Reassurance Seeking Behavior and Interpersonal Difficulties in University Students: Mediating Role of Self-Esteem

Received 16 Aug, 2021

Accepted 10 Nov, 2021

Published 31 Mar, 2023

The current study intended to investigate the role of self-esteem as a mediator between reassurance-seeking behavior and interpersonal difficulties in 300 university students (50% men and 50% women) aged between 18-30 years (M = 20.72, SD = 1.88). Measures consisted of the Reassurance Seeking Behavior Scale (Hafeez, 2020), Self-Esteem Scale (Zafar et al., 2012), Interpersonal Difficulty Scale (Saleem et al., 2014), and a demographic proforma. According to the results, reassurance-seeking behavior was positively correlated with low self-esteem, anxious self-esteem, and interpersonal difficulties. Low self-esteem and anxious self-esteem were also correlated positively with interpersonal difficulties. Furthermore, low self-esteem and anxious self-esteem significantly mediated the relationship between reassurance-seeking behavior and interpersonal difficulties in university students. The results of the study provide implications for mental health professionals in terms of developing structured prevention programs and taking preventative precautions to mitigate the devastating impacts of interpersonal difficulties.

During the transition from college to university life, students may face many issues regarding adjustment and maintaining new relationships and try to learn new skills to initiate and maintain relationships (Saleem et al., 2014). An individual's university years are emotionally and intellectually more demanding than almost any other stage of education. At this stage, a person is subjected to a plethora of pressures and challenges that present a variety of physical, social, and emotional difficulties (Rodgers & Tennison, 2009). New perspectives expand personal and social liberty, and the emergence of new social interactions may add discomfort and difficulty in adaptation for some individuals (Schraml et al., 2011). 
Failure to adjust to the social world may lead students to increase the likelihood of suffering from various psycho-social problems (Lange & Couch, 2011; Saleem et al., 2014). Most typical difficulties encountered by university students are mood disruptions, problematic behavior, interpersonal problems, and deterioration of self-esteem (Chung et al., 2017; Matin & Khan, 2017) which are associated with numerous adverse outcomes including low self-esteem, loneliness, substance use and poor academic performance (De Clercq et al., 2022; New & Ghafar, 2016).
According to attachment theory, in an intimate relationship the person who was affected by the anxious/avoidant attachment style, ultimately shows anxious and avoidant response toward significant others (Lancy, 2013). demanding reassurances from their partner as their relationship moves further (Grime et al., 2016). Coyne (1976) proposes that individuals who are mildly dysphoric, but not depressed, seek reassurance from significant others to help them feel more secure about their worth. In the beginning, others show genuine concern and support. As a result, the individual escalates their symptoms to obtain more reassurance and acceptance because they perceive this support to be insufficient. Researchers have observed that reassurance-seeking can be an etiological factor for depression as well as for negative interpersonal outcomes (Joiner, 2000).
Literature explored interpersonal difficulties (IDs) as one of the most common social problems during university years. These difficulties are defined as conflicted interaction, obscurity in trusting others, apprehension of abandonment, and patterns of over-involvement or abandonment as well as veneration or depreciation of relationships (Erozkan, 2012; Ooi et al., 2020; Zahra et al., 2020). The literature identified the increased prevalence of interpersonal and social problems in university students with an average prevalence rate of 25% (Saleem & Mahmood, 2013). There are many adverse consequences of interpersonal problems and difficulties that may lead to loneliness, social withdrawal, substance use, poor academic performance, low self-esteem, and a lower level of well-being and quality of life (Carter et al., 2012). According to the literature, women have more interpersonal difficulties than men (Saleem et al., 2014). Therefore, keeping in view the high rate of interpersonal problems and their consequences, it is necessary to find out the factors associated with interpersonal difficulties.
In literature, self-esteem is not used as a mediator between reassurance-seeking behavior and interpersonal difficulties. As a result of increased negative events that were not moderated by self–esteem, researchers examined whether excessive reassurance seeking was associated with greater depressive symptoms, examining trait self-esteem rather than self-esteem lability as a moderator (Abela et al., 2007). Furthermore, it is important to note that even after controlling for self-esteem, interpersonal difficulties, and attachment insecurity, research on adult populations has found that reassurance seeking is associated with depression symptoms (Fowler & Gasiorek, 2016).
