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Body Image and Its Association with Depression, Anxiety, and Self-esteem among College going Students: A Study from Northeast India

Background: Body image is conceptualized as a subjective perception of an individual one's own body and on how he/she is seen by others, and its distortion can lead to poor self-esteem and affect psychological adjustment among the youth. The objectives of the study were to assess body image and to see the association with depression, anxiety, and self-esteem among students. Materials and Methods: A cross-sectional correlational study was conducted among undergraduate students in Shillong, Meghalaya. The researcher used random sampling as for the selection of college. The Krejcie and Morgan (1970) sampling method was used to determine the sample size by a table using the sample size formula for the finite population. A total of 384 respondents were selected for the study, out of which 358 were included for the final analysis. Sociodemographic datasheet, Multidimensional Body-Self Relations Questionnaire–Appearance Scales, Rosenberg Self-Esteem Scale, Beck Depression Inventory-II, and Hamilton Anxiety Rating Scale were administered. Results: Regression analysis showed self-esteem and anxiety contribute significantly to the prediction of body image satisfaction among students (F[4353] = 3.816, P = 0.001), accounting for a 15.1% variance. Conclusion: Significant proportion of students were dissatisfied with their body image. Furthermore, a study reported that body image influences psychological well-being. There is a need for preventive measures and making these young people aware of the importance of both physical and mental health.

body-image literature, the present research needs to focus on exploring body image among students in the northeast region, particularly among the tribal group. The study investigates the prevalence of body-image perception of the students through various domains, from their appearance evaluation, overweight preoccupation, appearance orientation, body area satisfaction, and self-classified weight. This research provides for understanding the relationship between body image and psychological adjustment. Furthermore, it identified the predictors of body image dissatisfaction among college students.

MateRIals and Methods
A cross-sectional correlational study design was used. Random sampling was used for the selection of the college. The study was conducted at an educational institute of the Congregation of Christian Brothers located in Shillong, Meghalaya. The Krejcie and Morgan [9] sampling method was used to determine the sample size by a table using the sample size formula for the finite population. The samples of this study were 1 st -year college-going students were selected conveniently; from the age group of 18 to 24 years, willing to give consent was included for the analysis. Students below the age of 18 or above 24 years and those unwilling to consent were excluded. A total of 384 respondents were selected for the present study, out of which 358 were included for the final analysis. Permission from the college authority was obtained, and written informed consent was taken from the students. A sociodemographic datasheet was used for collecting details regarding age, sex, ethnicity, religion, body mass index (BMI) classification, etc. Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) [10] was used to assess the level of body image satisfaction or dissatisfaction, the 34 item MBSRQ-AS was used. This scale has five subscales: appearance evaluation, appearance orientation, overweight preoccupation, self-classified weight, and body areas satisfaction scale. Perceived self-worth and values were measured using the Rosenberg Self-Esteem Scale (RSES). [11] This scale contains ten items. Higher overall scores indicate higher self-esteem. The Beck Depression Inventory (BDI) Scale-II developed by Beck et al. [12] was used to measure the characteristics, attitudes, and symptoms of depression. This BDI-II is 21 item self-report screening for depression. The responses were made on a 4-point scale ranging from 0 to 3. Hamilton Anxiety Rating Scale (HAM-A) [13] was used to measure the severity of anxiety symptoms. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). BMI was calculated using an online standard BMI calculator provided by National Heart, Lung, and Blood Institute. According to the International World Health Organization, classification of BMI was used.
The study was carried out with the permission of the Institutional Ethics Committee, LGBRIMH, Tezpur. The descriptive and inferential statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 25 (SPSS South Asia Pvt. Ltd., Bangalore, Karnataka, India).

Results
The mean age of the participants was 19.7 years (standard deviation = 1.19), majority of the respondents were female (56.1%) and 43.6% of the respondents were male. The tribal participant was among the majority with 61.2%, Christianity was the highest (55.6%) in religion with a little more than half of the total population. Table 1 shows participants with a normal weight constituted 83.8%, 10.9% falls into the overweight category, 4.5% of the participant in the underweight category, and the least (.8%) belong to the obesity category. In the study, 1.1% of the participants only perceived themselves to be extremely thin, slightly thin (4.5%), and 3.6% to be moderately thin. Further, 34.9% perceived to have normal body weight and 44.1% assumed to be slightly overweight, 10.9% and. 8% perceived to be moderately and extremely overweight. In terms of the fear of participants in gaining weight, the outcome reflects that 38.0% were not worried about their weight gain, whereas 21.2% of slightly and moderately scared of gaining weight, 12.3% were very tense and 7.3% were extremely worried. In the study, 18.20% were slightly fear of losing weight and  8.4% of participants were moderately fear of losing weight, 4.7% were very much worried about losing weight, and 1.7% extremely fearful of losing weight [ Table 1].
In the current study, the overall body area satisfaction was seen in 41.6% of the participants, while 58.4% of the participants were dissatisfied with their body image. The findings show that a maximum of 225 of the participants, which account for 62.8% of the total numbers, feel highly dissatisfied with their physical appearance. The findings also show 62.8% of the total numbers feel highly dissatisfied with their physical appearance. In appearance orientation, 70.4% of the participants give importance to their looks. The present study finding shows that 53.1% of participants were highly unhappy with the size or appearance of several body areas. The majority of participants (59.2%) were preoccupied with their own weight. In the study, it was found that 7.0% of the respondent perceived themselves as underweight, 34.9% normal weight, and 58.1% perceived themselves as overweight [ Table 2]. Table 3 shows that overall body image score has significant positive relationship with self-esteem (r = 0.289, P = 0.01) and anxiety (r = 0.041, P = 0.05). Self-esteem has significant positive correlation with appearance evaluation (r = 0.241, P = 0.01), appearance orientation (r = 0.192, P = 0.01) body area satisfaction (r = 0.451, P = 0.01), and overall body image score, self-esteem has significant negative correlations with overweight preoccupation (r = −0.348, P = 0.01) and self-classified weight (r = −0.271, P = 0.01). Overweight preoccupation had a significant positive relationship with anxiety (r = 0.280 P = 0.01) and depression (r = 0.278, P = 0.01) and body area satisfaction had a significant negative correlation with anxiety (r = −0.138, P = 0.01) and depression (r = −0.148, P = 0.01). Self-classified weight had significant positive relationship with depression (r = 0.143, P < 0.01) and anxiety (r = 0.204, P = 0.01).
Multiple regression analysis was conducted to explore the predictors of body image. As shown in Table 4, self-esteem and anxiety contribute significantly to the prediction of body image satisfaction among college-going youth, (F[4353] = 3.816, P = 0.001) accounting for 15.1% variance. The remaining 84.9% was attributed to a variable not included in the study. Self-esteem (Beta = 0.296, t = 5.040, P = 0.001) and anxiety (Beta = 0.211, t = 2.915, P = 0.005) contribute strongly to the body image variance.

