The psychological factors mediating/moderating the association between body-image disturbance and depression: A systematic review

Abstract

Available evidence demonstrates that individuals with body-image disturbance (BID) are prone to suffer from depression. This systematic review provides, to our knowledge, the first synthesis of the psychological mechanism of the association between BID and depression. We conducted a thorough search of online databases, including PubMed, Web of Science, and PsycINFO, for articles published up until February 2024. The final analysis comprised a total of 23 studies that focused on the mediating or moderating effects of psychological factors between depression and BID. This review identifies self-esteem and social support as both mediators and moderators of the relationship between BID and depression, while perceived stress acted only as a mediator. High self-esteem and strong social support as well as low levels of perceived stress may help individuals experience lower levels of BID, thereby contributing to a decreased likelihood of depression. Interventions aimed at increasing self-esteem, developing strong support, and decreasing perceived stress may hold promise to reduce the risk of depression in those with BID.

Keywords

body-image disturbance / depression / perceived stress / psychological mechanism / self-esteem / social support

References

[1] Alleva, J. M., Sheeran, P., Webb, T. L., Martijn, C., & Miles, E. (2015). A meta-analytic review of stand-alone interventions to improve body image. PLoS One, 10(9), e139177.

[2] American College Health Association. (2013). National College Health Assessment. http://www.acha-ncha.org/docs/ACHA-NCHA-II_UNDERGRAD_ReferenceGroup_DataReport_Spring2013.pdf

[3] Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc.

[4] Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529.

[5] Brechan, I., & Kvalem, I. L. (2015). Relationship between body dissatisfaction and disordered eating: Mediating role of self-esteem and depression. Eating Behaviors, 17, 49–58.

[6] Brewis, A. A., & Bruening, M. (2018). Weight shame, social connection, and depressive symptoms in late adolescence. International Journal of Environmental Research and Public Health, 15(5), 891.

[7] Brown, B. L. (2008). elf-compassion as a moderating factor in the relation of body-image to depression and self-esteem. Available from APA PsycInfo^®.

[8] Brown, E. S., Varghese, F. P., & McEwen, B. S. (2004). Association of depression with medical illness: Does cortisol play a role? Biological Psychiatry, 55(1), 1–9.

[9] Brunet, J., Pila, E., Solomon-Krakus, S., Sabiston, C. M., & O’Loughlin, J. (2019). Self-esteem moderates the associations between body-related self-conscious emotions and depressive symptoms. Journal of Health Psychology, 24(6), 833–843.

[10] Bui, K. V. T. (2002). First-generation college students at a four-year university: Background characteristics, reasons for pursuing higher education, and first-year experiences. College Student Journal, 36(1), 3–11. https://www.proquest.com/scholarly-journals/first-generation-college-students-at-four-year/docview/619775128/se-2?accountid=48841

[11] Buote, V. M., Pancer, S. M., Pratt, M. W., Adams, G., Birnie-Lefcovitch, S., Polivy, J., & Wintre, M. G. (2007). The importance of friends: Friendship and adjustment among 1st-year university students. Journal of Adolescent Research, 22(6), 665–689.

[12] Butler, A. C., Hokanson, J. E., & Flynn, H. A. (1994). A comparison of self-esteem lability and low trait self-esteem as vulnerability factors for depression. Journal of Personality and Social Psychology, 66(1), 166–177.

[13] Choi, E., & Choi, I. (2016). The associations between body dissatisfaction, body figure, self-esteem, and depressed mood in adolescents in the United States and Korea: A moderated mediation analysis. Journal of Adolescence, 53, 249–259.

[14] Choi, I. J., Lee, K. B., Kim, H. J., Park, K. O., Lee, M. S., & Lee, E. (2010). Korean youth indicator survey V: Health and safety (protection). National Youth Policy Institute.

[15] Cohentovee, E. M. (1993). Depressed mood and concern with weight and shape in normal young-women. International Journal of Eating Disorders, 14(2), 223–227.

[16] Cooper, P. J., & Taylor, M. J. (1988). Body-image disturbance in bulimia-nervosa. British Journal of Psychiatry, 153, 32–36.

[17] Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130(3), 355–391.

[18] Duan, W., & Li, J. (2016). Distinguishing dispositional and cultivated forms of mindfulness: Item-level factor analysis of five-facet mindfulness questionnaire and construction of short inventory of mindfulness capability. Frontiers in Psychology, 7, 1348.

