Pathways to help-seeking in bulimia nervosa and binge eating problems: a concept mapping approach

The efficacy of internet-based cognitive behavioral therapy for adult binge spectrum eating disorders: A meta-analysis

OBJECTIVE

Internet-Based Cognitive Behavioral Therapy (iCBT) is an innovative modality of cognitive-behavioral intervention that presents a promising therapeutic strategy for individuals diagnosed with binge spectrum eating disorders. This study employed a meta-analysis methodology to assess the clinical effectiveness and acceptability of iCBT.

METHODS

We conducted searches in databases such as PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO, collecting literature that met the inclusion criteria until August 5, 2023.

RESULTS

A comprehensive analysis was conducted, encompassing a total of 11 randomized controlled studies that satisfied the predetermined criteria for inclusion. The summary results demonstrated that iCBT could significantly improve the pathological features related to eating in patients with binge spectrum eating disorders and also significantly reduce the frequency of binge episodes. Additionally, iCBT could ameliorate the depressive and anxious emotions of patients with binge spectrum eating disorders and boost their self-esteem. Furthermore, a notable disparity in dropout rates was seen in comparison to the control group.

LIMITATION

Heterogeneity across studies，limitations of self-assessment scales and potential publication bias.

CONCLUSION

iCBT can effectively assist patients with binge spectrum eating disorders in improving clinical symptoms. However, it is important to use caution when interpreting the findings of this study, as there are limitations pertaining to the quantity and quality of the included studies.

Does hopelessness predict treatment outcomes in adults with binge-spectrum eating disorders?

Using data from 165 adult participants who enrolled in four studies of cognitive-behavioral therapy (CBT) for binge-spectrum eating disorders (EDs), this secondary analysis examined 1) whether pretreatment hopelessness predicted posttreatment eating pathology, loss-of-control (LOC) eating frequency, and purging frequency; 2) whether treatment had an indirect effect on those outcomes through change in hopelessness; and 3) whether treatment had an indirect effect on hopelessness through those ED measures. The Eating Disorder Examination was used to assess overall eating pathology, LOC frequency, and purging frequency. Hopelessness was measured with one item from the Beck Depression Inventory-II. Regression models showed that pretreatment hopelessness predicted posttreatment LOC eating frequency but not overall eating pathology or purging frequency. Single-group tests of indirect effects showed no effect of reduction in hopelessness on reduction in ED symptoms, but there was an effect of reduction in ED symptoms on reduction in hopelessness.

The United Kingdom Eating Disorders Genetics Initiative

OBJECTIVE

The United Kingdom Eating Disorders Genetics Initiative (EDGI UK), part of the National Institute for Health and Care Research (NIHR) Mental Health BioResource, aims to deepen our understanding of the environmental and genetic etiology of eating disorders. EDGI UK launched in February 2020 and is partnered with the UK eating disorders charity, Beat. Multiple EDGI branches exist worldwide. This article serves the dual function of providing an in-depth description of our study protocol and of describing our initial sample including demographics, diagnoses, and physical and psychiatric comorbidities.

METHOD

EDGI UK recruits via media and clinical services. Anyone living in England, at least 16 years old, with a lifetime probable or clinical eating disorder is eligible to sign up online: edgiuk.org. Participants complete online questionnaires, donate a saliva sample for genetic analysis, and consent to medical record linkage and recontact for future studies.

RESULTS

As of September 2022, EDGI UK recruited 7435 survey participants: 98% female, 93.1% white, 97.8% cisgender, 65.9% heterosexual, and 52.1% have a university degree. Over half (57.8%) of these participants have returned their saliva DNA kit. The most common diagnoses are anorexia nervosa (48.3%), purging disorder (37.8%), bulimia nervosa (37.5%), binge-eating disorder (15.8%), and atypical anorexia nervosa (7.8%).

CONCLUSION

EDGI UK is the largest UK eating disorders study and efforts to increase its diversity are underway. It offers a unique opportunity to accelerate eating disorder research. Researchers and participants with lived experience can collaborate on projects with unparalleled sample size.

PUBLIC SIGNIFICANCE STATEMENT

Eating disorders are debilitating and costly for society but are under-researched due to underfunding. EDGI UK is one of the largest eating disorder studies worldwide with ongoing recruitment. The collected data constitute a resource for secondary analysis. We will combine data from all international EDGI branches and the NIHR BioResource to facilitate research that improves our understanding of eating disorders and their comorbidities.

The mobilisation of professional identity: A scoping and lexical review

Interprofessional care obliges different healthcare professions to share decision-making and sometimes, practices. Given established hierarchies, it can be difficult to promote interprofessional care, partly because of the need to reshape professional identities. Despite interest in effective interprofessional care, there is limited research on how professional identity can be mobilised to promote it. A scoping review as well as lexical review of academic publications was conducted to address this void. After searching seven academic databases and screening the identified publications, 22 publications met the inclusion criteria. They collectively reported on 22 interventions, most of which were used in healthcare. The scoping review suggested there is some evidence that professional identities can be mobilised. Yet, of the 22 interventions, only ten explicitly targeted professional identity. The most common intervention was a training or development program, followed by workplace redesign. The need for internal motivation to mobilise professional identity was reported as was the impact of external drivers, like extending the scope of practice. Extending these findings, the lexical review demonstrated that, among the 22 publications, the relationship between professional identity and mobilisation did not feature prominently within the discourse. Furthermore, it seems that geography matters-that is, while all the publications spoke of professional identity, they differed by region on how they did this. Given these findings, concentrated scholarship is needed on the relationship between professional identity and interprofessional care, lest interprofessional care programs have limited, sustained effect. Implications for scholars and practitioners are explicated.

Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives

OBJECTIVE

A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals.

METHOD

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies.

RESULTS

A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking.

DISCUSSION

Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.

Towards an understanding of help-seeking behaviour for disordered eating: Refinement of a barriers to help-seeking measure

AIM

Early intervention in eating disorders (EDs) is hampered by a lack of validated measures of barriers to treatment seeking. The present study examined the factor structure of the Perceived Barriers to Psychological Treatment scale (PBPT) and a combination of PBPT and Barriers to Seeking Help for ED items (BATSH-ED) with respect to treatment-seeking for an ED.

