Development of self-esteem from childhood to adolescence in children at Familial high-risk of schizophrenia or bipolar disorder.

Self-esteem is important for mental well-being. Children of parents with schizophrenia or bipolar disorder have multiple risk factors for low self-esteem. We aimed to examine their development of self-esteem and associations with bullying victimization, caregiver functioning, at-home support, and prevalence of mental illness. In a cohort of 519 children at familial high-risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) and population-based controls (PBC), self-esteem was assessed with the "I Think I Am" questionnaire at ages 7, 9, 11, and 14. Bullying victimization (using KIDSCREEN-52), caregiver functioning (using Personal and Social Performance Scale), and at-home support (using MC-HOME) were assessed at age 7, and prevalence of lifetime mental disorder (using K-SADS-PL) was assessed at ages 7 and 11. A time x group interaction was found for self-esteem development overall and for the subscales "Psychological well-being" and "Relationships with others" (p ≤ 0.01). Across assessments, lower self-esteem was found among children at FHR-SZ (p ≤ 0.001 for all), but only at age 11 for children at FHR-BP (p = 0.002), compared with PBC. Bullying victimization and low at-home support at age 7 were associated with lower self-esteem (Partial Eta Squared 0.05 and 0.01) at age 14. Low self-esteem at age 7 was associated with mental disorder (Partial Eta Squared 0.19) at age 11. More bullying victimization and poorer home environment quality are associated with later lower self-esteem, and low self-esteem is associated with later psychopathology among children at FHR. Awareness of self-esteem and risk factors for low self-esteem among children at FHR is needed.