Reassurance-seeking behavior (RSB) plays an important role as a risk factor for interpersonal difficulties. Reassurance-seeking behavior is described as the stable tendency to seek affirmation from those around them, regardless of whether they have already obtained such confirmation (Anagnostopoulos & Carter, 2019; Salkovskis & Kobori, 2015; Taylor et al., 2019). Reassurance-seeking behavior induces anxiety in an individual then the individual loses his/her confidence and gets approval from others again and again (Boss, 2016; Orr, 2021). Furthermore, the literature also identified that reassurance-seeking behavior also leads individual’s towards low self-esteem as they are being anxious about failure and being rejected, so they will do their best to prove themselves (Chong, 2020; Halldorsson, 2015; Stewart & Harkness, 2015). Moreover, reassurance-seeking behavior could also lead an individual toward negative outcomes including social isolation, distress, lack of trust, and poor psychosocial well-being (Hames et al., 2015; Pietrabissa & Simpson, 2020). 
Another factor associated with interpersonal difficulties is self-esteem (Shimizu et al., 2018). As defined by Orth (2017), self-esteem refers to one's general sense of value and measures how much he or she likes, applauds, or trusts themselves. While low self-worth is the undoing of high self-worth and directly relates to feelings of disapproval (Peterson et al., 2019). Low self-esteem is a source of numerous psychological problems, poor job performance, and relationship difficulties (Chun, 2016). Previous theoretical and empirical literature suggested the interrelatedness of self-esteem and interpersonal problems. The Sociometry theory of self-worth suggests that interpersonal troubles, problems, conflicts, and breakups are indicators of poor recognition and delicate refusal, a result leading to low self-worth and self-esteem (Luciano & Orth, 2017; Velotti et al., 2018). Another factor of self-esteem is anxious self-esteem which is defined as being sad, dissatisfied, easily irritated, and worried. It also includes quitting, having little interest in life, focusing on oneself, a lack of healthy relationships, and feeling anxious (Don et al., 2018; Zafar et al., 2012). A low sense of worth defends individuals from societal refusal by utilizing indirect support from others researchers identified that individuals with low self-esteem and anxious self-esteem faced more interpersonal disputes and problems in their life (Kiviruusu et al., 2016; Stavropoulos et al., 2015).  In psychological, social, and interpersonal relationships, low self-esteem and high anxious self-esteem are directly linked to feelings of rejection and lead to psychological, social, and interpersonal problems (Ha, 2006; Mackinnon, 2015; Marigold et al., 2010; Reis et al., 2017).
Several factors influence the level of self-esteem in university students. Among them, Reassurance seeking behavior is one of the most prominent factors associated with self-esteem. The result revealed that there was a negative relation between reassurance-seeking behavior and self-esteem (Forchuk et al., 2021; Stewart & Harkness, 2015; Wakeling et al., 2020).  It was also evident from the literature that self-esteem is negatively related to interpersonal difficulties (Yanhong, 2021). Culture plays a crucial part in defining and shaping human practices (Horlings, 2015). Pakistan is a collectivistic culture that is characterized by prolonged childhood and dependency on parents even during adulthood (Zahra et al., 2020). In such cultures, major life decisions of an individual are made by their parents or significant members of the family. Due to this parental and familial dependency, university students are more prone to interpersonal problems. So by exploring the factors associated with interpersonal problems, these problems can be handled effectively.
Since university years are a major transition time where the individual is facing numerous challenges including the desire to get autonomy from parents, developing and maintaining social interactions, and exercising self-reliance (Cunningham & Diversi, 2012). This is the time when gender role identity is maintained, and individuals tend to seek approval and social acceptance from significant others. The interplay of low self-esteem seeking social acceptance hinders the learning of new social skills that can be beneficial for long-term effective social interactions in university years.  Therefore, considering the above discussion, the current study aimed to find out the association between reassurance-seeking, low self-esteem, anxious self-esteem, and interpersonal difficulties in university students. It further aimed to find out the mediating role of low and anxious self-esteem in the association of reassurance-seeking behavior and interpersonal difficulties in university students.