METHOD

Participants were 456 female university students aged 17-25 reporting a wide range of disordered eating severity. Confirmatory factor analyses were conducted with the whole sample followed by correlational and regression analyses with a high-risk sample to assess validity of the selected questionnaire items.

RESULTS

Four models were tested. First, we replicated the original PBPT 8-factor structure in our sample with comparable fit indices. Second, the addition of six ED items comprising a Denial and Ambivalence subscale improved model fit. Third and fourth, when only significant subscales predicting treatment seeking were retained, with removal of items with weak loadings, a 15-item six-factor solution provided a best fit. A range of psychosocial measures had relationships in the expected directions with the questionnaire subscales. In addition to disordered eating, the denial subscale was uniquely associated with treatment seeking.

CONCLUSIONS

While the present study contributes to refining the assessment of barriers to help-seeking, future studies should consider co-design with lived experience to further improve the model fit of the questionnaire and improve predictiveness of help-seeking.

The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review

Background

Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males' misuse of insulin for weight and/or shape control.

Methods

A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021.

Results

A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies).

Conclusion

Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01151-8.

Cues Disseminated by Professional Associations That Represent 5 Health Care Professions Across 5 Nations: Lexical Analysis of Tweets

BACKGROUND

Collaboration across health care professions is critical in efficiently and effectively managing complex and chronic health conditions, yet interprofessional care does not happen automatically. Professional associations have a key role in setting a profession's agenda, maintaining professional identity, and establishing priorities. The associations' external communication is commonly undertaken through social media platforms, such as Twitter. Despite the valuable insights potentially available into professional associations through such communication, to date, their messaging has not been examined.

OBJECTIVE

This study aimed to identify the cues disseminated by professional associations that represent 5 health care professions spanning 5 nations.

METHODS

Using a back-iterative application programming interface methodology, public tweets were sourced from professional associations that represent 5 health care professions that have key roles in community-based health care: general practice, nursing, pharmacy, physiotherapy, and social work. Furthermore, the professional associations spanned Australia, Canada, New Zealand, the United Kingdom, and the United States. A lexical analysis was conducted of the tweets using Leximancer (Leximancer Pty Ltd) to clarify relationships within the discourse.

RESULTS

After completing a lexical analysis of 50,638 tweets, 7 key findings were identified. First, the discourse was largely devoid of references to interprofessional care. Second, there was no explicit discourse pertaining to physiotherapists. Third, although all the professions represented in this study support patients, discourse pertaining to general practitioners was most likely to be connected with that pertaining to patients. Fourth, tweets pertaining to pharmacists were most likely to be connected with discourse pertaining to latest and research. Fifth, tweets about social workers were unlikely to be connected with discourse pertaining to health or care. Sixth, notwithstanding a few exceptions, the findings across the different nations were generally similar, suggesting their generality. Seventh and last, tweets pertaining to physiotherapists were most likely to refer to discourse pertaining to profession.

CONCLUSIONS

The findings indicate that health care professional associations do not use Twitter to disseminate cues that reinforce the importance of interprofessional care. Instead, they largely use this platform to emphasize what they individually deem to be important and advance the interests of their respective professions. Therefore, there is considerable opportunity for professional associations to assert how the profession they represent complements other health care professions and how the professionals they represent can enact interprofessional care for the benefit of patients and carers.

An Assessment of Austrian School Students' Mental Health and Their Wish for Support: A Mixed Methods Approach

The mental health of school students has been severely impacted by the aftermath of the COVID-19 pandemic. The present study used a mixed methods approach to assess students' mental health and examine their wishes for support to improve their psychological well-being. We further investigated gender and age group differences in the amount of clinically relevant mental health problems and the roles that mental health and gender had on desired support. Between April and May 2022, a total of 616 Austrian students aged between 14 and 20 participated in a cross-sectional online survey (77.4% female; 19.8% male; 2.8% non-binary) assessing wishes for support regarding mental well-being and mental health indicators (depression: PHQ-9; anxiety: GAD-7; insomnia: ISI; stress: PSS-10; eating disorders: SCOFF; alcohol abuse: CAGE). A wish for support was expressed by 46.6% of the students. Qualitative content analysis revealed that the two most important categories of desired support types were "professional help" and "someone to talk to". The group of students with a wish for support in general significantly more often showed clinically relevant depression, anxiety, insomnia, eating disorders, or high stress symptoms. Students that wished for professional help significantly more often exceeded the cut-off for clinically relevant depression, anxiety, and high stress. Those who wished for someone to talk to significantly more often exceeded the cut-off for clinically relevant eating disorders. The results indicate a great need for support for young people's mental health problems and that this need is even more urgent for students.

Pathways to improve early intervention for eating disorders: Findings from a systematic review and meta-analysis

OBJECTIVE

Treatment-seeking rates among eating disorder (ED) populations are relatively low, with only one in four individuals seeking help. Previous research has identified many factors that might be associated with help-seeking in EDs, but to date no review has investigated the quantitative association between these factors and actual help-seeking behavior. The aim of the current review was to synthesize the relevant quantitative literature on factors (i.e., perceived barriers, characteristics associated with treatment seeking, demographic variables) associated with help-seeking using meta-analytic strategies, as well as provide recommendations on future early intervention research strategies to promote early help-seeking.

METHOD

Overall, 19 studies were included, identifying 141 perceived barriers (e.g., stigma) or individual characteristics (e.g., BMI, duration of illness) and 56 demographic variables (e.g., ethnicity), which were synthesized into 24 unique variables.

RESULTS

Less help-seeking was predicted by higher levels of denial and less perceived ability of others to provide help.

DISCUSSION

Given the small number of studies these results should be considered preliminary. Future studies should consider barriers to help-seeking when creating early intervention approaches. To improve help-seeking rates we suggest the use of targeted psychoeducational materials and co-design with people with lived experience when developing new strategies.

PUBLIC SIGNIFICANCE

The present study addresses a significant gap in the literature by synthesizing factors associated with help-seeking, with the aim of informing early intervention strategies to promote early help-seeking in eating disorder populations. Denial of illness and perceived inability of others to provide help were associated with lower help-seeking. Future studies should consider barriers to help-seeking and co-design with people with lived experience when creating new early intervention strategies.

