International Journal of Caring Sciences January-April 2023 Volume 16| Issue 1| Page 62

Original Article

Relationship between Sexting and Self-Esteem, Depression, Anxiety, and

Stress among Young People

Petros Galanis, MPh, PhD

Assistant Professor, Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian
University of Athens, Greece

Zoe Katsiroumpa, MSc

Department of Education and Social Work, University of Patras, Patras, Greece

Aglaia Katsiroumpa, RN, MSc, PhD (c)

Clinical Epidemiology Laboratory, Department of Nursing, National and Kapodistrian University of
Athens, Athens, Greece

Anastasia Tsakalaki, MSc

Institute of Educational Policy, Athens, Greece
Stefanos Vasilopoulos, PhD
Professor, Department of Education and Social Work, University of Patras, Patras, Greece

Correspondence: P. Galanis, 123 Papadiamantopoulou street, GR-11527, Athens, Greece, e-mail:

pegalan@nurs.uoa.gr

Abstract

Introduction: The huge spread of the internet and especially of social media has led to new ways of
communication, even erotic communication, especially among young people, replacing, in many cases, activities
that until now required the face-to-face meeting of individuals.
Aim: To investigate the relationship between sexting and self-esteem, depression, anxiety, and stress among
young people. Also, we investigated the impact of demographic characteristics on sexting.
Methods: A cross-sectional study was conducted with 368 young people aged 18-30 years old. We created an
anonymous form of the study questionnaire with Google forms and we disseminated it through social media. Thus,
we obtained a convenience sample. We used valid scales to measure sexting, self-esteem, depression, anxiety and
stress among young people. All scales in our study had very good Cronbach's alpha.
Results: Mean age of the participants was 23.7 years, while 82.3% was females. Mean every day time that
participants spent on social media/platforms/applications was 4.7 hours. Participants used more often to
communicate with others Instagram (86.8%) and Facebook (62.8%), and then Viber (29.9%), TikTok (9.8%),
Snapchat (6%) and WhatsApp (5.1%). Frequency of texting was low among participants, while self-esteem level
was average. Moreover, participants had higher levels of stress than depression and anxiety. We found that
increased sexting was associated with decreased self-esteem (r=-0.3, p=0.02), increased depression (r=0.4,
p=0.001), increased anxiety (r=0.3, p=0.005), and increased stress (r=0.4, p<0.001). Multivariable linear
regression analysis identified that increased number of accounts on social media/platforms/applications

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(coefficient beta=0.07, 95% confidence interval=0.01 to 0.13, p-value=0.023) and increased age (coefficient
beta=0.08, 95% confidence interval=0.01 to 0.13, p-value=0.003) was associated with increased sexting.
Conclusions: Understanding the relationship between sexting and self-esteem, depression, anxiety, and stress in
young people will give policy makers the opportunity to develop appropriate health education programmes to
reduce risky sexual behaviors.
Key-words: sexting, self-esteem, depression, anxiety, stress, Greece

