indicate a prevalent negative relationship between self-esteem and risk behaviours, they are
more vulnerable to engaging in risk behaviours [58], aligning with the prior literature [14].
The few studies reporting that males are more vulnerable usually coincide with the minority
of studies finding a positive relationship between self-esteem and risky behaviour [81].
Although our findings reflect a higher incidence of studies showing a negative rela-
tionship between self-esteem and risk behaviours, there is a minority of studies suggesting
a positive relationship. These differences are more fully explained when considering a
multidimensional view of self-esteem, in line with the proposal of Salmivalli et al. [35],
who show that it is necessary to go beyond high or low self-esteem and take into account
the “dark side” of self-esteem that the traditional literature, with a unidimensional view of
self-esteem, has ignored.
In addition, the vulnerability to risk behaviours may be influenced by a combination of
individual, social, economic and environmental factors that interact in complex ways [1,2],
Behav. Sci. 2024, 14, 432 13 of 17

suggesting a multifaceted picture that requires the adoption of an ecological approach, as

referenced by Bronfenbrenner, for comprehensive understanding.
Societal pressures and expectations can exert a significant influence on how adolescents
perceive their self-esteem. However, it is important to recognise that not all cultures adhere
to the same principles. For instance, in Slovenia, the normalisation of alcohol consumption
illustrates how cultural norms can vary widely. In this context, socialising and gathering
often involve alcohol, contributing to its normalisation as a means of social interaction.
In such a cultural milieu, individuals who do not partake in drinking may perceive their
self-esteem diminishing, as they may feel pressure to conform to group norms in order to
feel accepted and valued. These relationships are stronger among the female sex, as the
female sex is primarily driven by situational and socio-psychological factors, while the male
sex is determined to a greater extent by their personality [35,44]. This dynamic highlights
how cultural context can shape individuals’ behaviours and perceptions of self-worth.
However, it is worth noting that personal characteristics also play a role in how individuals
respond to societal pressures. Some individuals may resist the influence of cultural norms
and maintain their self-esteem despite external pressures to conform [1,2,41,46].
Interestingly, in Slovenia, individuals from higher socioeconomic backgrounds may
not experience a decline in self-esteem if they choose not to drink. This could be attributed
to different expectations and standards held by individuals in these social circles. In such
contexts, individuals may place greater emphasis on personal achievements and values
beyond social conformity, thereby maintaining their self-esteem independent of cultural
norms surrounding alcohol consumption. Although not everything is explained by self-
esteem and it is necessary to look at each situation in an ecological way, self-esteem plays
a fundamental role in adhering, to a greater or lesser extent, to these prevailing values
of the moment, since in this process, self-esteem can both affect and be affected by the
social role that is assumed, generating a continuous cycle of mutual influence between both
aspects [1,2,35,44].
Consequently, the question arises whether problematic and risky behaviours are a
reflection of a society with self-esteem problems, which adheres to prevailing social values
out of an uncontrollable need to belong. Today, tackling this endless cycle and fostering
self-esteem represents a considerable challenge, mainly due to the powerful influence
of social media and influencers on adolescents [83]. These actors have become major
socialisation agents, often challenging the authority of other socialisation agents. It is
crucial to examine how these contextual and socio-demographic variables interact with
self-esteem to influence the propensity for risky behaviours. This becomes imperative in
order to develop more accurate and effective prevention and intervention strategies.

5. Conclusions
This study provides a compilation of diverse research that examines the relationship
between self-esteem and various risk behaviours. This compilation has allowed us to fulfil
our main objective: to conduct a comprehensive analysis detailing the connection between
levels of self-esteem and risk behaviours.
