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Mereu A, Fantoni T, Caini S, Monzali F, Roselli E, Taddei S, Lucarelli S, Pisano T. Suicidality in adolescents with onset of anorexia nervosa. Eat Weight Disord 2022; 27:2447-2457. [PMID: 35277848 DOI: 10.1007/s40519-022-01384-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The mortality rate in patients with anorexia nervosa (AN) is 5 to 10 times higher than in general population and, suicide is one of the main causes of death. We evaluated the prevalence of suicidality (ideation, self-injurious behaviour, suicidal attempts) in 100 adolescents with onset of AN and we explored the correlation between suicidality, severity of AN symptoms and psychiatric comorbidity. METHODS We subdivided AN patients into restrictive (R-AN; n = 66) and restrictive atypical (A-AN; n = 34), according to the European Guidelines criteria. Assessment was performed using the eating disorder inventory 3rd version, the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version interview, and the Columbia-suicide severity rating scale. Fisher's exact test and Mann-Whitney test (with correction for multiple testing) were used to compare the distribution of categorical and continuous variables between R-AN and A-AN patients, and between patients with vs. without suicidal behaviours. RESULTS Twenty-seven patients (27%) presented suicidality as clinical feature, expressed as at least one of the following: suicidal ideation (24%), self-cutting (19%), and suicidal attempt (6%). Patients with suicidality showed greater severity of psychiatric symptoms related to AN psychopathology and presented psychiatric comorbidity, especially depression, more often than patients who did not reported suicidality (70,4% vs 29,6%). No significant differences in terms of suicidal behaviours and AN-specific psychopathology were found between R-AN and A-AN. CONCLUSIONS Suicidality in adolescent patients with R-AN and A-AN seems to be related to ED symptoms. These data highlight the importance of screening for suicidality among adolescents at onset of AN, and confirms that A-AN should not be considered a milder disease. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).
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Affiliation(s)
- Alberta Mereu
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Teresa Fantoni
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Francesca Monzali
- Dietetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Elena Roselli
- Dietetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Silvia Taddei
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | | | - Tiziana Pisano
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
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Validating the Danish version of the Eating Disorder Quality of Life Scale (EDQLS) in anorexia nervosa. Eat Weight Disord 2022; 27:1717-1728. [PMID: 34978053 DOI: 10.1007/s40519-021-01310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/20/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of this study was to explore the factor structure of the Danish translation of the eating disorder quality of life scale and evaluate the internal reliability and convergent validity of the scale in a Danish cohort of women with AN. METHODS The total sample comprised 211 patients diagnosed with anorexia nervosa age 13-40 years. Patients completed questionnaires assessing eating disorder psychopathology, physical and social functioning, and well-being. RESULTS Factor analyses were not able to support the current division of the scale into 12 factors. We found excellent internal consistency of the eating disorder quality-of-life scale total score. We found relevant associations between quality of life and pre-determined variables. CONCLUSION This study supports the use of the total score of the eating disorder quality of life scale in assessing quality of life in patients with anorexia nervosa. However, future studies should explore the factor structure of the scale further. LEVEL OF EVIDENCE III: Evidence obtained from cohort or case-control analytic studies.
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Kjeldbjerg ML, Clausen L, Højgaard DRMA. Factor analysis of the eating disorder examination in a sample of female adolescents and adults with eating disorders. Int J Eat Disord 2021; 54:879-886. [PMID: 33491797 DOI: 10.1002/eat.23475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Studies of the construct validity of the Eating Disorder Examination (EDE) show mixed results and none have included samples of adults with a sole diagnosis of either anorexia nervosa or bulimia nervosa. Thus, we examine the EDE's construct validity in a Danish clinical sample of adolescents and adults with eating disorders. METHOD Confirmatory factor analyses of the four-factor model indicated by the original four subscales and subsequent ad hoc exploratory factor analyses were performed in a sample of patients with eating disorders (N = 1,586) divided into five subsamples based on age and diagnosis: (a) adolescents with anorexia nervosa, (b) women with anorexia nervosa, (c) women with bulimia nervosa, and women with atypical versions of (d) anorexia nervosa, and (e) bulimia nervosa. RESULTS The four-factor model was not confirmed in these five subsamples. Subsequent exploratory factor analyses did not reveal a single model fit for all five groups. Rather, eating-disorder symptoms can be understood through a one-, two-, or three-factor model depending on the subsample. DISCUSSION The four-factor model indicated by the original EDE subscales cannot be supported. The four subscales should be used with great care, if used at all, in trying to understand specific symptoms of eating disorders.