Introduction by his or her digital analogue, socialized and

sexualized online. Particularly for young people,
The huge spread of the internet and especially of
who by definition are in the phase of searching
social media has led to new ways of
and developing their sexuality and sexual identity,
communication, even erotic communication,
it makes sense that the frequency of sexting is
especially among young people, replacing, in
increased (Barrense-Dias et al., 2017). Sexting
many cases, activities that until now required the
among young people is a predictor of sexual
face-to-face meeting of individuals. This
behaviors and may be associated with mental
changing context of communication has also
health disorders and risky behaviors
brought a change in behaviors, which is where
(Baumgartner et al., 2012). The role of gender in
sexting emerges from (Walker et al., 2011). The
sexting is controversial, as in some studies the
prevalence of sexting among young people is
prevalence of sexting is higher in boys and in
showing an increasing trend with a very wide
others it is higher in girls (Baumgartner et al.,
variation from 0.9% to 78% (Barrense-Dias et al.,
2012; Kerstens & Stol, 2014; Livingstone &
2017). The large variations in the prevalence of
Görzig, 2014; Vanden Abeele et al., 2012).
sexting are due to different measurement tools and
different study designs (Dake et al., 2012; Klettke The negative consequences of sexting in young
et al., 2018; Temple et al., 2014). people are numerous and can be summarized in
four broad categories (Doyle et al, 2021): (a)
Sexting among young people is becoming
psychological consequences (victimisation,
increasingly widespread, becoming an extremely
sexual bullying, mental health disorders, quality
important issue that needs systematic
of life and emotional disturbances; (b)
investigation, mainly because of the negative
behavioural consequences (sexual activity and
consequences it brings, especially when its
risky behaviours such as aggression); (c)
content is republished or shared, leading to
consequences on young people's relationships
humiliation, harassment or insult (Barrense-Dias
with others with these relationships being friends,
et al, 2017). Sexting is essentially defined as
family or personal; and (d) consequences on
sending and receiving personal material with
young people's personal lives by sharing/exposing
sexual content via mobile phones, social media,
their personal moments to third parties.
websites and platforms (Krieger, 2017).
To the best of our knowledge, there is no study in
The exposure of young people's personal
Greece that has investigated the relationship
information on social media is constantly
between sexting and self-esteem, depression,
increasing. Thus, the young person is represented

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anxiety, and stress among young people. Thus, the spending on Facebook, Instagram, TikTok,
aim of our study was to investigate the Snapchat, Viber, WhatsApp, and communication
relationship between sexting and self-esteem, with others through Facebook, Instagram,
depression, anxiety, and stress among young TikTok, Snapchat, Viber, WhatsApp.
people. Also, we investigated the impact of
To assess sexting among participants, the
demographic characteristics on sexting.
questionnaire of Bianchi et al. (2018) was used,
Methods which consists of 13 items (Bianchi et al., 2018).
Each item of the questionnaire as well as the total
Study design: A cross-sectional study was
score is given values from 1 to 5. Higher values in
conducted with 368 young people aged 18-30
the questionnaire indicate a higher frequency of
years old. We created an anonymous form of the
sexting. The questionnaire is reliable and valid in
study questionnaire with Google forms and we
Greek (Galanis et al., 2022). In our study,
disseminated it through social media. Data
Cronbach's alpha for the questionnaire was 0.81.
collection was performed in September 2022.
Thus, we obtained a convenience sample. The The "Rosenberg Self-Esteem scale" was used to
participants were informed about the purpose and assess self-esteem in participants, which consists
methodology of the study so that they could of 10 items and receives a total score from 10 to
decide whether or not they wished to participate 40 (Rosenberg, 1965). An increase in the score
in the study. The participants were then asked to indicates higher self-esteem. Validation of the
complete the questionnaire without giving their "Rosenberg Self-Esteem scale" has already
details (full name), which preserved their performed in Greek (Galanou et al. 2014). In our
anonymity. There was no time limit, so that study, Cronbach's alpha for the "Rosenberg Self-
participants were not pressed for time and did not Esteem scale" was 0.86.
lead to rushed responses. Each questionnaire was
The “Depression Anxiety Stress Scales” was used
placed in a special opaque envelope to which only
to assess depression, anxiety and stress in
the research team had access. This was the best
participants (Lovibond & Lovibond 1995).
way to ensure (a) the informed consent of the
Depression, anxiety and stress are measured by
participants to participate in the study, (b) the
seven items each one and take values from 0 to 42.
anonymity of the participants and (c) the
An increase in score indicates more depression,
confidentiality of the information to which only
anxiety and stress. The “Depression Anxiety
the research team had access. Study protocol was
Stress Scales” are proven reliable and valid in
approved by the Ethics Committee of Faculty of
Greek (Lyrakos et al. 2011). In our study,
Nursing of National and Kapodistrian University
Cronbach's alpha for the depression, anxiety and
of Athens (reference number: 418, 22 September
stress scales was 0.86, 0.78, and 0.89 respectively.
2022).
Statistical analysis: We present categorical
Measures: We collected the following
variables with numbers (percentages) and
demographic characteristics of the participants:
continuous variables with mean (standard
gender, age, kind of relationship, educational
deviation). We used the Kolmogorov-Smirnov
level of mothers and fathers, residence during the
test to assess the distribution of the continuous
adolescence, accounts on Facebook, Instagram,
variables. We found that the continuous variables
TikTok, Snapchat, Viber, WhatsApp, hours
followed the normal distribution. Bivariate