However, this study has some limitations, including the restriction imposed by our
exclusion criterion, which left out those articles in which the sample had physical, psycho-
logical or social peculiarities. Although we implemented this criterion with the intention of
ensuring the representativeness of the results, paradoxically, there is a risk of excluding
certain groups and affecting the generalisability of the findings. Furthermore, by limiting
our acceptance to exclusively quantitative studies, we prioritised the collection and analysis
of numerical and statistical data. Although these studies provide valuable and objective
information, they sometimes lack more descriptive or narrative contexts that could enrich
the understanding of the results. Also, by approaching self-esteem as a unidimensional
concept, there is a risk of oversimplifying the understanding of this psychological phe-
nomenon, which may limit the validity and applicability of the study results. It would
be beneficial to consider including multidimensional measures of self-esteem in order to
Behav. Sci. 2024, 14, 432 14 of 17

obtain a more complete and accurate understanding of how this construct relates to risk
behaviours. Additionally, it is worth noting that all papers reviewed were open access,
which may introduce a bias in the selection of the literature, excluding studies that were not
freely available. Finally, the thematic breadth addressed in this study, and, consequently,
the large sample collected, has presented a significant limitation in the analysis of the
results. The abundance of information has possibly limited the depth of our conclusions
and the identification of significant patterns by making it difficult to analyse each subgroup
or specific aspect in detail. It is essential to keep these limitations in mind when interpreting
the results and to consider possible areas for improvement in future research.
Despite the aforementioned limitations, this study achieves its main objective by pro-
viding an update on the relationship between self-esteem and risk behaviours, identifying
a general trend that recognises high self-esteem as a protective factor against these be-
haviours, highlighting the importance of developing interventions or programmes aimed
at strengthening adolescents’ self-esteem as a preventive strategy to reduce risk behaviours.
Furthermore, our results underline the need to explore factors that may affect this re-
lationship, such as gender and socioeconomic background, in order to design effective
interventions, presenting these factors as another solid basis for future research.

Author Contributions: All co-authors contributed to data collection and/or analysis of project results.
All authors have read and agreed to the published version of the manuscript.
Funding: This publication is part of the I+D+i PID2020-119411RB-I00 funded by MCIN/AEI/10.13039/
501100011033/ and FEDER “Una manera de hacer Europa”. It also has the support of the Ministry of
Education and Vocational Training, through the programme of grants for University Teacher Training
(FPU) awarded to Elena Martínez Casanova with reference number FPU22/02580.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: The authors declare no conflicts of interest.

References
1. Álvarez-García, D.; Núñez, A.; Pérez-Fuentes, M.D.C.; Vallejo, G. Efecto del grupo-clase sobre la cibervictimización en estudiantes
de Secundaria: Un análisis multinivel [Class-level effects on cybervictimization in secondary students: A multilevel analysis].
Rev. Educ. 2022, 397, 153–178. [CrossRef]
2. UNICEF. Adolescentes y Comportamientos de Riesgo. 7 June 2023. Available online: https://www.unicef.org/parenting/es/
salud-mental/adolescentes-y-comportamientos-de-riesgo (accessed on 1 April 2024).
3. Ahumada-Cortez, J.G.; Gámez-Medina, M.E.; Valdez-Montero, C. El consumo de alcohol como problema de salud pública. Rev.
Cuba. Hig. Epidemiol. 2017, 13, 13–24. [CrossRef]
4. Salas, F.G. Caracterización de factores implicados en las conductas de riesgo en adolescentes: Characterization of factors involved
in risk behaviors in adolescents. Rev. ABRA 2018, 38, 1–16. [CrossRef]
5. Rosabal, E.; Romero, N.; Gaquín, K.; Hernández, R.A. Conductas de riesgo en los adolescentes: Risk behavior in adolescents. Rev.
Cub. Med. Mil. 2015, 44, 218–229.
6. Organización Mundial de la Salud (OMS). Alcohol. 9 May 2022. Available online: https://www.who.int/es/news-room/fact-
sheets/detail/alcohol (accessed on 1 April 2024).
7. Organización Mundial de la Salud (OMS). Tabaco. 31 July 2023. Available online: https://www.who.int/es/news-room/fact-
sheets/detail/tobacco (accessed on 1 April 2024).
8. Veeranki, S.P.; Mamudu, H.M.; John, R.M.; Ouma, A.E. Prevalence and correlates of tobacco use among school-going adolescents
in Madagascar. J. Epidemiol. Glob. Health 2015, 5, 239–247. [CrossRef] [PubMed]
9. Hidalgo, C.C. Factores de riesgo familiar en el consumo de drogas y su relación con la conducta antisocial en adolescentes.
Distrito de salud 09d08. 2019. Más Vita 2020, 2, 54–64. [CrossRef]
10. Gaete, V.; López, C. Trastornos de la conducta alimentaria en adolescentes. Una mirada integral. Rev. Chil. Pediatr. 2020,
91, 784–793. [CrossRef]
11. Fichter, M.; Quadflieg, N. Mortality in eating disorders—Results of a large prospective clinical longitudinal study. Int. J. Eat.
