Self-esteem, inflammatory cytokines, and cognitive function in adolescents with emotional dysregulation

Accumulating evidence links emotion dysregulation (ED) to systemic inflammation and impaired cognitive function. However, whether low self-esteem (LSE) may relate to systemic inflammation and cognitive dysfunction remains uncertain, despite its frequent co-occurrence with emotion dysregulation.

In total, 105 adolescents with emotion dysregulation (ED), including 51 with attention deficit hyperactivity disorder, 26 with bipolar disorder, and 28 with major depressive disorder, and 54 neurotypical adolescents were enrolled. LSE was operationalized as a Rosenberg Self-Esteem Scale (RSES) total score < 15. All participants completed assessments of mood and attention symptoms and assays of proinflammatory markers, including C-reactive protein (CRP); interleukins (IL)-2, -6, and -17; interferon-γ; and tumor necrosis factor-α. The go/no-go task and 2-back working memory test were also performed.

In generalized linear models adjusting for demographics, clinical symptom severity, and medication use, LSE was independently associated with higher CRP levels (Wald χ² = 4.256, p = 0.039), whereas ED was independently associated with elevated IL-17 levels (Wald χ² = 14.093, p < 0.001). In addition, we also found an association between ED and impaired working memory function.

LSE may reflect low-grade systemic inflammation, independent of mood and attention symptoms. ED showed selective links to elevated IL-17 and worse working memory. Longitudinal work is required to determine temporal precedence and disentangle causal mechanisms among these domains.