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analysis included independent samples t-test, 2012. IBM SPSS Statistics for Windows, Version
analysis of variance, Pearson’s correlation 21.0 Armonk, NY, USA).
coefficient, and Spearman’s correlation
Results
coefficient. We used multivariable linear
regression analysis to assess the impact of Study sample included 368 young people aged 18-
demographic characteristics on sexting. All tests 30 years old. Demographic characteristics of the
of statistical significance were two-tailed, and p- participants are shown in Table 1. Mean age of the
values<0.05 were considered as statistically participants was 23.7 years. Among the
significant. Statistical analysis was performed participants, 82.3% was females, 41.3% was in a
with the IBM SPSS 21.0 (IBM Corp. Released serious relationship, and 50.3% were living in an
urban area during the adolescence.

Table 1. Demographic characteristics of the 368 participants.

Characteristics Ν %
Gender
Females 303 82.3
Males 65 17.7
Age (mean, standard deviation) 23.7 2.5
Relationship
No 184 49.9
Open 32 8.8
Serious 152 41.3
Mother’s educational level
Elementary school 25 6.9
High school 160 43.5
University degree 183 49.6
Father’s educational level
Elementary school 43 11.8
High school 189 51.3
University degree 136 36.9
Residence during the adolescence
Urban area 185 50.3
Semi urban area 138 37.5
Rural area 35 12.2

Social media/platforms/applications use of the media/platforms/applications was 4.7 hours (2.9),

participants is shown in Table 2. Mean every day while minimum value was 0.1 hours and
time that participants spent on social maximum value was 16 hours. Participants used

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more often to communicate with others Instagram (29.9%), TikTok (9.8%), Snapchat (6%) and
(86.8%) and Facebook (62.8%), and then Viber WhatsApp (5.1%).

Table 2. Social media/platforms/applications use of the participants.

Facebook Instagram TikTok Snapchat Viber WhatsApp

Account on 191 (81.6) 217 (92.7) 153 (65.4) 74 (31.6) 179 (76.5) 37 (15.8)

Communication with others 147 (62.8) 203 (86.8) 23 (9.8) 14 (6) 70 (29.9) 12 (5.1)
through

Values are expressed as numbers (percentages).

Descriptive statistics for sexting, self-esteem, anxiety level was average. Moreover,
depression, anxiety, and stress scales are participants had higher levels of stress than
shown in Table 3. Frequency of texting was depression and.
low among participants, while self-esteem

Table 3. Descriptive statistics for sexting, self-esteem, depression, anxiety, and stress scales.
Scale Mean Standard deviation Minimum value Maximum value
Sexting 1.7 0.8 1 3.5
Self-esteem 28.2 4.1 16 38
Depression 10.1 9.3 0 42
Anxiety 8.9 8.2 0 36
Stress 14.9 9.5 0 42

Relationships between sexting and self- esteem (r=-0.3, p=0.02), increased depression
esteem, depression, anxiety, and stress scales (r=0.4, p=0.001), increased anxiety (r=0.3,
are shown in Table 4. We found that increased p=0.005), and increased stress (r=0.4,
sexting was associated with decreased self- p<0.001).

Table 4. Relationships between sexting and self-esteem, depression, anxiety, and stress scales.