Training Conditions and Psychological Health: Eating Behavior Disorders in Spanish High-Performance Women's Olympic Wrestling Athletes-A Qualitative Study

(1) Background: the aim of this study was to determine the factors that affect the occurrence of behaviors related to possible eating disorders in Spanish high-performance Olympic wrestling athletes. (2) Methods: The sample consisted of 22 elite female wrestlers selected through purposive sampling with inclusion criteria of (i) having been a national champion, (ii) having been part of the Spanish team, and (iii) suffering or having suffered from an eating disorder. The semistructured interviews were conducted online and lasted between 20 and 40 min. A statistical analysis was performed with NVivo10 software. (3) Results: the athletes showed a series of issues grouped into three main themes, which were divided into the following categories-firstly, the reasons why wrestlers lose weight; secondly, the inadequate procedures they use; and, finally, the reference persons involved in the process. (4) Conclusions: The training conditions in high-performance sports have psychological and behavioral effects on wrestlers. Wrestlers have to move down to lower categories; however, they do not take into account how this practice influences their health when using inadequate procedures. Rapid and significant weight loss produces negative effects, especially in the female population, generating an incidence of eating disorders. The information obtained provided elements of interest for reflection on possible solutions to prevent existing eating disorders.

Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches

BACKGROUND

App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials.

OBJECTIVE

To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding.

METHODS

In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified.

RESULTS

Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery.

CONCLUSIONS

Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.

The Impact Factors of Industry 4.0 on ESG in the Energy Sector

Digital transformation refers to highly thought-out social, manufacturing, and organizational transitions driven by digital revolutions and emerging technologies. On the other hand, energy is a critical pillar of the economic growth of the country. Meanwhile, global interest in environmental, social, and governance (ESG) investment is growing. The conventional investment paradigm is being phased out in favor of investments that prioritize environmental, social, and corporate responsibility. The energy sector is one of the most significantly affected. Presently, the field of digital transformation is limited in its analysis about the sustainability factors and is still controversial, especially in the energy business. This paper identifies an in-corporation factor in Industry 4.0, taking into account the effect on ESG. The research papers and the World Economic Forum reports were investigated and identified the correlation factor using machine learning to analyze their contents. We spotlighted the documents relevant to the energy industry and sustainable development. To quantify the model, confirmatory factor analysis (CFA) is proposed to generate a valid model, followed by path analysis with latent variables to evaluate the structural equation modeling (SEM). The result provides the conceptual model with impact factors and their correlations. The goodness of fit value is acceptable for the agreed-upon condition, as well as a descriptive that incorporates Industry 4.0 and ESG in terms of business, industry, and ESG in relation to the energy sector’s key issues.

Mental health stigma among college students: misperceptions of perceived and personal stigmas

ObjectiveThe purpose of this study was to assess the relationship between college student perceived and personal mental health stigmas. Participants: A sample of 352 undergraduate college students from two large Universities in the Eastern United States was utilized. Methodology: A self-report anonymous online survey was utilized. The survey contained demographics as well as questions to assess participant levels of perceived stigma, personal stigma, and social desirability.ResultsResults revealed that college student perceived stigma was significantly greater than personal stigma, and that perceived stigma and personal stigma were significantly and positively correlated. Conclusions: Overall findings suggest a misperception of campus mental health stigma levels. Based upon these student misperceptions of stigma, best practices for addressing stigma within the clinical setting are discussed. Overall implications for college counseling centers are presented, including campus outreach strategies.

Leadership During a Pandemic: A Lexical Analysis

To manage pandemics, like COVID-19, leadership can enable health services to weather the storm. Yet there is limited clarity on how leadership manifested and was discussed in the literature during COVID-19. This can have considerable public health implications given the importance of leadership in the health sector. This article addresses this missed opportunity by examining the literature on leadership during a pandemic. Following a systematic search of nine academic databases in May 2021, 1,747 publications were screened. Following this, a lexical analysis of the results section was conducted, sourced from a corpus of publications across myriad journals. The results found a prevalence of references to “leader” as a sole actor, risking the perpetuation of a view that critical decisions emanate from a singular source. Moreover, “leadership” was a concept disconnected from the fray of frontline workers, patients, and teams. This suggests a strong need for more diverse vocabularies and conceptions that reflect the “messiness” of leadership as it takes shape in relation to the challenges and uncertainties of COVID-19. There is a considerable opportunity to advance scholarship on leadership via further empirical studies that help to clarify different approaches to lead teams and organizations during a pandemic.

Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating

BACKGROUND

Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting).

OBJECTIVE

The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions.

METHODS

This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented.

RESULTS

The findings showed unique differences in the types of sensor data that were triangulated with the individuals' episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants' awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet.

CONCLUSIONS

This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population.

Understanding treatment delay: Perceived barriers preventing treatment-seeking for eating disorders

OBJECTIVE

Only a small proportion of individuals with an eating disorder will receive targeted treatment for their illness. The aim of this study was to examine the length of delay to treatment-seeking and determine the barriers preventing earlier access and utilisation of eating disorder treatment for each diagnostic group - anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorder.

METHOD

Participants were recruited as part of the TrEAT multi-phase consortium study. One hundred and nineteen Australians (13-60 years; 96.9% female) with eating disorders currently accessing outpatient treatment for their illness completed an online survey comprised of self-report measures of eating disorder severity, treatment delay and perceived barriers to treatment-seeking. The treating clinician for each participant also provided additional information (e.g. body mass index and diagnosis).

RESULTS

Overall, the average length of delay between onset of eating disorder symptoms and treatment-seeking was 5.28 years. Controlling for age, latency to treatment-seeking was significantly longer for individuals with bulimia nervosa and binge eating disorder compared to anorexia nervosa. However, when perceived barriers to treatment-seeking were investigated, there were no significant differences between the diagnostic groups in regard to the perceived barriers they experienced. Stigma was rated as the most impactful barrier for each diagnostic group.

CONCLUSION

Findings suggest that individuals with eating disorders face substantial delays in accessing appropriate treatment and that latency to treatment-seeking is often magnified for counter-stereotypical eating disorder presentations. Further research is required to investigate other factors contributing to this delay.