Disord. 2016, 49, 391–401. [CrossRef]
12. Rosenberg, M. Society and the Adolescent Self-Image, 1st ed.; Princeton University Press: Princeton, NJ, USA, 1965; pp. 1–326.
Behav. Sci. 2024, 14, 432 15 of 17

13. Dudok, R.; Piko, B.F. Multi-Level Protective Factors of Adolescent Smoking and Drinking. Eur. J. Investig. Health Psychol. Educ.
2023, 13, 932–947. [CrossRef]
14. González, A.; Molero, M.D.M. Estilo de vida saludable en la adolescencia: Relación con autoestima y diferencias según sexo
[Healthy Lifestyle in Adolescence: Relationship with Self-Esteem and Gender differences]. Acción Psicol. 2023, 20, 47–56.
[CrossRef]
15. Yepes, A.C.; Rubio, N.; Vinaccia, S.; Bernal, S. Relación entre los niveles de autoestima, resiliencia, ideación suicida y riesgo
suicida en jóvenes indígenas zenúes de Córdoba, Colombia: Relationship between levels of self-esteem, resilience, suicidal
ideation and suicidal risk in Zenú indigenous youth from Córdoba, Colombia. Psicol. Salud 2022, 32, 295–304. [CrossRef]
16. Raffagnato, A.; Iannattone, S.; Fasolato, R.; Parolin, E.; Ravaglia, B.; Biscalchin, G.; Traverso, A.; Zanato, S.; Miscioscia, M.; Gatta,
M. A pre-adolescent and adolescent clinical sample study about suicidal ideation, suicide attempt, and self-harming. Eur. J.
Investig. Health Psychol. Educ. 2022, 12, 1441–1462. [CrossRef] [PubMed]
17. Enejoh, V.; Pharr, J.; Octavie, B.; Olutolula, A.; Karick, H.; Ezeanolue, E. Impact of self-esteem on risky sexual behavior among
Nigerian adolescents. AIDS Care 2016, 28, 672–676. [CrossRef] [PubMed]
18. De la Villa Moral-Jiménez, M.; Fernández-Domínguez, S. Uso problemático de internet en adolescentes españoles y su relación
con autoestima e impulsividad. Av. Psicol. Lat. 2019, 37, 103–119. [CrossRef]
19. Hidalgo-Fuentes, S. Uso problemático de Internet y procrastinación en estudiantes: Un meta-análisis. Uso de Internet y
procrastinación. Eur. J. Educ. Psychol. 2022, 15, 5. [CrossRef]
20. Gámez-Guadix, M.; Mateos-Pérez, E. Longitudinal and reciprocal relationships between sexting, online sexual solicitations, and
cyberbullying among minors. Comput. Hum. Behav. 2019, 94, 70–76. [CrossRef]
21. Gan, X.; Wang, P.; Huang, C.; Li, H.; Jin, X. Alienation from school and cyberbullying among Chinese middle school students: A
moderated mediation model involving self-esteem and emotional intelligence. Front. Public Health 2022, 10, 903206. [CrossRef]
[PubMed]
22. Noel, A.; Donald, C.; Hutchinson, G. Risk Factors for Delinquency among Adolescent Boys in Trinidad and Tobago. West Indian
Med. J. 2016, 65, 455–460. [CrossRef]
23. Park, M.; Choi, J.; Lim, S.J. Factors Affecting Aggression in South Korean Middle School Students. Asian Nurs. Res. 2014,
8, 247–253. [CrossRef]
24. Tobalino-López, D.; Dolorier-Zapata, R.G.; Villa-López, R.M.; Menacho, I. Acoso escolar y autoestima en estudiantes de educación
primaria de Perú. Opción 2017, 84, 359–377.