[19] Duan, W., & Wang, Z. (2019). Mindfulness capability mediates the association between weight-based stigma and negative emotion symptoms. Mindfulness, 10(6), 1074–1081.

[20] Duchesne, A.-P., Dion, J., Lalande, D., Bégin, C., Émond, C., Lalande, G., & McDuff, P. (2017). Body dissatisfaction and psychological distress in adolescents: Is self-esteem a mediator? Journal of Health Psychology, 22(12), 1563–1569.

[21] Evans, M. A. (2011). Unattainable beauty: An analysis of the role of body shame and self-objectification in hopelessness depression among college-age women. Graduate Doctoral Dissertations, 8. https://scholarworks.umb.edu/doctoral_dissertations/8

[22] Ferreiro, F., Seoane, G., & Senra, C. (2012). Gender-related risk and protective factors for depressive symptoms and disordered eating in adolescence: A 4-year longitudinal study. Journal of Youth and Adolescence, 41(5), 607–622.

[23] Ferrer-Garcia, M., & Gutierrez-Maldonado, J. (2012). The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: A review of the literature. Body Image, 9(1), 1–11.

[24] Gardner, R. M., & Brown, D. L. (2014). Body size estimation in anorexia nervosa: A brief review of findings from 2003 through 2013. Psychiatry Research, 219(3), 407–410.

[25] Garland, E., Gaylord, S., & Park, J. (2009). The role of mindfulness in positive reappraisal. Explore (New York, N.Y.), 5(1), 37–44.

[26] Gilbert, P. (2000). The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology & Psychotherapy, 7(3), 174–189.

[27] Gillen, M. M., & Lefkowitz, E. S. (2006). Gender role development and body image among male and female first year college students. Sex Roles, 55, 25–37.

[28] Goldstein, D. S., & McEwen, B. (2002). Allostasis, homeostats, and the nature of stress. Stress: The International Journal on the Biology of Stress, 5(1), 55–58.

[29] Gruenewald, T. L., Kemeny, M. E., Aziz, N., & Fahey, J. L. (2004). Acute threat to the social self: Shame, social self-esteem, and cortisol activity. Psychosomatic Medicine, 66(6), 915–924.

[30] Hanley, S., & McLaren, S. (2015). Sense of belonging to layers of lesbian community weakens the link between body image dissatisfaction and depressive symptoms. Psychology of Women Quarterly, 39(1), 85–94.

[31] Hartley, E., Hill, B., McPhie, S., & Skouteris, H. (2018). The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: A rapid systematic review. Journal of Reproductive and Infant Psychology, 36(1), 81–101.

[32] Hassani, F., Koraei, A., Yaghoobi, R., & Zarea, K. (2021). An evaluating of the relationship between body image, body satisfaction, depression, marital quality, and self-esteem in patients with psoriasis. Psychology, Health & Medicine, 26(4), 467–477.

[33] Hoffman, D. S. (2007). Media exposure, body dissatisfaction and depressive symptoms during adolescence: Daily fluctuations and moderating influences (Publication Number AAI3230300) APA PsycInfo^®. https://www.proquest.com/dissertations-theses/media-exposure-body-dissatisfaction-depressive/docview/622008478/se-2?accountid=48841

[34] Hunger, J. M., & Major, B. (2015). Weight stigma mediates the association between BMI and self-reported health. Health Psychology, 34(2), 172–175.

[35] Keel, P. K., Mitchell, J. E., Davis, T. L., & Crow, S. J. (2001). Relationship between depression and body dissatisfaction in women diagnosed with bulimia nervosa. International Journal of Eating Disorders, 30(1), 48–56.

[36] Keller, J., Gomez, R., Williams, G., Lembke, A., Lazzeroni, L., Murphy, G. M., Jr., & Schatzberg, A. F. (2017). HPA axis in major depression: Cortisol, clinical symptomatology and genetic variation predict cognition. Molecular Psychiatry, 22(4), 527–536.

[37] Kok, X. L. F., Newton, J. T., Jones, E. M., & Cunningham, S. J. (2023). Social support and pre-operative anxiety in patients undergoing elective surgical procedures: A systematic review and meta-analysis. Journal of Health Psychology, 28(4), 309–327.