Objectives

The current study addressed the following objectives:

1. To find out the association of reassurance-seeking behavior, low self-esteem, anxious self-esteem, and interpersonal difficulties in university students.
2. To explore the mediating role of anxious self-esteem and low self-esteem in the association of reassurance-seeking behavior and interpersonal difficulties.

Hypotheses

The hypotheses of the current study are phrased as follows:

• It is hypothesized that reassurance-seeking behavior would be positively associated with low self-esteem, anxious self-esteem, and interpersonal difficulties.
• Low self-esteem and anxious self-esteem would be positively associated with interpersonal difficulties.
• Low self-esteem and anxious self-esteem would mediate the association between reassurance-seeking behavior and interpersonal difficulties.

Method

Participants

A cross-sectional research design was used in the study and data were gathered from students at government and private universities in Lahore and Gujranwala. A multistage sampling technique was used to recruit 300 people (50 percent men and 50 percent women). The participants ranged in age from 18 to 30 years (M = 20.72, SD = 1.88). The first strata were based on gender (50 % men and 50 % women) and further substrata were based on academic years (BS 1st year = 26%, BS 2nd year = 32%, BS 3rd year = 23% and BS 4th year = 19%).

Measures

The following measures were used to assess the study constructs.

Reassurance Seeking Behavior Scale 

Reassurance Seeking Behavior Scale (RSBS; Hafeez, 2020) is the indigenous scale consisted of two sub-factors self-exaggeration and low confidence developed in the Pakistani context. It had 27 items that were scored on 5-point Likert scale ranging from 0 = not at all to 4 = always. The sample items areexaggerating things, difference covert and overt, showing off money, fear of isolation,lying, sentience, giving too much importance to others, small friend circle, and thinking things happen according to them. The participant had to read each item and mark it to extend as it applied to them. There was no reverse scoring and high scores indicating high reassurance seeking behavior. A significant positive correlation (r = .83, p < .01) is found between these two groups of items, which indicated that there is a highly significant positive correlation between two halves (even and odd sets) of RSBS (Hafeez & Saleem, 2020).

Self-Esteem Scale

Self-Esteem Scale (SES; Zafar et al., 2012) is an indigenous tool developed in Pakistan and consists of 62 items to be rated on 3-point Likert scale ranging from 0 = not at all to 3 = most of the time. This scale covered various factors such as low self-esteem, competence, anxious/withdrawal, scalability, and self-confidence. The two factors of the self-esteem scale used are low self-esteem and anxious self-esteem. Scores ranged from 0 to 186, with higher scores indicating a higher level of self-esteem. The sample items were feeling inferior, optimistic, hardworking, having high aims, and decision power. The split half reliability of SES was .76 and the test-retest reliability was .97 indicating adequate reliability of the scale (Zafar et al., 2012).  For the current study, the Cronbach alphas of low self-esteem is .82 and anxious self-esteem is .79.

The Interpersonal Difficulty Scale

The Interpersonal Difficulty Scale (IDS; Saleem et al., 2014) is employed to measure interpersonal difficulties in the Pakistani context. It consists of 61 items with the scoring on 5-point Likert scale ranged from 0 = not at all to 4 = always. This scale covers the various factors as dominated by others, low self-confidence, mistrust, lack of assertiveness, lack of boundaries, and unstable relationships. The sample items were obedience, interference with individuals in other’s life having poor convincing power, being unable to trust, and being easily frustrated. An individual could receive a score between 0 and 244, with higher scores reflecting greater interpersonal difficulty. The IDS had a significantly highest test-retest reliability .83 and split-half reliability of .79; whereas for the current study, the Cronbach Alpha of .85 is acquired for the total IDS.

Procedure

First of all, approval from the Research Review Board was taken, and then the authors of the scales that were employed for data collection took permission letters from the supervisor for information collected from different universities (private and government) of Lahore and Gujranwala. After that, the researcher got approval from the authorities of the selected universities, was gained and students were asked to fill out a questionnaire. Before giving the questionnaires to the students, the researcher introduced herself and briefly explained the research purpose to them. Those students who agreed to participate in the research were given a set of questionnaires which included the Reassurance Seeking Behavior Scale, Self Esteem Scale, and Interpersonal Difficulty Scale. It was assured that their information was kept confidential. Participants were asked to mark these items according to the extent they applied. The average time taken by the participant was 40 minutes.

Results    

The total numbers of sample in this study were 300 students from private and government universities of Lahore and Gujranwala were included. Both men and women were the participants.

Table 1
Frequencies and Percentages of Demographic Variables of the Participants (N=300)

Table 1 showed that both men and women were the same in numbers (50%) and students of bachelor included semesters 1, 2, 3, and 4. Mostly the birth order of students was middle (44%), (33%) belonged to the first birth order, and (22%) of the last birth order. Most participants were from nuclear families (67%) and (33%) joint families. Most participant’s fathers did bachelor’s (41%) and their mothers also (28%). Some participants’ fathers had their businesses (49%), and some did their job (48 %). Most mothers were housewives (77%), (12%) were working ladies, and (11%) runs their businesses. The mean age of participants (N = 300) was 20.72 (SD = 1.88) and the average number of siblings was 4.00 (SD = 1.72). 
To reveal the relationship between the reassurance-seeking behavior scale, self-esteem, and interpersonal difficulty, the Pearson Product-Moment Correlation method was used.

Table 2
Inter-Correlations Among Reassurance Seeking Behavior, Self Esteem, and Interpersonal Difficulties (N = 300)

Note. RSB = Reassurance Seeking Behavior; ASE = Anxious Self Esteem; LSE = Low self-esteem; ID = Interpersonal Difficulties.
***p < .001. **p < .01. df = 299.

Table 2 shows the significant positive relationship between reassurance-seeking behavior, anxious self-esteem, low self-esteem, and interpersonal difficulties. The reassurance-seeking behavior positively correlated with low self-esteem, anxious self-esteem, and interpersonal difficulties. Furthermore, low self-self-esteem and anxious self-esteem are also positively correlated with interpersonal difficulties.
As determined by Rockwood and Hayes (2020), self-esteem fully mediates the relationship between reassurance-seeking behavior and interpersonal difficulties.