25. Molero, M.M.; Martos, Á.; Barragán, A.B.; Pérez-Fuentes, M.C.; Gazquez, J.J. Anxiety and depression from cybervictimization in
adolescents: A metaanalysis and meta-regression study. Eur. J. Psychol. Appl. Legal Context 2022, 14, 42–50. [CrossRef]
26. Molero, M.M.; Pérez-Fuentes, M.C.; Martos, Á.; Pino, R.M.; Gázquez, J.J. Network analysis of emotional symptoms and their
relationship with different types of cybervictimization. Eur. J. Psychol. Appl. Legal Context 2023, 15, 23–32. [CrossRef]
27. Zhao, J.; Wang, Y. Harsh parenting and suicide ideation among Chinese adolescents: The roles of self-esteem and school social
support. BMC Psychiatry 2023, 23, 609. [CrossRef]
28. Luna-Contreras, M.; Dávila-Cervantes, C.A. Efecto de la depresión y la autoestima en la ideación suicida de adolescentes
estudiantes de secundaria y bachillerato en la Ciudad de México: Effects of depression and self-esteem on suicide ideation in
high school adolescent students in Mexico City. Pap. Pobla 2020, 26, 75–103. [CrossRef]
29. Hargreaves, D.S.; McVey, D.; Nairn, A.; Viner, R.M. Relative importance of individual and social factors in improving adolescent
health. Perspect. Public Health 2013, 133, 122–131. [CrossRef] [PubMed]
30. Muhammed, F.M.; Sharma, V.; Fatima, J. A Correlational Study to Assess the Relationship Between Eating Pattern and Self-Esteem
among Adolescents in a Selected School of Delhi. Int. J. Nurs. Midwifery Res. 2018, 5, 2–6. [CrossRef]
31. Andrade, J.A.; Gonzáles, J. Relación entre riesgo suicida, autoestima, desesperanza y estilos de socialización parental en
estudiantes de bachillerato. Psicogente 2017, 20, 70–88. [CrossRef]
32. Basauri, M.Á. Factores asociados a la adicción a redes sociales en universitarios: Una revisión sistemática y metaanálisis. Persona
2023, 26, 11–56. [CrossRef] [PubMed]
33. Tizoc, A.; Moreno-Monsiváis, M.G.; Esquivel-Rubio, A.; Rivera-Fierro, K.; González-Vázquez, A. Autoestima y su relación con
la conducta sexual de riesgo para el VIH en migrantes: Revisión sistemática [Self-esteem and its relationship with sexual risk
behavior for HIV in migrants: Systematic review] [Autoimagem e sua relação com o comportamento sexual de risco para o HIV
em migrantes: Revisão sistemática]. Sanus 2021, 6, e213. [CrossRef]
34. Gámez-Medina, M.E.; Guzmán-Facundo, F.R.; Ahumada-Cortez, J.G.; Alonso-Castillo, M.M.; Gherardi-Donato, E.C.D.S. Autoes-
tima y consumo de alcohol en adolescentes escolarizados: Self-esteem and alcohol consumption in adolescent students. Nure
Investig. 2017, 14, 1–9.
35. Salmivalli, C.; Kaukiainen, A.; Kaistaniemi, L.; Lagerspetz, K.M. Self-evaluated self-esteem, peer-evaluated self-esteem, and
defensive egotism as predictors of adolescents’ participation in bullying situations. Personal. Soc. Psychol. Bull. 1999,
25, 1268–1278.
36. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Moher, D.
Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement. J. Clin. Epidemiol. 2021,
134, 103–112. [CrossRef]
Behav. Sci. 2024, 14, 432 16 of 17

37. Herzog, R.; Álvarez-Pasquin, M.J.; Díaz, C.; Del Barrio, J.L.; Estrada, J.M.; Gil, Á. Are healthcare workers’ intentions to vaccinate
related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 2013, 13, 154. [CrossRef] [PubMed]
38. Rial, A.; Burkhart, G.; Isorna, M.; Barreiro, C.; Varela, J.; Golpe, S. Consumo de cannabis entre adolescentes: Patrón de riesgo,
implicaciones y posibles variables explicativas [Cannabis use among adolescents: Risk pattern, implications and possible
explanatory variables]. Adicciones 2019, 31, 64–77. [CrossRef] [PubMed]
39. Anbarlouei, M.; Sarbakhsh, P.; Dadashzadeh, H.; Ghiasi, A.; Ataieasl, M.; Dorosti, A.; Mohammadpoorasl, A. Cigarette and
hookah smoking and their relationship with self-esteem and communication skills among high school students. Health Promot.