Early detection of eating disorders: a scoping review

PURPOSE

Early detection of eating disorders (EDs) could improve their prognosis, decrease morbidity and mortality, and prevent the risk of evolution towards a chronic form and somatic, psychiatric and psychosocial complications. The objective of this review was to examine the current scientific data concerning the early detection of EDs, which is one of the facets of secondary prevention.

METHOD

A scoping literature review was carried out following the PRISMA-ScR criteria, including all articles on ED detection published up to 2021 on PUBMED and PSYCINFO.

RESULTS

43 articles were included. Anorexia nervosa and bulimia nervosa were the most widely studied disorders. The articles focused on professionals from the medical field (GPs, psychiatrists, gynaecologists, gastroenterologists and residents), from the paramedical field, from education and sport, and from the general population. The assessments conducted with the professionals receiving interventions aiming to improve detection demonstrated their efficacy. Interventions for ED detection in the general population and at school seemed less efficacious.

CONCLUSION

The results highlighted some lines of action to be implemented. They pointed towards improving initial and continuing education for professional carers; e-learning could be an interesting solution for continuing education. Improving training with specific instructors, school personnel and sports professionals is also one of the solutions for a better detection of EDs. Specific recommendations could be published for fitness centre professionals to help them to deal with clients suspected of having an ED. Among secondary school students and in the general population, a better dissemination of mental health literacy and the development of mental health first aid programs could help improve early detection.

LEVEL OF EVIDENCE

Level I: Evidence obtained from systematic reviews.

Hearing parents' voices: A priority-setting workshop to inform a suite of psychological resources for parents of children with rare genetic epilepsies

Objective

To understand parents' of children with developmental and epileptic encephalopathies needs and preferences for psychological resources.

Methods

Using a person-based approach, a multidisciplinary panel of clinician and researchers (n = 9) hosted a priority-setting workshop to 1) understand parents' needs and preferences for psychological resources and 2) to develop ‘guiding principles’ to inform a future suite of psychological resources. The multidisciplinary panel analysed the parent priority-setting workshop data, using a combination of thematic and lexical analysis.

Results

Thematic analysis identified six key domains wherein parents (n = 8) prioritised a need for psychological resources to support adaptation to their child's genetic DEE diagnosis. Lexical analysis revealed that connection to diagnosis-specific resources provided a pathway to promote enhanced psychological adaptation, by reducing social isolation and reorienting parents towards feelings of hope. Combination of both analyses generated six thematic informed ‘guiding principles’.

Conclusion

Codesigned psychological resources may help parents to cope with the unique and complex interplay of stressors associated with their child's DEE diagnosis and treatment. Our ‘guiding principles’ will be translated to inform a future suite of tailored psychological resources.

Innovation

This study demonstrates an innovative codesign approach to inform tailored psychological resources for families of children with rare genetic conditions.

•

There is a deficit of research exploring the psychological impacts of parenting children with genetic DEEs.

•

Tailored and codesigned psychological resources are essential due to the complexity and uniqueness of genetic DEEs.

•

We collaborated with parents to codesign the content and scope of a future suite of person-based psychological resources.

•

Thematic and lexical analyses combined identified that person-based resources reduced parent isolation and promoted hope.

•

Insights generated from this study will be applied to inform psychological resources tailored for rare disease families.

A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project

Because of the serious consequences of eating disorders on young women’s lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18–25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants’ satisfaction with the interventions, group discussion at the end of the intervention, and with participants’ rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.

Predictors of healthcare use in community women with eating disorder symptoms: a longitudinal study

OBJECTIVES

This study aimed to investigate associations between eating disorder mental health literacy (EDMHL), defense style, eating disorder (ED) symptom severity, psychological distress and mental-health-related quality of life (MHRQoL) and the likelihood of formal and informal healthcare use (HCU) across multiple time points.

METHODS

A community sample of 445 young women with ED symptoms were followed over 7 years. Questionnaires were distributed via email and postal mail across multiple time points; this study includes data from years 2 (baseline in this study), 4 and 9. The inclusion criteria was provision of HCU data at year 2.

RESULTS

ED symptom severity at baseline was significantly associated with greater HCU two and seven years later. Accurate identification of an ED by participants (i.e. EDMHL) at baseline was associated with greater HCU seven years later. Defense style, psychological distress, MHRQoL and other aspects of EDMHL were not significantly associated with HCU over time.

CONCLUSIONS

Individuals with more severe ED symptoms, and with greater EDMHL, may be more likely to seek help over time. However, individuals with EDs may not seek help directly for poorer MHRQoL and higher levels of psychological distress. This reinforces the importance of ED screening, particularly in primary care settings.

Stigmatization and attitudes toward eating disorders: a comparison between native German adolescents, Turkish immigrant adolescents in Germany, and native Turkish adolescents

BACKGROUND AND AIMS

The purpose of this study was to investigate the attitudes toward eating disorders in native German adolescents (Germans), adolescents with Turkish migration background in Germany (Immigrants), and native Turkish adolescents (Turks).

METHOD

A total of 507 adolescents (N = 139 Germans; N = 126 Immigrants; N = 242 Turks) read a vignette describing a 16-year-old female with bulimic symptoms. Participants completed questionnaires on mental health literacy, stigmatization, desirability of eating disorder-related behaviors and acquaintance with bulimic symptoms.

RESULTS

Adolescents living in Germany were more likely to recognize the vignette as an eating disorder than Turks. Immigrants were more similar to Germans in mental health literacy of eating disorders than Turks. However, in terms of stigmatizing attitudes, immigrants blamed more than Germans, Turks being intermediate on this variable. In Turks, higher desirability of eating disorder-related behaviors was associated with an increased acquaintance with bulimic symptoms and decreased evaluations of impairment. Higher mental health literacy was associated with less blame in Germans.

CONCLUSIONS

Migration background was associated with increased mental health literacy of eating disorders but did not result in reduced stigma. Differences in attitudes toward eating disorders indicate the need for differential interventions across the groups.