Sexting
Pearson’s correlation coefficient P-value
Self-esteem -0.3 0.02
Depression 0.4 0.001
Anxiety 0.3 0.005
Stress 0.4 <0.001

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Bivariate analysis between demographic beta=0.07, 95% confidence interval=0.01 to 0.13,

characteristics of the participants and sexting p-value=0.023) and increased age (coefficient
score are shown in Table 2. Multivariable linear beta=0.08, 95% confidence interval=0.01 to 0.13,
regression analysis identified that increased p-value=0.003) was associated with increased
number of accounts on social sexting.
media/platforms/applications (coefficient

Table 5. Bivariate analysis between demographic characteristics of the participants and sexting score.
Independent variables Mean sexting score Standard P-value
deviation

Gender 0.12a

Females 1.73 0.59

Males 1.51 0.61

Age 0.3b 0.01b

Mother’s educational level 0.027c 0.7c

Father’s educational level -0.12c 0.1c

Relationship 0.3d

No 1.69 0.62

Open 1.71 0.63

Serious 1.73 0.61

Residence during the adolescence 0.9d

Urban area 1.61 0.62

Semi urban area 1.62 0.65

Rural area 1.56 0.66

Every day hours that participants spent on 0.12b 0.22b

social media/platforms/applications

Number of accounts on social 0.11c 0.04c

media/platforms/applications

Number social media/platforms/applications 0.16c 0.11c

that participants use to communicate with
others

a
independent samples t-test, b Pearson’s correlation coefficient, c Spearman’s correlation coefficient, d analysis of variance

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Discussion This communication includes communication on

an erotic level, including sexting. However,
We conducted a cross-sectional study to
young people are not yet mature enough to
investigate the relationship between sexting and
manage the internet use properly, so that in many
self-esteem, depression, anxiety, and stress among
cases they spend an excessive number of hours on
young people. We found that lower self-esteem
it and even engage in risky sexual behavior at the
was associated with an increased frequency of
same time. As a result, the increased use of social
sexting among young people, a finding that is
media, and more specifically sexting, leads young
confirmed by studies in other countries such as
people to mental health problems such as
Germany, Spain, Australia, the USA and Croatia
depression, anxiety and stress. Particular attention
(Eugene, 2015; Klettke et al., 2019; Schoeps et al.,
needs to be paid to this link between sexting and
2020; Scholes-Balog et al., 2016; Sesar, 2021;
mental health problems in young people as if not
Tamarit et al., 2021; Wachs et al., 2017). One
addressed early and effectively they can lead to
possible explanation for this relationship is that
even worse problems such as aggressive behavior,
young people who have a negative self-image and
substance use, suicidal tendencies etc. For this
underestimate their abilities tend to doubt
reason, parents and teachers need to identify
themselves. For this reason, they try to increase
dangerous behavior of young people online, so
their self-confidence by seeking both
that any mental health problems can be managed
communication with other people and validation
more effectively.
from others. It is also typical that young people
with low self-esteem also have a worse body Regarding the effect of demographic
image which leads them sexting more often (Frost characteristics on the frequency of sexting, we
& McKelvie, 2004). found that older teenagers sexting more often.
This finding is confirmed by similar studies
In addition, we found that increased depression,
(Gámez-Guadix & de Santisteban, 2018; Molla-
anxiety and stress in young people were
Esparza et al., 2021; Ybarra & Mitchell, 2014). It
associated with increased frequency of sexting.
seems that as they get older, people have less
This finding is supported by several studies that
hesitations and reservations regarding the use of
have found sexting to be associated with mental
sexting. In addition, older people may want to
health problems in young people such as
experiment more about their sex lives, with such
depression, anxiety and stress (Chaudhary et al.,
experimentation including sexting. We also found
2017; Dake et al., 2012; Eugene, 2015; Frankel et
that young people with more social media
al., 2018; Gámez-Guadix & de Santisteban, 2018;
accounts sexting more frequently. This finding
Kim et al., 2020; Klettke et al., 2018, 2019;
makes sense, as young people with more social
Temple et al., 2014; Van Ouytsel et al., 2014;
media accounts are also quite likely to use these
Ybarra & Mitchell, 2014). The amount of time
media more which increases the likelihood that
that young people spend on the internet and
they will use them for sexting.
especially on social media has increased
significantly in recent years, particularly with the The present study also had some limitations.
emergence of smart phones that provide easy and Specifically, the information on the young people
quick access to social media. As a result, the was obtained at a specific point in time without
internet is now one of the most common ways for knowing the temporal sequence between the
young people to communicate with each other. variables. For this reason, there is a need for

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