Table 3
Regression Coefficient, Standard Error, and Model Summary for the Reassurance Seeking Behavior, Low Self Esteem, Anxious Self Esteem, and Interpersonal Difficulties (N=300)

 Indirect effects of reassurance-seeking behavior on interpersonal difficulties through low self-esteem and anxious self-esteem are shown in Table 3.

Table 4
Indirect Effects of Reassurance Seeking Behavior on Interpersonal Difficulties through Low Self-Esteem and Anxious Self-Esteem

Note. RSB =Reassurance Seeking Behavior; LSE = Low Self Esteem; ASE = Anxious Self Esteem; ID = Interpersonal Difficulties.

Indirect effects within the model presented in the current study were also examined over 5000 bootstrap samples by taking estimates at a 95 percent confidence interval. The bias-corrected and accelerated confidence interval (BCa CI) findings are described in Table 4. The total indirect effect of reassurance-seeking behavior on interpersonal difficulties via low self-esteem and anxious self-esteem is statistically significant. In the current tested model, the indirect effects of reassurance-seeking behavior on interpersonal difficulties via low self-esteem and anxious self-esteem are also found to be statistically significant. Therefore, it is concluded that anxious self-esteem and low self-esteem significantly mediated the association between reassurance-seeking behavior and interpersonal difficulties.
The Pearson Product-Moment Correlation found a link between reassurance-seeking behavior, anxious self-esteem, low self-esteem, and interpersonal difficulties. Thus further, the mediating role of anxious self-esteem and low self-esteem within the relationship between reassurance-seeking behavior and interpersonal difficulties was discovered. For this context, Rockwood and Hayes (2020) used a bootstrapping approach to determine whether anxious self-esteem and low self-esteem mediate the relationship between reassurance-seeking behavior and interpersonal difficulties or not. The overall effect of reassurance-seeking behavior on interpersonal difficulties is significant (β = .51, SE = .06, p < .01). Further to that, there are significant direct effects of reassurance-seeking behavior on low self-esteem (β = -.30, SE = .02, p <.001) and anxious self-esteem (β = -.19, SE = .02, p < .05). The direct effect of the first mediating variable low self-esteem on interpersonal difficulties (β = .35, SE = .15, p < .001) was a significant and the direct effect of the second mediating variable anxious self-esteem on interpersonal difficulties (β = .54, SE = .15,
p < .001) was also significant. Low self-esteem and anxiety were found to significantly mediate the relationship between reassurance-seeking behavior and interpersonal difficulties in the current study while the c' model (β = -.29, SE = .06, p = .14) was not.

Discussion

The study investigated the relationship between reassurance-seeking behavior, self-esteem, and interpersonal problems in university students. Many studies were conducted to find out the nature, etiological aspects, and possible treatments for interpersonal difficulties that are affecting many people around the world, particularly our youth (Cha et al., 2017). Reassurance-seeking behavior is thought to be a major risk factor for the development and maintenance of interpersonal difficulties. If a person gets approval from others again and again through this behavior, other people's irritation ultimately leads to interpersonal problems. These interpersonal difficulties caused depressive symptoms (McLaughlin & Nolen-Hoeksema, 2012).
The first hypothesis is supported by the correlation analysis, which is consistent with the literature (De Jong et al., 2016). In addition, a significant positive relationship was discovered between reassurance-seeking behavior and self-esteem. It was also evident in literature that individuals ask others for opinions to test their own beliefs, their job, or results (Hudson et al., 2018). It easily reduces anxiety, leading to immediate relief. The relief does not last and returns needing reassurance (Orr, 2021). In response to increased anxiety, it threatens self-esteem (Forchuk, 2021).  According to the theory, self-monitoring is the foundation of self-esteem as it protects self-control from negative emotions when there is any issue in self-regulation and it permits repeated communication and non-stop self-management at the time of any difficulty. In this way, self-esteem achieved the purpose of self-verification and secures position as it stimulates individuals to embody and sustain their relationship that proves their identity (Hogg, 2021).
Furthermore, a significant positive relationship was discovered between reassurance-seeking behavior and interpersonal difficulties. Interpersonal relation is disturbed by attention-seeking behavior from the partner; this disturbance decreases the value of companionship which creates emotional distress, and depression (Preston, 2020). A positive relationship was found between self-esteem and interpersonal difficulties. Moreover, participants with low self-worth rate high on negative attitudes toward others and personal circumstances (Mackinnon et al., 2019).
The research findings revealed a negative relationship between anxiety, reassurance-seeking, and self-esteem while a positive relationship between anxiety and reassurance seeking behavior was found (Nappa et al., 2021). Pakistan is a patriarchal society, it is believed that women depend on male members in their surroundings and get attention from others to verify the sincerity of their partners (Sheikh & Ahmad, 2015). With time, individuals become older and get experience from every passing moment, learn the skills to maintain relationships, and get the reality of life. Verification and confirmation were common in collectivistic culture and Pakistan collectivistic culture prevailed; individuals were humiliated psychologically and physically due to ERS (Haider et al., 2017). The reassurance-seeking behaviors had many negative consequences like it low self-worth of individuals. 
The results also suggest that low and anxious self-esteem are fully responsible for mediating the relationship between reassurance-seeking behavior and interpersonal difficulties. Interpersonal difficulties are precipitated and retained by the interaction of various types of self-esteem. It is essential to keep in mind that as an outcome of reassurance-seeking behavior the individuals faced interpersonal problems because reassurance-seeking behavior could lead to personal suffering that induces the thought of doubt about the sincerity of other connected individuals, sometimes individuals around such person become fed up and left the person with his isolation (Hudson et al., 2018). Research revealed that excessive investment in interpersonal relationships and negative interpersonal life events predict reassurance seeking (Birgenheir et al., 2009). The problematic behavior is not only confined to childhood, it goes on with their adulthood. One of the problematic behaviors is reassurance-seeking behavior, the person who engaged in reassurance-seeking behavior faced many problems in their life and there is also the comorbidity of reassurance-seeking behavior with a psychological disorder. It also developed low self-worth and this low self-worth ultimately developed interpersonal problems in the future. Parenting may be the factor that directly causes interpersonal problems.
As reassurance seeking behaviors leads to relational issues, it also explains low confidence in young adults. So, the psycho-instructive module on consolation looking for conduct will produce for the clinical reason with the assistance of this examination. The social explicit instrument will help in recognizing the risk factors of encouragement searching for lead and social issues in adults. It would assist in creating understanding in guardians to identify child-rearing practices and improve the confidence in college understudies. Reassurance-seeking behavior will assist the advisor with reducing relational clashes in college understudies as this examination gives proof of factor, which causes interpersonal problems. 