Psychological and eating disorder symptoms as predictors of starting eating disorder treatment

OBJECTIVE

Little is known about the treatment uptake rate for adults diagnosed with an eating disorder through formal assessment. This study aimed to identify psychological and eating disorder symptoms that predict whether individuals with diagnosed eating disorders start treatment after receiving a diagnostic assessment and recommendation to begin treatment. Identifying barriers to starting treatment can inform interventions to improve the uptake of treatment.

METHOD

After a diagnostic assessment at an eating disorder specialty clinic, 223 adults were recommended to begin treatment and completed self-report measures of psychological functioning, clinical impairment, and eating psychopathology. Patient attendance was assessed to determine rates and predictors of starting treatment within 3 months of the assessment.

RESULTS

Of the 223 patients recommended to begin treatment, approximately two-third started treatment within 3 months of the assessment. Logistic regression identified greater avoidance of eating, greater laxative use frequency, more social eating concerns, and lower weight dissatisfaction as predicting lower likelihood of beginning treatment after assessment. A chi-square test for independence found no significant differences between diagnostic groups on starting treatment.

DISCUSSION

Findings identify eating disorder symptoms that predict treatment enrollment after diagnostic assessment and recommendation to begin treatment. Assessing for these symptoms at the diagnostic assessment stage is recommended to address potential treatment barriers. Future research should identify strategies that increase treatment uptake at this stage of the process.

Shame and binge eating pathology: A systematic review

OBJECTIVE

Shame is broadly implicated in the development and maintenance of eating pathology. However, the relationship between shame and binge eating symptoms specifically is less clear. This review aimed to clarify what types of shame are associated with binge eating symptoms and the antecedents and maintenance factors in these relationships.

METHOD

A systematic search for quantitative and qualitative empirical studies was conducted to identify evidence of the relationship between shame and binge eating symptoms. Altogether, 270 articles were identified and screened for eligibility in the review.

RESULTS

Results of the relevant empirical studies (n = 31) identified several types of shame associated with binge eating pathology: (i) internal shame, (ii) external shame, (iii) body shame and (iv) binge eating-related shame, as well as several mechanisms and pathways through which shame was associated with binge eating symptoms.

DISCUSSION

Drawing from the research findings, this review presents an original, integrated model of the cyclical shame-binge eating relationship. Clinical interventions that might break this cycle are discussed, as well as methodological weaknesses which limit causal inferences and important areas of future research.

Online Test of Risk Self-Detection of Eating Disorders

This study's central aim was to examine the effectiveness of an online test of the Risk Self-Detection of Eating Disorders through the evaluation of (1) its psychometric properties, the significant probability of predicting risk eating behavior and the correct classification of membership to the risk or non-risk group and (2) the ability to measure users' risk self-awareness through a group of statements and explore the expected responses through frequency analysis of the content provided by the users. The non-probability sample was comprised of n = 541 women aged 15 to 25 (M = 18.3; SD = 2.4). The instrument showed good psychometric properties, a structure of three predictive risk factors, and proper effect sizes (R² = 0.67-0.69). Among the most critical findings were high percentages of correct classification (94-97%) and expected responses (61%). The logistic regression analysis showed that the risk of presenting eating disorders was higher if the participants smoked, consumed alcohol, had sexual experiences before the age of 15, and if those sexual experiences were non-consensual. Evidence is presented about the promising results of the online data collection method and its potential benefits.

Leadership and management in midwifery-led continuity of care models: A thematic and lexical analysis of a scoping review

OBJECTIVE

Although midwifery-led continuity of care is associated with superior outcomes for mothers and babies, it is not available to all women. Issues with implementation and sustainability might be addressed by improving how it is led and managed - yet little is known about what constitutes the optimal leadership and management of midwifery-led continuity models.

DESIGN

Following a systematic search of academic databases for relevant publications, 25 publications were identified. These were analysed, thematically to clarify (dis)similar themes, and lexically, to clarify how words within the publications travelled together.

FINDINGS

The publications were replete with three key themes. First, leadership - important yet challenged. Second, management of organisational change; barriers and enhancers. Third, promotors of sustainable models of care. Complementarily, the lexical analysis suggests that references to midwives and leadership among the publications did not typically travel together, as reported in the publications and were distant to one another, although management was inter-connected to both and to change. Leadership and management were not closely coupled with midwives or relationships with women.

KEY CONCLUSIONS

Midwifery leadership matters and can be enacted irrespective of position or seniority. Midwifery-led continuity of care models can be better managed via a multipronged approach. Improved leadership and management can help sustain such care. Although there was a perceived need for midwifery leadership, there did not seem to be an association between leadership and midwives in the lexical analysis. Many publications focused on the style theory of leadership and the transformational style theory.

IMPLICATIONS FOR PRACTICE

Instead of focusing on leaders and the presumption of a leadership scarcity, it might be more beneficial to start focusing within, looking with a new lens on leadership within midwifery at all levels. It might also be constructive for the profession to investigate a more progressive form of leadership, one that is relational and focuses on leadership rather than on the leader.

Fear of Stigma Mediates the Relationship between Internalized Stigma and Treatment-Seeking among Individuals with Substance Use Problems

BACKGROUND

Despite the high prevalence and significant health consequences of substance use disorders, rates of treatment seeking are low. Identifying as an "addict" caries a mainstream connotation that the individual is blameworthy, which contributes to unique stressors and stigma that shape how they are viewed and treated. While substantial literature demonstrates this stigmatizing perspective may serve as a barrier to treatment-seeking, other studies present discrepant findings. The current study seeks to examine the role of fear of stigma and anticipation of being stigmatized in the relationship between internalized stigma and help-seeking for substance use disorders.

OBJECTIVE

We examined substance use-related stigma, fear of stigma, and treatment-seeking behaviors in a national sample of young adults with a history of problematic substance use.

METHODS

Participants (N = 171) completed an online, anonymous survey.

RESULTS

When controlling for enacted stigma and severity of alcohol and other drug use problems, more fear of stigma significantly mediated the relationship between higher internalized stigma and more help-seeking intentions. The sequentially mediated paths between internalized stigma and both help-seeking intentions and previous behaviors through fear of stigma and anticipated stigma were not significant.

CONCLUSIONS

Findings highlight the importance of fear of substance-related stigma as one mechanism by which internalized stigma may motivate individuals to seek treatment for substance use problems.