dIscussIon
The finding from the study shows that in the domain of appearance evaluation, 62.8% of the respondents were dissatisfied; in the body area satisfaction domain, 53.1% of the respondents were not satisfied with body parts, 59.2% of respondents were preoccupied with their overweight. In self-classified weight, 58.1% perceived themselves as overweight. Studies have reported that college-going students are dissatisfied with their body image. [7,8] The finding of the study shows that overall body image has a significant positive correlation with self-esteem and anxiety. Johnson [14] stated that development of body image dissatisfaction may lead to unhealthy preoccupation, obsessions, and distorted perception of body image which can cause anxiety-related issue in the college students. Aydin et al. [15] also found that body image was positively correlated with anxiety. Yazdani et al. [16] also found body image and psychological well-being had a significant relationship between the total score of the body image being (r = 0.43) (P < 0.001). If the youths are more concerned about their body shape and image, they may develop inappropriate weight-control behaviors, emotional distress (anxiety, depressive symptoms, etc.,) and concerns about one's own body. [17] In the present study, there was a significant positive correlation of self-esteem with the overall body image satisfaction, and in the subscale of body image satisfaction viz-a-viz appearance evaluation, appearance orientation, and body area satisfaction, it was found out that there is a significant positive correlation with self-esteem, whereas, in the domain of overweight preoccupation and self-classified weight, it was seen there is a significant negative correlation with self-esteem. A study by hardwood [18] supported the current study in which there was a correlation between self-esteem (RSES) and body image (MBSRQ). The RSES was positively correlated with several MBSRQ subscales such as appearance evaluation, fitness evaluation, health evaluation, health orientation, and body assessment. Dissatisfaction with one's body image is highly associated with low self-esteem. [19,20] Previous studies also suggest that body-image concerns also define the level of self-esteem and emotional reactions to the environment and risk-taking behavior. [21] Findings from the present study show that overall body image scores and appearance orientation have a significant positive correlation with anxiety. On the other hand, appearance evaluation has a negative correlation with anxiety. Overweight preoccupation and self-classified found to have a significant positive correlation with anxiety. Likewise, the finding from the present study shows that anxiety has a negative correlation with appearance evaluation and a significantly negative association with body area satisfaction can be supported by an online study conducted among the youth whereby the finding indicates that there was an appearance has a negative relation with anxiety. [22] Archibald [23] inspection on the connection between anxiety and body image found that negative connections were seen between the appearance evaluation and body areas satisfaction subscales with Social Anxiety Scale , proposing that a degree of social anxiety is associated with body dissatisfaction. The current finding shows a similar outcome where a significant negative correlation was found between the body area satisfaction scale and a negative correlation of appearance evaluation. In the current study, self-classified weight had a significant positive relationship with depression) and a significant negative correlation was found between body area satisfaction and depression. The result of the study was consistent with the previous study by hamilton [24] research on the relationship between perceived body image and depression, using MBSRQ and BDI found out that Pearson correlation showed no significant relationship between body image and depression; however, the subscale of MBSRQ showed a significant relationship with depression. Furthermore, studies also demonstrated that low body satisfaction substantially led to higher depression over time and greater perceived pressure to be thin. [25] Olivardia, Pope, Borowiecki, and Cohane [26] examined the interrelatedness of body image satisfaction with that of depression, their finding indicates that there was a significantly positive correlation (r. 30, p. 001) between the two. The disappointment that young people have with regard to their weight and shape has an impact on how they feel and which further leads to severe mental health issues. [27,28] In the present study, self-esteem and anxiety contribute significantly to the prediction of body image satisfaction among college-going youth. Self-esteem and anxiety contribute strongly to body image variance. A study on body image dissatisfaction from self-esteem also found out that self-esteem plays a central role in predicting body image dissatisfaction. [29] Arasa [30] found that self-esteem was a significant predictor of body image dissatisfaction using linear regression analysis. Anxiety in the current study was also a significant predictor of body image. A similar finding has been reported in other studies. [31,32]

Limitations
The study was cross-sectional in nature, and it can have different responses on further assessment, and scales used were self-reported. The gender difference can be studied in the future along with other psychosocial factors such as media, culture, and family factors. conclusIon A significant proportion of students are dissatisfied with their body image leading to lower self-esteem, anxiety, and depression. Realizing the outcome of how the negative body image has negative repercussions on young people, an appropriate intervention approach should be an area of focus for mental health professionals.

Financial support and sponsorship
Nil.

Conflicts of interest
There are no conflicts of interest.