Limitations and Recommendations

This study had some limitations, which should be noted. First of all, because this study was cross-sectional, causal relationships could not be drawn. In the future, researchers may conduct experimental or longitudinal studies to examine the mediation model. Second, the data relied exclusively on self-report measures, multiple assessment methods (e.g., peer reports) may be used to further strengthen the validity of the findings in future studies. Furthermore, data were collected merely from urbanized populations. It is recommended for upcoming studies to get the data from rural populations also and make comparisons between both samples. We also have the limitation that, although self-esteem has been demonstrated as a mediator in our study, other mediators need to be identified and tested in order to further develop the theory regarding reassurance-seeking behavior and interpersonal difficulties.
Despite these limitations, the current study is the first attempt to investigate the relationship between reassurance-seeking behavior, self-esteem (low and anxious self-esteem), and interpersonal difficulties in a sample of students in the Pakistani context. A sample of Pakistani participants provides compelling evidence for the external validity of reassurance-seeking behavior as a predictor of self-esteem and interpersonal difficulties. The study provides important implications for understanding the link between reassurance-seeking behavior, self-esteem (low and anxious self-esteem), and interpersonal difficulties and treating self-esteem issues and interpersonal difficulties. The findings of this mechanism can provide useful suggestions to design intervention and prevention programs. These interventions can have an impact on students’ self-esteem and interpersonal difficulties in their university years and this learning may help them later in their careers as well.

Implications
Reassurance-seeking behavior is a mental construct that originates from the parental raising style. It will lead to relational issues and it is simply one of the explanations for low confidence in adults. It would assist in creating understanding in guardians to identify child-rearing practices and improve the confidence of college understudies. Reassurance-seeking behavior will assist the advisor with reducing relational clashes in university students as this examination gives proof of factor, which causes interpersonal problems. 

Conclusion

In sum, current study findings indicate that excessive seeking is associated with greater increases in interpersonal difficulties following increases in self-esteem in university students. At the same time, according to the integrative model, self–esteem fully mediates this relationship. Interpersonal difficulties are not solicited with a single factor, but it is the interplay of numerous factors. The current study explores the mediational interaction of self-esteem and reassurance-seeking behaviors with interpersonal difficulties.