Perspect. 2018, 8, 230–236. [CrossRef] [PubMed]
40. Jongenelis, M.; Pettigrew, S.; Lawrence, D.; Rikkers, W. Factors associated with poly drug use in adolescents. Prev. Sci. 2019,
20, 695–704. [CrossRef]
41. Pérez-Fuentes, M.D.C.; Martos, Á.; Molero, M.D.M.; Barragán, A.B.; Simón, M.D.M.; del Pino, R.M. Presión percibida para el
consumo de alcohol y variables de resistencia en la adolescencia: Perceived pressure for drinking alcohol and endurance variables
in adolescence. Rev. Investig. Educ. 2020, 18, 332–344. [CrossRef]
42. Baheiraei, A.; Soltani, F.; Ebadi, A.; Foroushani, A.R.; Cheraghi, M.A. Risk and protective profile of tobacco and alcohol use
among Iranian adolescents: A population-based study. Int. J. Adolesc. Med. Health 2017, 29, 20150089. [CrossRef] [PubMed]
43. Chen, L.Y.; Martins, S.S.; Strain, E.C.; Mojtabai, R.; Storr, C.L. Sex and age differences in risk factors of marijuana involvement
during adolescence. Addict. Disord. Their Treat. 2018, 17, 29–39. [CrossRef]
44. Mehanović, E.; Košir, M.; Talić, S.; Jeriček, H.; Vigna-Taglianti, F. Socio-economic differences in factors associated with alcohol use
among adolescents in Slovenia: A cross-sectional study. Int. J. Public Health 2020, 65, 1345–1354. [CrossRef]
45. Ninkron, P.; Yau, S.; Khuntiterakul, P.; Nakamadee, B. Substance use and related risk behaviors among junior high school students
in Nakhon Pathom province, Thailand. J. Health Res. 2022, 36, 345–353. [CrossRef]
46. Pérez-Fuentes, M.D.C.; Molero, M.D.M.; Gázquez, J.J.; Martos, Á.; Mercader, I.; Saracostti, M. Individual variables involved in
perceived pressure for adolescent drinking. Int. J. Environ. Res. Public Health 2020, 17, 2012. [CrossRef] [PubMed]
47. Gutiérrez, T.; Espinoza, P.; Penelo, E.; Mora, M.; González, M.L.; Rosés, R.; Raich, R.M. Association of biological, psychological
and lifestyle risk factors for eating disturbances in adolescents. J. Health Psychol. 2015, 20, 839–849. [CrossRef] [PubMed]
48. Ying, W.; Mohamad, N.; Shii, L. Factors associated with binge eating behavior among Malaysian adolescents. Nutrients 2018,
10, 66. [CrossRef] [PubMed]
49. Gomez-Sanchez, P.; Gutierrez, K.; Gutierrez, E.L. Frequency of risk factors that develop anorexia and bulimia in a private
educational institution in Lima, Perú, 2017. Apunt. Univ. 2020, 10, 197–206. [CrossRef]
50. Zhao, Z.; Ma, Y.; Han, Y.; Liu, Y.; Yang, K.; Zhen, S.; Wen, D. Psychosocial Correlates of Food Addiction and Its Association with
Quality of Life in a Non-Clinical Adolescent Sample. Nutrients 2018, 10, 837. [CrossRef] [PubMed]
51. Mora, F.; Alvarez-Mon, M.A.; Fernandez-Rojo, S.; Ortega, M.A.; Felix-Alcantara, M.P.; Morales-Gil, I.; Rodriguez-Quiroga, A.;
Alvarez-Mon, M.; Quintero, J. Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders. Nutrients 2022,
14, 1481. [CrossRef]
52. Pamies-Aubalat, L.; Quiles, Y.; Torregrosa, M.S. Psychosocial profile related to disordered eating attitudes in Spanish adolescents.
Curr. Psychol. 2023, 42, 20193–20202. [CrossRef]
53. Cella, S.; Cipriano, A.; Aprea, C.; Cotrufo, P. Risk factors for binge eating severity among adolescent girls and boys. A structural
equation modeling approach. Appetite 2022, 169, 105825. [CrossRef]
54. Frieiro, P.; González-Rodríguez, R.; Domínguez-Alonso, J. Self-esteem and socialisation in social networks as determinants in
adolescents’ eating disorders. Health Soc. Care Community 2022, 30, e4416–e4424. [CrossRef]
55. Olsen, E.M.; Koch, S.V.; Skovgaard, A.M.; Strandberg-Larsen, K. Self-reported symptoms of binge-eating disorder among
adolescents in a community-based Danish cohort—A study of prevalence, correlates, and impact. Int. J. Eat. Disord. 2021,
54, 492–505. [CrossRef] [PubMed]
56. Lee, J.S.; Kwon, H.; Park, J.; Hong, H.J.; Kweon, Y.S. A latent class analysis of suicidal behaviors in adolescents. Psychiatry Investig.