Normative feedback and intentions to help friends with bulimic symptoms

The current study examined accuracy in estimating campus norms for eating disorder (ED) pathology and the impact of normative feedback on intentions to help friends. Participants: The sample included 130 undergraduate women. Method: Participants estimated prevalence of ED pathology and were randomly assigned to normative feedback or a control condition. Vignettes were presented describing bulimic and sleep disorder symptoms. After presentation of each vignette, participants reported sympathy for and intentions to help friends with similar symptoms. Results: Nine ED pathology estimates were significantly higher than comparison values documented in a larger survey of women attending their university in the previous year. Those who received normative feedback reported lower intentions to help and lower sympathy for a student with bulimic symptoms compared to sleep disorder symptoms. Conclusion: Results raise the possibility that normative feedback could reduce support for friends with bulimic symptoms.

"I'm not a teenager, I'm 22. Why can't I snap out of it?": a qualitative exploration of seeking help for a first-episode eating disorder during emerging adulthood

BACKGROUND

Eating disorders (EDs) typically have their onset during adolescence or the transition to adulthood. Emerging adulthood (~ 18-25 years) is a developmental phase which conceptually overlaps with adolescence but also has unique characteristics (e.g. increased independence). Emerging adults tend to come to ED services later in illness than adolescents, and emerging adulthood's unique characteristics may contribute to such delays.

OBJECTIVE

This study aimed to explore attitudes towards ED symptoms, and their implications for help-seeking, amongst emerging adults receiving ED treatment through FREED, an early intervention care pathway.

METHOD

Participants were 14 emerging adults (mean age 20.9 years; SD = 2.0), all currently receiving specialist treatment for a first-episode, recent-onset (< 3 years) ED. Semi-structured interviews relating to experiences of help-seeking were conducted, and data were analysed thematically.

RESULTS

Symptom egosyntonicity, gradual reappraisal and feelings of exclusion from ED discourse were key attitudinal phases prior to help-seeking, each of which had distinct implications for help-seeking.

CONCLUSIONS

Emerging adults with first-episode EDs show a distinct set of help-seeking-related challenges and opportunities (e.g. help-seeking for others; help-seeking at transitions; self-sufficiency). This research might be used to inform the development and evaluation of interventions which aim to facilitate help-seeking amongst emerging adults with first-episode recent-onset EDs.

Preliminary data on help-seeking intentions and behaviors of individuals completing a widely available online screen for eating disorders in the United States

OBJECTIVE

Scaling an online screen that provides referrals may be key in closing the treatment gap for eating disorders (EDs), but we need to understand respondents' help-seeking intentions and behaviors after receiving screen results. This study reported on these constructs among respondents to the National Eating Disorders Association online screen who screened positive or at high risk for an ED.

METHOD

Respondents completed the screen over 18 months (February 9, 2018-August 28, 2019). Those screening positive or at high risk for an ED (n = 343,072) had the option to provide data on help-seeking intentions (after screen completion) and behaviors (2-month follow-up).

RESULTS

Of eligible respondents, 4.8% (n = 16,396) provided data on help-seeking intentions, with only 33.7% of those reporting they would seek help. Only 7.6% of eligible respondents opted in to the 2-month follow-up, with 10.6% of those completing it (n = 2,765). Overall, 8.9% of respondents to the follow-up reported being in treatment when they took the screen, 15.5% subsequently initiated treatment, and 75.5% did not initiate/were not already in treatment.

DISCUSSION

Preliminary results suggest that among the small minority who provided data, only one-third expressed help-seeking intentions and 16% initiated treatment. Online screening should consider ways to increase respondents' motivation for and follow-through with care.

Perceived need for treatment associated with orthorexia nervosa symptoms

Orthorexia Nervosa is characterised by a pathological fixation on food purity and nutrition, coupled with a severely restricted diet and avoidance of food believed to be unhealthy. Little is known about the risk factors associated with the condition or if the condition should be treated in a similar way to other eating disorders or whether distinct interventions are required. This study aimed to identify (1) putative variables of the need for treatment in those with orthorexia symptomology and (2) assess whether comorbid psychological symptomologies were associated with orthorexia nervosa. An online cross-sectional self-report survey was developed and the data of 130 participants analysed using regression analyses. As predicted, individuals with higher levels of orthorexic symptomology, eating disorder symptomology and those who identified their healthy eating as problematic were significantly more likely to have a perceived need for treatment, however those who self-identified as having a current or past eating disorder were not. Orthorexic symptomatology was significantly correlated with eating disorder symptomatology, obsessive-compulsive symptoms, anxiety, and depression, however in the regression analysis, eating disorder symptomatology was the only significant variable. These findings highlight the need to consider orthorexic symptoms in people with eating disorders and that this inter-relationship and the ego-syntonicity of symptoms may reduce help-seeking.

A survey study of attitudes toward, and preferences for, e-therapy interventions for eating disorder psychopathology

OBJECTIVE

E-therapy shows promise as a solution to the barriers that stand in the way of people receiving eating disorder (ED) treatment. Despite the potential for e-therapy to reduce the well-known treatment gap, little is known about public views and perspectives on this mode of intervention delivery. This study explored attitudes toward, and preferences for, e-therapy among individuals spanning the spectrum of eating pathology.

METHOD

Survey data assessing e-therapy attitudes and preferences were analyzed from 713 participants recruited from the public. Participants were categorized into one of five subgroups based on the type of self-reported ED symptoms and severity/risk level, ranging from high risk to a probable threshold or subthreshold ED.

RESULTS

Attitudes toward e-therapies appeared to be relatively positive; participants largely supported health care insurance coverage of costs for e-therapies, and were optimistic about the wide-ranging benefits of e-therapy. Although three-quarters of participants expressed a preference for face-to-face therapy, a significant percentage of participants (∼50%) reported an intention to use an e-therapy program for current or future eating problems, with intention ratings highest (70%) among those with probable bulimia nervosa (BN). Variables associated with an e-therapy preference were not currently receiving psychotherapy, more positive e-therapy attitudes, and greater stigma associated with professional help-seeking. Variables associated with e-therapy intentions were more positive e-therapy attitudes and a probable BN classification.

