Self-Esteem as an Outcome Measure in Studies of Vocational Rehabilitation for Adults With Severe Mental Illness

OBJECTIVE: Self-esteem is widely used as an outcome variable in studies of psychiatric rehabilitation, based on the assumption that improved functional status leads to higher self-esteem. Little is known, however, about the determinants of self-esteem among adults with severe mental illness. The utility of a popular measure of global self-esteem—the Rosenberg Self-Esteem Scale—as an outcome measure was examined in this population. METHODS: A total of 143 participants enrolled in a study of vocational rehabilitation were assessed at baseline and six, 12, and 18 months later using measures of self-esteem, symptoms, life satisfaction, work status, housing status, and total income. RESULTS: Scores on the Rosenberg Self-Esteem Scale did not vary with work status or other functional outcomes but instead were strongly related to measures of life satisfaction and affective symptoms. CONCLUSIONS: The hypothesis that working leads to improved self-esteem for people with severe mental illness was not supported. For this population, self-esteem, as measured by the Rosenberg Self-Esteem Scale, appears to be a relatively stable trait that reflects general life satisfaction and affective symptoms rather than objective functional status.