[38] Koronczai, B., Kökönyei, G., Urbán, R., Kun, B., Pápay, O., Nagygyörgy, K., Griffiths, M. D., & Demetrovics, Z. (2013). The mediating effect of self-esteem, depression and anxiety between satisfaction with body appearance and problematic internet use. The American Journal of Drug and Alcohol Abuse, 39(4), 259–265.

[39] Lewis, S., Thomas, S. L., Blood, R. W., Castle, D. J., Hyde, J., & Komesaroff, P. A. (2011). How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study. Social Science & Medicine, 73(9), 1349–1356.

[40] Liu, J., Peh, C. X., & Mahendran, R. (2017). Body image and emotional distress in newly diagnosed cancer patients: The mediating role of dysfunctional attitudes and rumination. Body Image, 20, 58–64.

[41] Ma, X., Biaggi, A., Sacchi, C., Lawrence, A. J., Chen, P.-J., Pollard, R., Matter, M., Mackes, N., Hazelgrove, K., Morgan, C., Harding, S., Simonelli, A., Schumann, G., Pariante, C. M., Mehta, M., Montana, G., Rodriguez-Mateos, A., Nosarti, C., & Dazzan, P. (2022). Mediators and moderators in the relationship between maternal childhood adversity and children’s emotional and behavioural development: A systematic review and meta-analysis. Psychological Medicine, 52(10), 1817–1837.

[42] Marsh, H. W., & O’Neill, R. (1984). Self description questionnaire III: The construct validity of multidimensional self-concept ratings by late adolescents. Journal of Educational Measurement, 21(2), 153–174.

[43] McAndrew, F. T. (1998). The measurement of “rootedness” and the prediction of attachment to home-towns in college students. Journal of Environmental Psychology, 18(4), 409–417.

[44] McGregor, C. C. (2022). Understanding and addressing the relationship between weight bias and depressive symptoms in college men (Publication Number AAI29024375) [Ph.D., University of North Texas]. APA PsycInfo^®. https://www.proquest.com/dissertations-theses/understanding-addressing-relationship-between/docview/2696898737/se-2?accountid=48841

[45] McGregor, C. C., Kaminski, P. L., & McFarland, M. B. (2020). Feeling fat and depressed? Dimensions of self-concept that affect men. Journal of College Counseling, 23, 142–153.

[46] Moola, S., Munn, Z., Sears, K., Sfetcu, R., Currie, M., Lisy, K., Tufanaru, C., Qureshi, R., Mattis, P., & Mu, P. (2015). Conducting systematic reviews of association (etiology): The Joanna Briggs Institute’s approach. International Journal of Evidence-Based Healthcare, 13(3), 163–169.

[47] Morken, I. S., Røysamb, E., Nilsen, W., & Karevold, E. B. (2019). Body dissatisfaction and depressive symptoms on the threshold to adolescence: Examining gender differences in depressive symptoms and the impact of social support. The Journal of Early Adolescence, 39(6), 814–838.

[48] Neff, K. D. (2011). Self-compassion, self-esteem, and well-being. Social and Personality Psychology Compass, 5(1), 1–12.

[49] O’Reilly, G. A., Cook, L., Spruijt-Metz, D., & Black, D. S. (2014). Mindfulness-based interventions for obesity-related eating behaviours: A literature review. Obesity Reviews, 15(6), 453–461.

[50] Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan-a web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210.

[51] Paans, N. P. G., Bot, M., Brouwer, I. A., Visser, M., & Penninx, B. (2018). Contributions of depression and body mass index to body image. Journal of Psychiatric Research, 103, 18–25.

[52] Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71.

[53] Pehlivan, M. J., Sherman, K. A., Wuthrich, V., Horn, M., Basson, M., & Duckworth, T. (2022). Body image and depression in endometriosis: Examining self-esteem and rumination as mediators. Body Image, 43, 463–473.

[54] Pimenta, A. M., Sanchez-Villegas, A., Bes-Rastrollo, M., Lopez, C. N., & Martinez-Gonzalez, M. A. (2009). Relationship between body image disturbance and incidence of depression: The SUN prospective cohort. BMC Public Health, 9, 1.

[55] Przezdziecki, A., Sherman, K. A., Baillie, A., Taylor, A., Foley, E., & Stalgis-Bilinski, K. (2013). My changed body: Breast cancer, body image, distress and self-compassion. Psychooncology, 22(8), 1872–1879.