CONCLUSIONS

Present findings have important implications for increasing online intervention acceptance, engagement, and help-seeking among those at different stages of illness.

What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology

OBJECTIVES

The aim of this study was to investigate help-seeking attitudes, intentions, and behaviors, and to systematically explore perceived barriers to help-seeking for eating, weight, or shape concerns among young adults. Differences in perceived barriers as a function of type of eating disorder symptomatology were also examined.

METHOD

Data were collected using an online survey among individuals (aged 18-25 years) in Australia. Overall, 291 young adults with varying levels of eating disorder symptoms completed measures of disordered eating, weight or shape concerns, help-seeking barriers, attitudes, intentions, and behaviors. According to their self-reported symptoms, participants were classified into four subgroups (i.e., anorexia nervosa [AN] symptoms, bulimia nervosa [BN] symptoms, binge-eating disorder [BED] symptoms, and other eating disorder symptoms).

RESULTS

Despite the belief that help-seeking is useful, only a minority of participants with elevated symptoms, namely those with AN, BN, and BED symptoms, believed they needed help. Across the sample, the most frequently cited barriers to seeking help for eating disorder symptoms were: concern for others, self-sufficiency, fear of losing control, denial and failure to perceive the severity of the illness, and stigma and shame.

DISCUSSION

The findings highlight the need to educate young adults about the severity of eating disorders and the importance of seeking help, and to increase the awareness of help-seeking barriers among those designing public health interventions as well as clinicians. Our findings suggest that help-seeking barriers may differ depending on the type of eating disorder symptomology.

Eating disorders "mental health literacy": a scoping review

Background: While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear.Aims: A scoping review was conducted to inform the current state of knowledge in this field.Methods: A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings.Results: The number of eligible studies increased from 32 in 1997-2001 to 98 in 2012-2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available.Conclusion: Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL.

Cognitive-Behavioral Therapy in the Digital Age: Presidential Address

Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field's challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.

Healthcare utilisation for eating disorders among patients with depression: a cross-sectional study in Taiwan

OBJECTIVES

Although depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED.

DESIGN

A cross-sectional study.

SETTING

This population-based study used claims data from Taiwan's National Health Insurance Research database between 2001 and 2012.

PARTICIPANTS

The study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED.

OUTCOME MEASURES

We tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups.

RESULTS

Patients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED.

CONCLUSION

Depression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.

How do people with eating disorders experience the stigma associated with their condition? A mixed-methods systematic review

BACKGROUND

Public opinion research shows that eating disorders (EDs) are a major target of stigmatisation. To understand the implications of this stigma, research investigating how stigma is experienced by individuals with EDs is critical.

AIM

This paper aims to collate, evaluate and synthesise the extant empirical research illuminating how people with EDs experience the stigma associated with their condition.

METHOD

A systematic mixed-methods literature search was performed. Articles that met a specified set of inclusion criteria underwent a quality assessment and thematic synthesis.

RESULTS

Twenty-nine articles were included in the review. Studies were mostly qualitative and of reasonable methodological quality. The literature was characterised by five research themes, illuminating (i) the nature and prevalence of stigma experienced, (ii) stigma in families, (iii) stigma in healthcare contexts, (iv) self-stigmatisation and illness concealment, and (v) stigma resistance.

CONCLUSIONS

The reviewed research showed that people with EDs have extensive experience of stigma in diverse settings. They report that stigma has negative implications for their psychological wellbeing and likelihood of help-seeking. However, research also shows that people with EDs actively seek to resist and challenge stigma. The review identifies the outstanding gaps and weaknesses in this literature.

What does it mean to conduct participatory research with Indigenous peoples? A lexical review

BACKGROUND

To better understand and promote public health, participatory research with Indigenous peoples represents recommended practice, worldwide. However, due to the different ways such research is referred to, described, and used, it is unclear what might (and might not) warrant the term when collaborating with Indigenous peoples. As such, this article expands conceptual understandings of participatory research with Indigenous peoples, across timelines and regions.

METHOD

Following a systematic search of 29 academic databases in April 2018, a lexical analysis of the methods sections was conducted, which were sourced from 161 publications across 107 journals.

RESULTS

The active involvement of Indigenous peoples in research that is expressly participatory is limited across all project phases. This might be because the ways in which Indigenous peoples were involved throughout were not reported - however, it might also be because Indigenous peoples were not involved in all project phases. Furthermore, descriptions differ by study location and publication timeframe - notably, studies in the region of the Americas chiefly refer to pandemics, surveyors, and art; and those published in the last two decades have given primacy to artifacts of interest.

CONCLUSIONS

Findings from this corpus of data suggest participatory research with Indigenous peoples is not always described across different project phases; furthermore, it differs according to study location and publication timeframe. This offers considerable opportunity to further this important research area via alternative methodologies that award primacy to Indigenous expertise and agency.

Reach Out and Recover: Intentions to seek treatment in individuals using online support for eating disorders

OBJECTIVE

The aim of this study was to explore characteristics and treatment-seeking intentions of consumers accessing an online resource for eating disorders support, Reach Out and Recover (ROAR). Factors associated with treatment-seeking intent among visitors to ROAR were also examined.

METHOD

Participants were 200 visitors to the website aged 18 to 60 plus. The majority of participants (93.5%) identified as women. Responses to self-report questions assessing treatment-seeking intention, eating disorder symptoms and their impact on health, and attitudes to treatment were collected.

RESULTS

Participants experienced a range of eating disorder symptoms, yet the majority (86.0%) was not receiving treatment. Importantly, of those not in treatment, the majority (82.6%) indicated that they planned to get treatment. In addition, more than half of participants (52.9%) downloaded a report to present to their health practitioner to facilitate communication with a health professional. Intention to seek treatment and download of the report were positively associated with motivation to change, confidence to achieve change, greater frequency of binge eating, and greater recognition of the impact of eating disorder symptoms on relationships and well-being but not with stigma or ambivalence.

DISCUSSION

Study findings indicated that the ROAR website was accessed by individuals for whom it was designed, namely those experiencing eating disorder symptoms who are not receiving treatment. Encouragingly, participants had strong intentions to seek treatment, and the majority downloaded a report that could be used to facilitate the first step toward treatment. Greater focus on enhancing motivation and confidence to change may further promote treatment-seeking.