References

1. Abela, J. R., Morrison, E., & Starrs, C. (2007). Excessive reassurance seeking, self-esteem, and depressive symptoms in children of affectively ill parents: An experience sampling analysis. Journal of Social and Clinical Psychology, 26(7), 849-869. doi.org/10.1521/jscp.2007.26.7.849
2. Anagnostopoulos, V., & Carter, M. M. (2019). Self-report versus informant responses: Exploring the relationship between excessive reassurance seeking and depression. Journal of Social and Clinical Psychology, 38(1), 1-27.
3. Birgenheir, D. G., Pepper, C. M., & Johns, M. (2009). Excessive reassurance seeking as a mediator of sociotropy and negative interpersonal life events. Cognitive Therapy and Research, 34(2), 188-195. doi.org/10.100 7/s10608-009-9242-1
4. Boss, P. (2016). The context and process of theory development: The story of ambiguous loss. Journal of Family Theory & Review, 8(3), 269-286. doi.org/10.1111/jftr.12152
5. Carter, J. C., Kelly, A. C., & Norwood, S. J. (2012). Interpersonal problems in anorexia nervosa: Social inhibition as defining and detrimental. Personality and Individual Differences, 53(3), 169-174. doi.org/10.1016/ j.paid.2012.02.020
6. Cha, C. B., Franz, P. J., M. Guzmán, E., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2017). Annual research review: Suicide among youth: Epidemiology, etiology, and treatment. Journal of Child Psychology and Psychiatry, 59(4), 460-482. doi.org/10.1111/jcpp.12831
7. Chong, C. (2020). Symptoms of low self-esteem and the root causes of it. Lifehack. Retrieved from https://www.lifehack.org/ 5658 16/low-self-esteem
8. Chun, J. S. (2016). Effects of psychological problems, emotional dysregulation, and self-esteem on problematic internet use among Korean adolescents. Children and Youth Services Review, 68(1), 187-192. doi.org/10.1016/j.childyouth.2016.07.005
9. Chung, E., Turnbull, D., & Chur-Hansen, A. (2017). Differences in resilience between ‘traditional’ and ‘non-traditional’ University students. Active Learning in Higher Education, 18(1), 77-87. doi.org/10.1177/14697874 17693493
10. Coyne, J. C. (1976). Depression and the response of others. Journal of Abnormal Psychology, 85(2), 186-193. doi.org/10.1037/0021-843x.85.2 .186
11. Cunningham, M. J., & Diversi, M. (2012). Aging out: Youths’ perspectives on foster care and the transition to independence. Qualitative Social Work, 12(5), 587-602. doi.org/10.1177/1473325012445833
12. De Clercq, L. E., Prinzie, P., Swerts, C., Ortibus, E., & De Pauw, S. S. (2022). Tell me about your child, the relationship with your child and your parental experiences: A qualitative study of spontaneous speech Samples among parents raising a child with and without autism spectrum disorder, cerebral palsy or Down syndrome. Journal of Developmental and Physical Disabilities, 46(1), 22-34.
13. De Jong, B. A., Dirks, K. T., & Gillespie, N. (2016). Trust and team performance: A meta-analysis of main effects, moderators, and covariates. Journal of Applied Psychology, 101(8), 1134-1148.
14. Don, B. P., Girme, Y. U., & Hammond, M. D. (2018). Low self-esteem predicts indirect support seeking and its relationship consequences in intimate relationships. Personality and Social Psychology Bulletin, 45(7), 1028-1041. doi.org/10.1177/014616721 8802837
15. Erozkan, A. (2012). The effect of communication skills and interpersonal problem-solving skills on social self-efficacy. Educational Sciences: Theory and Practice, 13(2), 739-745.
16. Forchuk, C. A., Plouffe, R. A., & Saklofske, D. H. (2021). Do you “like” me? the roles of Facebook reassurance seeking and attachment style on depression. Psychology of Popular Media, 10(2), 223-229. doi.org/10. m1037/ppm0000312
17. Fowler, C., & Gasiorek, J. (2016). Depressive symptoms, excessive reassurance seeking, and relationship maintenance. Journal of Social and Personal Relationships, 34(1), 91-113. doi.org/10.1177/0265407515624 265
18. Girme, Y. U., Molloy, P. R., & Overall, N. C. (2016). Repairing distance and facilitating support. Personality and Social Psychology Bulletin, 42(5), 645-661. doi.org/10.1177/0146167216637846
19. Ha, Y. J. (2006). The relationship among self-esteem, internal locus of control, and psychological well-being, (Unpublished Master Dissertation), Department of Psychology, Yonsei University, South Korea.
20. Hafeez, Q. (2020). Parental rearing styles, reassurance seeking behavior, self-esteem and interpersonal difficulties in university students. (Unpublished master's thesis), University of Management and Technology, Lahore, Pakistan.