[56] Rawana, J. S., Morgan, A. S., Hien, N., & Craig, S. G. (2010). The relation between eating-and weight-related disturbances and depression in adolescence: A review. Clinical Child and Family Psychology Review, 13(3), 213–230.

[57] Richard, A., Rohrmann, S., Lohse, T., & Eichholzer, M. (2016). Is body weight dissatisfaction a predictor of depression independent of body mass index, sex and age? Results of a cross-sectional study. BMC Public Health, 16, 863.

[58] Roberts, C. M. (2023). Illness stigma, body image dissatisfaction, thwarted belongingness, and depressive symptoms in youth with inflammatory bowel disease (Publication Number AAI29063134) [Ph.D., Oklahoma State University]. APA PsycInfo^®. https://www.proquest.com/dissertations-theses/illness-stigma-body-image-dissatisfaction/docview/2805216549/se-2?accountid=48841

[59] Rosenberg, M. (1979). Conceiving the self. Basic Books.

[60] Sabik, N. J., Lupis, S. B., Geiger, A. M., & Wolf, J. M. (2019). Are body perceptions and perceived appearance judgments by others linked to stress and depressive symptoms? Journal of Applied Biobehavioral Research, 24(1), 12131.

[61] Santos, W. M. D., Secoli, S. R., & Püschel, V. A. A. (2018). The Joanna Briggs institute approach for systematic reviews. Revista Latino-Americana de Enfermagem, 26, e3074.

[62] Sapolsky, R. M., Romero, L. M., & Munck, A. U. (2000). How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocrine Reviews, 21(1), 55–89.

[63] Sick, K., Pila, E., Nesbitt, A., & Sabiston, C. M. (2020). Does self-compassion buffer the detrimental effect of body shame on depressive symptoms? Body Image, 34, 175–183.

[64] Soo, H., Burney, S., & Basten, C. (2009). The role of rumination in affective distress in people with a chronic physical illness: A review of the literature and theoretical formulation. Journal of Health Psychology, 14(7), 956–966.

[65] Stice, E., & Bearman, S. K. (2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37(5), 597–607.

[66] Thompson, M. A., & Gray, J. J. (1995). Development and validation of a new body-image assessment scale. Journal of Personality Assessment, 64(2), 258–269.

[67] Todd, M. M. (2007). A mediational model linking objectified body consciousness, symptoms of depression, and perceptions of self-efficacy in women (Publication Number AAI3268876) APA PsycInfo^®. https://www.proquest.com/dissertations-theses/mediational-model-linking-objectified-body/docview/622062535/se-2?accountid=48841

[68] Townsend, S. S. M., Major, B., Gangi, C. E., & Mendes, W. B. (2011). From “In the Air” to “Under the Skin”: Cortisol Responses to Social Identity Threat. Personality and Social Psychology Bulletin, 37(2), 151–164.

[69] Vartanian, L. R., & Shaprow, J. G. (2008). Effects of weight stigma on exercise motivation and behavior: A preliminary investigation among college-aged females. Journal of Health Psychology, 13(1), 131–138.

[70] Wang, Y., Lynne, S. D., Witherspoon, D., & Black, M. M. (2020). Longitudinal bidirectional relations between body dissatisfaction and depressive symptoms among Black adolescents: A cross-lagged panel analysis. PLoS One, 15(1), e0228585.

[71] Wilson, R. E., Latner, J. D., & Hayashi, K. (2013). More than just body weight: The role of body image in psychological and physical functioning. Body Image, 10(4), 644–647.

[72] Zhao, Y., Han, L., Teopiz, K. M., McIntyre, R. S., Ma, R., & Cao, B. (2022). The psychological factors mediating/moderating the association between childhood adversity and depression: A systematic review. Neuroscience and Biobehavioral Reviews, 137, 104663.

[73] Ziser, K., Finklenburg, C., Behrens, S. C., Giel, K. E., Becker, S., Skoda, E.-M., Teufel, M., Mack, I., Zipfel, S., & Junne, F. (2019). Perceived stress mediates the relationship of body image and depressive symptoms in individuals with obesity. Frontiers in Psychiatry, 10, 852.

RIGHTS & PERMISSIONS

2024 The Authors. PsyCh Journal published by Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.