Weighty decisions: How symptom severity and weight impact perceptions of bulimia nervosa

OBJECTIVE

The current study examined whether variations in patient weight and eating-disorder behavior frequency influenced the recognition of bulimia nervosa (BN) and the perception that it is a serious mental health concern.

METHOD

Participants (N = 320) were randomly assigned to one of six conditions in which they read a vignette describing a young woman with BN. Each vignette was identical except for the variables of interest: weight status (underweight, healthy-weight, and overweight), and symptom frequency (daily or weekly binge-eating episodes and purging).

RESULTS

Participants were more likely to have negative attitudes toward and blame the patient with overweight. Participants were less likely to believe that the patient with overweight was experiencing mental illness and that her problems were too serious to handle on her own. There were no significant differences by symptom frequency.

DISCUSSION

Findings suggest the presence of weight stigma and that overweight might impede the recognition of eating disorders.

Cost-Effectiveness of Internet-Based Cognitive-Behavioral Treatment for Bulimia Nervosa: Results of a Randomized Controlled Trial

OBJECTIVE

To evaluate the cost-effectiveness of Internet-based cognitive-behavioral therapy for bulimia nervosa (CBT-BN) compared to face-to-face delivery of CBT-BN.

METHODS

This study is a planned secondary analysis of data from a randomized clinical trial. Participants were 179 adults (98% female, mean age = 28 years) meeting DSM-IV criteria for bulimia nervosa who were randomized to group face-to-face or group Internet-based CBT-BN for 16 sessions during 20 weeks. The cost-effectiveness analysis was conducted from a third-party payor perspective, and a partial societal perspective analysis was conducted to investigate cost-utility (ie, cost per gain in quality-adjusted life-years) and patient out-of-pocket travel-related costs. Net health care costs were calculated from protocol and nonprotocol health care services using third-party payor cost estimates. The primary outcome measure in the clinical trial was abstinence from binge eating and purging, and the trial start and end dates were 2008 and 2016.

RESULTS

The mean cost per abstinent patient at posttreatment was $7,757 (95% confidence limit [CL], $4,515, $13,361) for face-to-face and $11,870 (95% CL, $6,486, $22,188) for Internet-based CBT-BN, and at 1-year follow-up was $16,777 (95% CL, $10,298, $27,042) for face-to-face and $14,561 (95% CL, $10,165, $21,028) for Internet-based CBT-BN. There were no statistically significant differences between treatment arms in cost-effectiveness or cost-utility at posttreatment or 1-year follow-up. Out-of-pocket patient costs were significantly higher for face-to-face (mean [95% CL] = $178 [$127, $140]) than Internet-based ($50 [$50, $50]) therapy.

CONCLUSIONS

Third-party payor cost-effectiveness of Internet-based CBT-BN is comparable with that of an accepted standard. Internet-based dissemination of CBT-BN may be a viable alternative for patients geographically distant from specialist eating disorder services who have an unmet need for treatment.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00877786​.

Treatment experiences of Latinas with current or past binge eating disorder and/or bulimia nervosa

This study utilized a female sample of 43 Latinas with a history of binge eating disorder and/or bulimia nervosa to investigate disparities in health care that may act as barriers to or correlates of treatment for these women. Results indicated that 65% of our sample sought treatment for their eating disorder. The most commonly utilized treatment providers were psychologist/therapist for individual therapy and nutritionist/dietician, while therapist-led group therapy was rated as the most helpful treatment and treatment by a physician was rated as least helpful. Participants endorsed eating disorder stigma, eating disorder shame, mental health shame, and cost of treatment as the most influential barriers to seeking or receiving treatment. Acculturation to White dominant society was associated with greater perceived treatment helpfulness. Findings from this study can be used to inform treatments for Latinas in order to potentially increase effectiveness, treatment-seeking, and recovery rates.

Researching Eating Disorders and Body Image in Sport: Challenges and Recommendations

The number of studies examining eating disorders and body image in sport has increased, although several major challenges associated with conducting this research must be addressed to continue growth. In this paper, we describe these challenges based on our professional experiences and the academic literature. Mistrust of researchers and the area of study, communication gaps, and factors that affect data quality are among the strong barriers discussed. However, we suggest that these challenges may be addressed by building stronger partnerships between researchers and practitioners and offer critical steps for developing meaningful professional relationships that will help move the field forward.

Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach

Background

Eating Disorders (ED) are mental health disorders that typically effect women of childbearing age and are associated with adverse maternal and infant outcomes. UK healthcare guidance recommends routine enquiry for current and past mental illness in antenatal and postnatal care for all women, and that pregnant women with a known ED are offered enhanced monitoring and support. Midwives and health visitors are ideally placed to identify and support women with ED as they are often the primary point of contact during the antenatal and postnatal periods. However, research on the barriers to identifying ED in the perinatal period is limited. This study aimed to understand the barriers to disclosure and identification of ED in pregnancy and postnatally as perceived by women with past or current ED, and midwives and health visitors working in the UK National Health Service.

Methods

Two studies were undertaken: mixed-measures survey of pregnant and postnatal women with current or past ED; focus groups with student and qualified midwives and health visitors.

Results

Five themes emerged on the barriers to disclosure in pregnancy as perceived by women: stigma, lack of opportunity, preference for self-management, current ED symptomatology and illness awareness. Four themes were identified on the barriers to identification of ED in pregnancy and in the postnatal period as perceived by health professionals: system constraints, recognition of role, personal attitudes, and stigma and taboo.

Conclusions

Several barriers to the identification of ED during and after pregnancy were described, the main factors were stigma and poor professional training. Perinatal mental health is becoming increasingly prioritised within national policy initiatives; however, ED continue to be neglected and increased awareness is needed. Similarly, clinical guidance aimed at responding to the rising prevalence of obesity focus on changing nutrition but not on assessing for the presence of ED behaviours that might be affecting nutrition. Improving education and training for health professionals may contribute to reducing stigma and increase confidence in identifying ED. The barriers identified in this research need to be addressed if recognition and response to women with ED during the perinatal period is to improve.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1745-x) contains supplementary material, which is available to authorized users.