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Affiliation(s)
- Marie L Kjeldbjerg
- Department of Child and Adolescent Psychiatry, Research, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
| | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Research, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - David R M A Højgaard
- Department of Child and Adolescent Psychiatry, Research, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
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Winkler LAD, Gudex C, Lichtenstein MB, Røder ME, Adair CE, Sjögren JM, Støving RK. Explanatory Factors for Disease-Specific Health-Related Quality of Life in Women with Anorexia Nervosa. J Clin Med 2021; 10:1592. [PMID: 33918786 PMCID: PMC8069859 DOI: 10.3390/jcm10081592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/05/2022] Open
Abstract
A better understanding of explanatory factors for disease-specific health-related quality of life (HRQoL) in anorexia nervosa (AN) could help direct treatment providers to aspects of the most relevance for patient wellbeing and recovery. We aimed to investigate whether factors associated with HRQoL are the same for women with AN and normal-weight controls. The participants in this study were women with AN recruited from specialized eating disorder centers in Denmark and healthy, normal-weight controls invited via online social media. Participants completed online questionnaires on medical history, disease-specific HRQoL (Eating Disorders Quality of Life Scale, EDQLS) and generic HRQoL (SF-36), eating disorder symptomatology, depression, psychological wellbeing, and work and social adjustment. Questionnaires were fully completed by 211 women with AN (median age 21.7 years) and 199 controls (median age 23.9 years). Women with AN had poorer scores on all measures, i.e., worse HRQoL, psychological health, and work/social functioning. Eating disorder symptomatology affected EDQLS score in both groups, but poorer HRQoL in women with AN was also significantly associated with worse scores on bulimia, maturity fears, depression, vitality, and with older age. The factors investigated together explained 79% of the variance in EDQLS score. Management of disordered self-assessment and thought processes may be of particular importance to women with AN. Greater emphasis on these aspects alongside weight gain could enhance patient-clinician alliance and contribute to better treatment outcomes.
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Affiliation(s)
- Laura Al-Dakhiel Winkler
- Center for Eating Disorders, Research Unit for Medical Endocrinology, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, DK-5000 Odense, Denmark; (L.A.-D.W.); (R.K.S.)
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Region of Southern Denmark, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark;
| | - Michael Ejnar Røder
- Steno Diabetes Center Odense, Odense University Hospital, DK-5000 Odense, Denmark;
| | - Carol E. Adair
- Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Jan Magnus Sjögren
- Center for Eating Disorders, Ballerup Psychiatric Center, DK-2750 Ballerup, Denmark;
- Institute for Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - René Klinkby Støving
- Center for Eating Disorders, Research Unit for Medical Endocrinology, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, DK-5000 Odense, Denmark; (L.A.-D.W.); (R.K.S.)
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Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers. Eur Child Adolesc Psychiatry 2021; 30:1081-1094. [PMID: 32666204 PMCID: PMC8295075 DOI: 10.1007/s00787-020-01595-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m2), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9-18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.
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Maria Monteleone A, Mereu A, Cascino G, Ruzzi V, Castiglioni MC, Patriciello G, Criscuolo M, Pellegrino F, Vicari S, Zanna V. The validity of the fifth and the 10th Body Mass Index percentile as weight cut-offs for anorexia nervosa in adolescence: No evidence from quantitative and network investigation of psychopathology. EUROPEAN EATING DISORDERS REVIEW 2020; 29:232-244. [PMID: 33314419 DOI: 10.1002/erv.2814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although the fifth Body Mass Index (BMI) percentile is the Diagnostic and Statistic Manual of Mental Disorders -5 weight cut-off criterion to diagnose anorexia nervosa (AN) in children and adolescents, its validity has not been proved, and the 10th percentile value is often applied. We aimed to investigate the diagnostic validity of these weight cut-offs. METHOD We compared general and eating-disorder (ED) specific psychopathology in 380 adolescents with AN or atypical AN. They were grouped first with respect to the fifth BMI percentile and then with respect to the 10th BMI percentile and differences between groups were analysed. Network analyses on psychopathological symptoms were also conducted. RESULTS Adolescents with BMI above the fifth and the 10th percentile reported more severe ED specific symptomatology compared to those with BMI below these cut-offs. No significant differences emerged between groups neither in general psychopathology nor in the network structure of psychopathology. CONCLUSIONS The fifth BMI percentile does not discriminate psychopathology severity in adolescents with AN. From the psychopathology perspective, our findings suggest that adolescents with atypical AN deserve the same clinical and research attention as those with full AN. Future studies are needed to identify a more accurate definition of underweight in adolescents.
