Social Science & Medicine 56 (2003) 1737–1747 Self-esteem and women with disabilities Margaret A. Nosek a, *, Rosemary B. Hughes a , Nancy Swedlund a , Heather B. Taylor a , Paul Swank b a Department of Physical Medicine and Rehabilitation, Center for Research on Women with Disabilities, Baylor College of Medicine, 3440 Richmond, Suite B, Houston, TX 77046, USA b School of Nursing, The University of Texas, Houston, TX, USA Abstract This study examines the sense of self of women with physical disabilities in terms of self-esteem, self-cognition (perceptions of how others see them), and social isolation. It was hypothesized that these variables mediate the relation of precursor variables (age, education, severity of disability, and childhood experiences, including overprotection, familial affection, and school environment) and outcomes (intimacy, employment, and health promoting behaviors). Data were gathered from a sample of 881 community-dwelling women in the USA, 475 with a variety of mild to severe physical disabilities, and 406 without disabilities. Correlation analyses indicated that the women with disabilities had significantly lower self-cognition and self-esteem, and greater social isolation than the women without disabilities, as well as significantly less education, more overprotection during childhood, poorer quality of intimate relationships, and lower rates of salaried employment. Path analysis indicated that each of the sense of self mediators was significantly related to the outcome of intimacy, that both social isolation and self-esteem were significantly related to health promoting behaviors, and that only self-esteem was significantly related to employment. Respondents who were older, less disabled, less educated, less over-protected, and had more affection shown in the home tended to feel that others saw them more positively. Women with positive school environments, less over-protection, and more affection in the home experienced less social isolation; age, education, and disability severity were not significantly related to social isolation. Older respondents with less disability, a more positive school environment, less over-protection, and more affection in the home tended to have greater self-esteem; education was not significantly related to self-esteem. Older respondents tended to report less intimacy. Younger, more educated, and less disabled respondents were significantly more likely to be employed. More highly educated respondents reported engaging in more health promoting behaviors. r 2002 Elsevier Science Ltd. All rights reserved. Keywords: Physical disability; Self-esteem; Women; USA Introduction Disability is a stigmatizing phenomenon. Its effects can be profound when combined with women’s social devaluation. Yet, clinical experience shows that many women who acquire disability at birth or later develop and maintain high self-worth. The literature on the self- esteem of people with disabilities fails to explain these differences and the connections between self-esteem and health-related outcomes, particularly as related to gender. The proportion of women with physical disabilities in the United States population is substantial and growing. The 1992 Census reports that 26 million women have disability-related work limitations, comprising 20% of the total population of women (McNeil, 1993). Recent analysis of 1994–1995 Census data shows that 16% of women have at least one limitation in physical functioning (National Center for Health Statistics, 2002). Our study of women with physical disabilities *Corresponding author. Tel.: +1-713-960-0505; fax: +1- 713-961-3555. E-mail address: mnosek@bcm.tmc.edu (M.A. Nosek). 0277-9536/03/$-see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(02)00169-7