Self-esteem of children and adolescents with chronic illness: a meta-analysis.
Pinquart, M · Child: care, health and development · 2013 · DOI
Quick Summary
This study combined results from 621 research studies to see whether children and teens with long-term illnesses have lower self-esteem (feeling good about themselves) compared to healthy peers. The findings show that children with chronic illnesses do tend to have somewhat lower self-esteem, with children who have chronic fatigue syndrome (ME/CFS) and chronic headaches experiencing the most significant drops. The study suggests that helping these children experience success and maintain good friendships can boost their self-esteem.
Why It Matters
ME/CFS is identified as one of the chronic illnesses associated with the most significant self-esteem challenges in children and adolescents. Understanding this psychological burden is critical for comprehensive care, as low self-esteem can complicate disease management, worsen psychosocial outcomes, and reduce quality of life. This evidence supports the need for integrated psychosocial interventions specifically tailored for ME/CFS patients.
Observed Findings
Children and adolescents with chronic illness show significantly lower self-esteem than healthy peers (effect size = -0.18 SD)
Chronic fatigue syndrome and chronic headaches are associated with the lowest self-esteem levels among all chronic illnesses studied
Girls with chronic illness show greater self-esteem reductions than boys
Adolescents show greater self-esteem deficits than younger children with chronic illness
Directly comparing children with chronic illness to healthy peers produces larger self-esteem gaps than comparing to standardized test norms
Inferred Conclusions
Chronic illness represents a meaningful risk factor for reduced self-esteem in pediatric populations, with ME/CFS and chronic headaches showing particular vulnerability
Psychosocial factors such as peer relationships and experienced success are modifiable targets for intervention
Age, sex, and measurement methodology significantly moderate the relationship between chronic illness and self-esteem
Clinicians should routinely assess and address self-esteem as part of comprehensive care for children with chronic illness
Remaining Questions
Why do children with ME/CFS and chronic headaches experience disproportionately lower self-esteem compared to other chronic illnesses?
What This Study Does Not Prove
This meta-analysis does not establish causality—it cannot determine whether chronic illness causes low self-esteem, or whether pre-existing low self-esteem affects vulnerability to chronic illness. The study also cannot explain the specific mechanisms driving low self-esteem in ME/CFS versus other chronic illnesses, nor does it provide information about the temporal relationship between illness onset and self-esteem decline.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
What specific mechanisms—social isolation, functional limitations, symptom burden, or identity disruption—most strongly predict self-esteem deficits in pediatric ME/CFS?
Do psychosocial interventions targeting self-esteem improve both psychological and clinical outcomes in children with ME/CFS?
How does disease course and symptom severity longitudinally impact self-esteem trajectory in pediatric ME/CFS populations?