Self-esteem and adolescent sexual behaviors, attitudes, and intentions: a systematic review

This review systematically examined the relationship between self-esteem and adolescents' sexual behaviors, attitudes, and intentions, as empirically investigated by researchers over the last 20 years.

Based on the Matrix Method for systematic reviews, five electronic databases and reference lists of published studies were searched. Thirty-eight (n = 38) publications met specific inclusion and exclusion criteria and comprised the final sample. Each study was assigned a methodological quality score (MQS; maximum = 20 points). Each study's empirical test of the relationship between self-esteem and sexual behaviors/attitudes/intentions was counted as a single finding and was classified as exhibiting an inverse linear relationship, no statistically significant linear relationship, or a positive linear relationship.

A total of 189 findings (average = 4.97/publication, range 1-28) were analyzed. Most findings (n = 138, 73%) consisted of tests of self-esteem and sexual behaviors. Regarding the nature of the relationship between self-esteem and the various behavior/attitude/intention variables, 62% of behavior findings and 72% of the attitudinal findings exhibited no statistically significant association. All of the intention-related findings exhibited some type of relationship (either positive or inverse). Studies' average MQS was 11.71 (SD = 1.60). Higher quality studies yielded findings of positive or absence of relationship (Cramer's V = .329, p = .001).

If most findings exhibit no association between self-esteem and adolescent sexual behaviors/attitudes/intentions, questions are inevitably raised whether the emphasis placed on self-esteem by public health professionals is innocuous. Recommendations for methodological improvement of this body of research are also presented.