2023, 20, 93–100. [CrossRef]
57. Huang, Y.H.; Liu, H.C.; Tsai, F.J.; Sun, F.J.; Huang, K.Y.; Chiu, Y.C.; Huang, Y.H.; Huang, Y.P.; Liu, S.I. Correlation of impulsivity
with self-harm and suicidal attempt: A community study of adolescents in Taiwan. BMJ Open 2017, 7, e017949. [CrossRef]
[PubMed]
58. Muñetón, M.; Uribe, I.; Trejos, A.M.; Alarcón-Vásquez, Y.; Reyes, L. Estilos de afrontamiento como predictores del riesgo suicida
en estudiantes adolescentes: Coping styles as predictors of suicide risk teen students. Psicol. Caribe 2019, 36, 120–132. [CrossRef]
59. Tang, W.C.; Lin, M.P.; You, J.; Yung-Wei, J.; Chen, K.C. Prevalence and psychosocial risk factors of nonsuicidal self-injury among
adolescents during the COVID-19 outbreak. Curr. Psychol. 2023, 42, 17270–17279. [CrossRef] [PubMed]
60. Delfabbro, P.H.; Winefield, H.R.; Winefield, A.H. Life-time and current suicide-ideation in Australian secondary school students:
Socio-demographic, health and psychological predictors. J. Affect. Disord. 2013, 151, 514–524. [CrossRef] [PubMed]
61. Fonseca-Pedrero, E.; Al-Halabí, S.; Pérez-Albéniz, A.; Debbané, M. Risk and protective factors in adolescent suicidal behaviour: A
network analysis. Int. J. Environ. Res. Public Health 2022, 19, 1784. [CrossRef] [PubMed]
62. Brausch, A.M.; Decker, K.M. Self-esteem and social support as moderators of depression, body image, and disordered eating for
suicidal ideation in adolescents. J. Abnorm. Child Psychol. 2014, 42, 779–789. [CrossRef] [PubMed]
63. Oktan, V. Self-harm behaviour in adolescents: Body image and self-esteem. J. Psychol. Couns. Sch. 2017, 27, 177–189. [CrossRef]
Behav. Sci. 2024, 14, 432 17 of 17

64. Garbus, P.; González-Forteza, C.; Cano, M.; Jiménez, A.; Juárez-Loya, A.; Wagner, F.A. Suicidal behavior in Mexican adolescents:
A test of a latent class model using two independent probability samples. Prev. Med. 2022, 157, 106984. [CrossRef]
65. Vawda, N. The prevalence of suicidal behaviour and associated risk factors in grade 8 learners in Durban. S. Afr. Fam. Pract. 2014,
56, 37–42. [CrossRef]
66. Ybarra, M.L.; Mitchell, K.J.; Kosciw, J.G.; Korchmaros, J.D. Understanding linkages between bullying and suicidal ideation in a
national sample of LGB and heterosexual youth in the United States. Prev. Sci. 2015, 16, 451–462. [CrossRef] [PubMed]
67. Lin, M.P.; You, J.; Ren, Y.; Yung-Wei, J.; Hu, W.H.; Yen, C.F.; Zhang, X. Prevalence of nonsuicidal self-injury and its risk and
protective factors among adolescents in Taiwan. Psychiatry Res. 2017, 255, 119–127. [CrossRef]
68. Kerpelman, J.L.; McElwain, A.D.; Pittman, J.F.; Adler-Baeder, F.M. Engagement in Risky Sexual Behavior: Adolescents’ Perceptions
of Self and the Parent–Child Relationship Matter. Youth Soc. 2016, 48, 101–125. [CrossRef]
69. Li, L.; Wang, X.; Tang, S.; Wang, J. Family functioning and problematic internet pornography use among adolescents: A moderated
mediation model. Front. Public Health 2023, 11, 1199835. [CrossRef] [PubMed]
70. Ramiro, M.T.; Teva, I.; Bermúdez, M.P.; Buela-Casal, G. Social support, self-esteem and depression: Relationship with risk for
sexually transmitted infections/HIV transmission. Int. J. Clin. Health Psychol. 2013, 13, 181–188. [CrossRef]
71. Ssewanyana, D.; Abubakar, A.; Mabrouk, A.; Kagonya, V.A.; Nasambu, C.; Dzombo, J.T.; Angwenyi, V.; Kabue, M.; Scerif, G.;