21. Haider, S. N. A., Tahir, S. H., & Kiyani, A. A. (2017). The relationship of social distrust with personal suffering: Mediating capacity of excessive reassurance seeking. ASEAN Journal of Psychiatry, 18(1), 76-84.
22. Halldorsson, B. (2015). "Please help me": Excessive reassurance seeking as an interpersonal process in obsessive compulsive disorder and health anxiety, (Unpublished Doctoral dissertation). University of Bath, United Kingdom.
23. Hames, J. L., Chiurliza, B., Podlogar, M. C., Smith, A. R., Selby, E. A., Anestis, M. D., & Joiner, T. E. (2015). Perceived burdensomeness and thwarted belongingness predict excessive reassurance seeking among clinical outpatients. Journal of Clinical Psychology, 71(6), 597-605.
24. Hogg, M. A. (2021). Self-uncertainty and group identification: Consequences for social identity, group behavior, intergroup relations, and society. Advances in Experimental Social Psychology, 263-316. doi.org/10.10 16/bs.aesp.2021.04.004.
25. Horlings, L. G. (2015). The inner dimension of sustainability: Personal and cultural values. Current Opinion in Environmental Sustainability, 14, 163-169. doi.org/10.1016/j.cosust.2015.06.006.
26. Hudson, C. C., Shamblaw, A. L., Wilson, G. A., Roes, M. M., Sabbagh, M. A., & Harkness, K. L. (2018). Theory of mind, excessive reassurance-seeking, and stress generation in depression: A social-cognitive-interpersonal integration. Journal of Social and Clinical Psychology, 37(9), 725-750. doi.org/10.1521/jscp.2018.37 .9.725 .
27. Joiner, T. E. (2000). A test of the hopelessness theory of depression in youth psychiatric inpatients. Journal of Clinical Child
    sychology, 29(2), 167–176. doi.org/10.1207/s15374424jccp2902_3
28. Kiviruusu, O., Berg, N., Huurre, T., Aro, H., Marttunen, M., & Haukkala, A. (2016). Interpersonal conflicts and development of self-esteem from adolescence to mid-adulthood: A 26-year follow-up. PLOS ONE, 11(10). doi.org/10.1371/journal.pone. 0164942
29. Lancy, K. M. (2013). The attachment styles of an adult-child of divorce: The effect of interparental conflict on parent-adult child attachment and adult romantic attachment, (Unpublished Doctoral Dissertation), Department of Psychology, Purdue University, Indiana, USA.
30. Lange, T. M., & Couch, L. L. (2011). An assessment of links between components of empathy and interpersonal problems. PsycEXTRA Dataset. doi.org/10.1037/e741452011-009
31. Luciano, E. C., & Orth, U. (2017). Transitions in romantic relationships and development of self-esteem. Journal of Personality and Social Psychology, 112(2), 307-328. doi.org/10.1037/pspp0000109
32. MacKinnon, N. J. (2015). Psychological centrality and Rosenberg’s interactive hypothesis. Self-Esteem and Beyond, 96-111. doi.org/10.10 57/9781137542304_5
33. Mackinnon, S. P., Ray, C. M., Firth, S. M., & O'Connor, R. M. (2019). Perfectionism, negative motives for drinking, and alcohol-related problems: A 21-day diary study. Journal of Research in Personality, 78(1), 177-188. doi.org/10.1016/j.jrp.2018.12.003
34. Marigold, D. C., Holmes, J. G., & Ross, M. (2010). Fostering relationship resilience: An intervention for low self-esteem individuals. Journal of Experimental Social Psychology, 46(4), 624-630. doi.org/10.1016/j.jesp. 2010.02.011
35. Matin, M. A., & Khan, M. A. W. (2017). Common problems faced by postgraduate students during their thesis works in Bangladesh. Bangladesh Journal of Medical Education, 8(1), 22-27. doi.org/10.3329/ bjme.v8i1.32245
36. McLaughlin, K. A., & Nolen-Hoeksema, S. (2012). Interpersonal stress generation as a mechanism linking rumination to internalizing symptoms in early adolescents. Journal of Clinical Child & Adolescent Psychology, 41(5), 584-597.
37. Nappa, M. R., Bartolo, M. G., Pistella, J., Petrocchi, N., Costabile, A., & Baiocco, R. (2021). “I do not like being me”: The impact of self-hate on increased risky sexual behavior in sexual minority people. Sexuality Research and Social Policy, 18(4), 1060-1077.
38. New, K., & Ghafar, M. N. (2016). The social Change experiences of college students at an institution of higher learning. Higher Education Studies, 1(2), 14-28.
39. Ooi, J., Michael, J., Lemola, S., Butterfill, S., Siew, C. S., & Walasek, L. (2020). Interpersonal functioning in borderline personality disorder traits: A social media perspective. Scientific Reports, 10(1), 1-8.
40. Orr, E.(2021). Reassurance-seeking behaviour, intolerance of uncertainty, and neurocognitive functioning in obsessive-compulsive disorder.doi.org/10.32920/ryerson.14665695.v1
41. Orth, U. (2017). The lifespan development of self-esteem. Personality Development Across the Lifespan, 181-195. doi.org/10.1016/b978-0-12-804674-6.00012-0