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Affiliation(s)
| | - Alberta Mereu
- Child and Adolescent Psychiatry, Center of Excellence in Neuroscience, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Maria Chiara Castiglioni
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | | | - Michela Criscuolo
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Stefano Vicari
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Valeria Zanna
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
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Nagamitsu S, Fukai Y, Uchida S, Matsuoka M, Iguchi T, Okada A, Sakuta R, Inoue T, Otani R, Kitayama S, Koyanagi K, Suzuki Y, Suzuki Y, Sumi Y, Takamiya S, Fujii C, Tsurumaru Y, Ishii R, Kakuma T, Yamashita Y. Validation of a childhood eating disorder outcome scale. Biopsychosoc Med 2019; 13:21. [PMID: 31528200 PMCID: PMC6737718 DOI: 10.1186/s13030-019-0162-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
We developed and validated a childhood eating disorder outcome scale based on outcomes associated with body mass index standard deviation score (BMI-SDS). This prospective observational study included 131 children with eating disorders (aged 5-15 years). Participants' outcomes scales were completed at the first visit and at 1, 3, 6, and 12 months. The scale evaluated 12 outcomes: body weight change (BW), eating attitude (EA), fear of being fat (FF), body image distortion (BD), menstruation (ME), perceived physical condition (PC), attending school (AS), disease recognition by school (RS), family function (FA), disease recognition by parent (RP), social adaptation (SA), and relationships with friends (RF). Responses to all items were on a four-point Likert scale. Exploratory factor analysis was used to determine the number of factors based on the 12 outcomes. The relation between outcome scale scores and BMI-SDS over the 12-month follow-up period was analyzed. Two types of factors were extracted: disease-specific factors (EA, FF, BD) and biopsychosocial factors (BW, PC, AS, FA, SA, RF). Three items (ME, RS, RP) were excluded because they showed no significant loading effect. There was a significant negative correlation between the outcome scale and BMI-SDS, and changes in outcome scale scores from baseline to 12 months were significantly associated with improvement in BMI-SDS. We developed a childhood eating disorder outcome scale characterized by disease-specific and biopsychosocial factors. Biopsychosocial management combined with a therapeutic approach for disease-specific symptoms may support body weight recovery for children with eating disorders.
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Affiliation(s)
- Shinichiro Nagamitsu
- 1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 Japan
| | - Yoshimitsu Fukai
- 2Psychosomatic Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - So Uchida
- 3Department of Pediatrics, Tachikawa Hospital, Tachikawa, Japan
| | - Michiko Matsuoka
- 4Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Toshiyuki Iguchi
- Department of Pediatrics Hoshigaoka Maternity Hospital, Nagoya, Japan
| | - Ayumi Okada
- 6Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoichi Sakuta
- 7Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Takeshi Inoue
- 7Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryoko Otani
- 7Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | - Kenshi Koyanagi
- Nagasaki Prefectural Center of Medicine and Welfare for Children, Nagasaki, Japan
| | - Yuichi Suzuki
- 10Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Suzuki
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Yoshino Sumi
- 12Department of Pediatrics, School of Medicine, Sapporo Medical University, Sapporo, Japan.,Mental and Developmental Clinic for Children "ELM TREE", Sapporo, Japan
| | - Shizuo Takamiya
- 14Psychiatry Department, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.,Takamiya Medical Clinic, Akashi, Japan
| | - Chikako Fujii
- 16Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Yasuko Tsurumaru
- 16Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Ryuta Ishii
- 1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 Japan
| | | | - Yushiro Yamashita
- 1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 Japan
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