Newton, C.R. The Occurrence of Sexual Risk Behaviors and Its Association with Psychological Well-Being Among Kenyan
Adolescents. Front. Reprod. Health 2021, 3, 659665. [CrossRef]
72. Thurston, I.B.; Dietrich, J.; Bogart, L.M.; Otwombe, K.N.; Sikkema, K.J.; Nkala, B.; Gray, G.E. Correlates of sexual risk among
sexual minority and heterosexual South African youths. Am. J. Public Health 2014, 104, 1265–1269. [CrossRef]
73. Munno, D.; Cappellin, F.; Saroldi, M.; Bechon, E.; Guglielmucci, F.; Passera, R.; Zullo, G. Internet Addiction Disorder: Personality
characteristics and risk of pathological overuse in adolescents. Psychiatry Res. 2017, 248, 1–5. [CrossRef]
74. Warburton, W.A.; Parkes, S.; Sweller, N. Internet Gaming Disorder: Evidence for a Risk and Resilience Approach. Int. J. Environ.
Res. Public Health 2022, 19, 5587. [CrossRef]
75. Barthorpe, A.; Winstone, L.; Mars, B.; Moran, P. Is social media screen time really associated with poor adolescent mental health?
A time use diary study. J. Affect. Disord. 2020, 274, 864–870. [CrossRef]
76. Akbari, M.; Hossein, M.; Khanbabaei, S.; Boruki, B.; Jamshidi, S.; Potenza, M.N. Potential risk and protective factors related to
problematic social media use among adolescents in Iran: A latent profile analysis. Addict. Behav. 2023, 146, 107802. [CrossRef]
77. Lin, M.P.; Yung-Wei, J.; You, J.; Hu, W.H.; Yen, C.F. Prevalence of internet addiction and its risk and protective factors in a
representative sample of senior high school students in Taiwan. J. Adolesc. 2018, 62, 38–46. [CrossRef]
78. Li, C.; Liu, D.; Dong, Y. Self-Esteem and Problematic Smartphone Use Among Adolescents: A Moderated Mediation Model of
Depression and Interpersonal Trust. Front. Psychol. 2019, 10, 1–9. [CrossRef] [PubMed]
79. Wang, H. The Effects of School Climate, Parent–Child Closeness, and Peer Relations on the Problematic Internet Use of Chinese
Adolescents: Testing the Mediating Role of Self-Esteem and Depression. Int. J. Environ. Res. Public Health 2022, 19, 7583. [CrossRef]
[PubMed]
80. Tural, S.; Yeşilova, H. Internet addiction prevalence in youths and its relation with depressive symptoms, self-esteem, and
bullying. Anadolu Psikiyatr. Derg. 2020, 21, 483–490. [CrossRef]
81. Gauthier-Duchesne, A.; Hébert, M.; Blais, M. Child sexual abuse, self-esteem, and delinquent behaviors during adolescence: The
moderating role of gender. J. Interpers. Violence 2022, 37, NP12725–NP12744. [CrossRef] [PubMed]
82. Dosil, M.; Jaureguizar, J.; Bernaras, E.; Burges, J. Teen dating violence, sexism, and resilience: A multivariate analysis. Int. J.
Environ. Res. Public Health 2020, 17, 2652. [CrossRef] [PubMed]
83. Rial, A.; Golpe, S.; Isorna, M.; Braña, T.; Gómez, P. Minors and problematic Internet use: Evidence for better prevention. Comput.
Human Behav. 2018, 87, 140–145. [CrossRef]
84. Garaigordobil, M. Prevención del cyberbullying: Variables personales y familiares predictoras de ciberagresión. Rev. Psicol. Clín.
Niños Adolesc. 2019, 6, 9–17. [CrossRef]
85. R˛ebisz, S.; Jasińska-Macia˛żek, A.; Grygiel, P.; Dolata, R. Psycho-social correlates of cyberbullying among Polish adolescents. Int. J.
Environ. Res. Public Health 2023, 20, 5521. [CrossRef] [PubMed]

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