42. Peterson, J. L., DeHart, T., Bellows, A., Giguere, B., & Sherman, J. (2019). Partner self-esteem and interpersonal risk: Rejection from a low self-esteem partner constrains connection and increases depletion. Journal of Experimental Social Psychology, 80, 17-30. doi.org/10.1016/j.jesp.2018. 09.006
43. Pietrabissa, G., & Simpson, S. G. (2020). Psychological consequences of social isolation during COVID-19 outbreak. Frontiers in Psychology, 11, 2201.
44. Preston, M. (2020). The depressive symptom contagion between romantic partners explained by anxious attachment. K-State Electronic Thesis. Advanced Online Publication. https://krex.k-state.edu/dspace/handle/ 2097/40359
45. Reis, H. T., Lemay, E. P., & Finkenauer, C. (2017). Toward understanding: The importance of feeling understood in relationships. Social and Personality Psychology Compass, 11(3), 412-428.
46. Rockwood, N. J., & Hayes, A. F. (2020). Mediation, moderation, and conditional process analysis. The Cambridge Handbook of Research Methods in Clinical Psychology, 396-414. doi.org/10.1521/jscp.2015. 34.5.392
47. Rodgers, L. S., & Tennison, L. R. (2009). A preliminary assessment of adjustment disorder among first-year college students. Archives of Psychiatric Nursing, 23(3), 220-230. doi.org/10.1016/j.apnu.2008.0 5.007
48. Saleem, S., & Mahmood, Z. (2013). Mental health problems in university Students: A prevalence study. Retrieved from Research Gate. https://www.research gate.net/publication/310596848_Mental_Health_Problems_in_University_Students_A_pevalence_study
49. Saleem, S., Ihsan, Z., & Mahmood, Z. (2014). Interpersonal difficulties scale. PsycTESTS Dataset. doi.org/10.1037/t54691-000
50. Salkovskis, P. M., & Kobori, O. (2015). Reassuringly calm? Self-reported patterns of responses to reassurance seeking in obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 49(1), 203-208. doi.org/10.1016/j.jbtep.2015.09.002
51. Schraml, K., Perski, A., Grossi, G., & Simonsson-Sarnecki, M. (2011). Stress symptoms among adolescents: The role of subjective psychosocial conditions, lifestyle, and self-esteem. Journal of Adolescence, 34(5), 987-996. doi.org/10.1016/j.adolescence.2010. 11.010
52. Sheikh, A. A., & Ahmad, N. (2015). Femininities in the discourse of Khawateen digest Of Pakistan. Pakistan Journal of Gender Studies, 11(1), 23-36.
53. Shimizu, H., Nakashima, K., & Morinaga, Y. (2018). The role of individual factors in friendship formation: Considering shyness, self-esteem, social skills, and defensive pessimism. Japanese Psychological Research, 61(1), 47-56.
54. Stavropoulos, V., Lazaratou, H., Marini, E., & Dikeos, D. (2015). Low family satisfaction and depression in adolescence: The role of self-esteem. Journal of Educational and Developmental Psychology, 5(2), 310-325.
55. Stewart, J. G., & Harkness, K. L. (2015). The interpersonal toxicity of excessive reassurance-seeking: Evidence from a longitudinal study of romantic relationships. Journal of Social and Clinical Psychology, 34(5), 392-410. doi.org/10.1521/jscp.2015. 34.5.392
56. Taylor, D. L., Kraines, M. A., Grant, D. M. M., & Wells, T. T. (2019). The role of excessive reassurance seeking: An eye tracking study of the indirect effect of social anxiety symptoms on attention bias. Psychiatry Research, 274, 220-227.
57. Velotti, P., Garofalo, C., Bottazzi, F., & Caretti, V. (2018). Faces of shame: Implications for self-esteem, emotion regulation, aggression, and well-being. Emotions and Their Influence on Our Personal, Interpersonal and Social Experiences, 87-100. doi.org/10.4324/9781315100319-8
58. Wakeling, S., Stukas, A. A., Wright, B. J., & Evans, L. (2020). Negative feedback seeking and excessive reassurance seeking behavior and depression: A meta-analytic review. Journal of Social and Clinical Psychology, 39(9), 788-823. https://doi.org/10.1521/jscp.2020.39.9.788
59. Yanhong, L., Zhenrong, S., & Yiping, Z. (2021). Self-esteem and interpersonal difficulties of college students: Influences of self-control and self-concept. Journal of Psychology in Africa, 31(6), 615-621. https://doi.org/10.1080/14330237.2021.2001950
60. Zafar, N., Saleem, S., & Mahmood, Z. (2012). The development of a Self-esteem Scale for University Students. FWU Journal of Social Sciences, 6(1), 26-30.
61. Zahra, S. T., Saleem, S., Subhan, S., & Mahmood, Z. (2020). Interpersonal skills scale: Development and validation in urbanized sample of adolescents. Social Development, 30(1), 23-37. doi.org/10.1111/sode.12475

Received 16 August 2021
Revision received 3 February 2022