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Holtzhausen N, Hay P, Foroughi N, Mannan H. Predictors of healthcare use in community women with eating disorder symptoms: a longitudinal study. Australas Psychiatry 2021; 29:504-507. [PMID: 34263664 DOI: 10.1177/10398562211009264] [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] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Nicol Holtzhausen
- School of Medicine, Western Sydney University, Penrith South, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, NSW, Australia
| | - Nasim Foroughi
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South DC, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South DC, NSW, Australia
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Aouad P, Hay P, Foroughi N, Cosh SM, Mannan H. Associations Between Defence-Style, Eating Disorder Symptoms, and Quality of Life in Community Sample of Women: A Longitudinal Exploratory Study. Front Psychol 2021; 12:671652. [PMID: 34276493 PMCID: PMC8281956 DOI: 10.3389/fpsyg.2021.671652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
Background and Aim: Eating Disorders (EDs) impact an estimated 15% of the global population and are linked to maladaptive defence-styles (coping strategies) and poorer mental health outcomes. Defence-styles have been grouped into immature, neurotic, and mature behaviours. Studies have yet to examine all three defence-styles in ED symptomatic individuals over an extended period of time. The current study aimed to investigate using converse analysis the relationships between defence-style and ED outcomes over a 5-years period. Methods: Participants (n = 216, mean age 33 years) were recruited through the Women's Eating and Health Literacy study, with the current study examining a 5-years period of two waves (year-4 and year-9). The current study tested associations over time between eating pathology (EDE-Q), psychological distress (K10), mental and physical health related quality of life (M/PHRQoL, SF-12), and defence-style (DSQ-40). Results: Mature, immature and neurotic defence-styles did not significantly change over 5 years. Over the same period, only PHRQoL significantly predicted mature defence-styles having positive effect. Both MHRQoL and PHRQoL significantly predicted immature defence-styles having positive and negative effects, respectively. Psychological distress, PHRQoL and weight concern significantly predicted neurotic defence-styles having positive effects except for psychological distress. PHRQoL, MHRQoL, restraint and eating concern significantly predicted overall eating pathology having positive effects except for PHRQoL and MHRQoL. Conversely, among the defence-style variables, over 5 years, both immature and neurotic defence-styles significantly predicted psychological distress having positive effects, immature and mature defence-styles significantly predicted MHRQoL having negative and positive effects, respectively, while only immature defence-styles significantly predicted overall eating pathology having positive effect. Conclusions: The results of the current study suggest that immaturity and neuroticism but not maturity were the defence-style variables predicting psychological distress over a 5-years period while conversely psychological distress predicted only neurotic defence styles. The findings of the current study may suggest that without intervention, mature, immature and neurotic defence-styles may largely remain immutable to significant shifts over time. Limitations in the current study included limited demographic representation. The current study is anticipated to generate considerations into treatments that could strengthen defence-styles in individuals with increased eating pathology.
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Affiliation(s)
- Phillip Aouad
- InsideOut Institute, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Nasim Foroughi
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Glazer KB, Sonneville KR, Micali N, Swanson SA, Crosby R, Horton NJ, Eddy KT, Field AE. The Course of Eating Disorders Involving Bingeing and Purging Among Adolescent Girls: Prevalence, Stability, and Transitions. J Adolesc Health 2019; 64:165-171. [PMID: 30509766 PMCID: PMC10535941 DOI: 10.1016/j.jadohealth.2018.09.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States. METHODS Using 11 prospective assessments from 9,031 U.S. females ages 9-15 years at baseline of the Growing Up Today Study, we classified cases of the following EDs involving bingeing and purging: bulimia nervosa (BN), binge ED, purging disorder (PD), and subthreshold variants defined by less frequent (monthly vs. weekly) bingeing and purging behaviors. We measured number of years symptomatic and probability of maintaining symptoms, crossing to another diagnosis, or resolving symptoms across consecutive surveys. RESULTS Study lifetime disorder prevalence was 2.1% for BN and roughly 6% each for binge ED and PD. Most cases reported symptoms during only one survey year. Twenty-six percent of cases crossed between diagnoses during follow-up. Among participants meeting full threshold diagnostic criteria, transition from BN was most prevalent, crossing most frequently from BN to PD (12.9% of BN cases). Within each disorder phenotype, 20%-40% of cases moved between subthreshold and full threshold criteria across consecutive surveys. CONCLUSIONS Diagnostic crossover is not rare among adolescent and young adult females with an ED. Transition patterns from BN to PD add support for considering these classifications in the same diagnostic category of disorders that involve purging. The prevalence of crossover between monthly and weekly symptom frequency suggests that a continuum or staging approach may increase utility of ED classification for prognostic and therapeutic intervention.
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Affiliation(s)
- Kimberly B Glazer
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
| | | | - Nadia Micali
- Child and Adolescent Psychiatry Division, University of Geneva, DEA, HUG, Geneva, Switzerland; Institute of Child Health, University College London, London, United Kingdom
| | - Sonja A Swanson
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ross Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Department of Pediatrics, Warren Alpert Medical School, Providence, Rhode Island
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Trojanowski PJ, Fischer S. The role of depression, eating disorder symptoms, and exercise in young adults' quality of life. Eat Behav 2018; 31:68-73. [PMID: 30149364 DOI: 10.1016/j.eatbeh.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Eating disorder (ED) symptoms are negatively associated with quality of life (QOL), while exercise is typically positively associated with QOL. Past studies have not examined the relative contribution of depression to this outcome. This study examined the influence of ED symptoms, exercise frequency, and exercise motivation on global QOL in undergraduates while accounting for the shared relationship between ED symptoms and depression. METHOD Students (N = 851) completed the EDE-Q, Reasons for Exercise Inventory, BDI-II, Quality of Life Inventory, and a 1-month exercise timeline followback calendar. Hierarchical regression analyses were conducted to examine the relative contributions of ED symptoms, depression, and exercise variables to QOL. RESULTS Shape concern and BDI-II scores accounted for significant variance in QOL scores. Depressive symptoms, however, accounted for 9.55% of the unique variance in QOL, while shape concern accounted for only 0.77%. Exercise frequency did not explain significant variance in QOL. The motivations of exercising for mood improvement and for enjoyment explained significant variance in QOL. No interactions between exercise frequency and exercise motivations were significant. In the final model, identifying as a woman was associated with decreased QOL. DISCUSSION Results suggest that studies examining the impact of disordered eating and exercise on QOL should account for depression due to depression's high comorbidity with EDs and its influence on exercise behavior and motivation. Additionally, results support findings that factors such as exercise motivation may better account for differences in QOL than exercise frequency.
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Landstedt E, Hammarström A, Fairweather-Schmidt AK, Wade T. Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being. Br J Health Psychol 2018; 23:496-518. [DOI: 10.1111/bjhp.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 01/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anne Hammarström
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | | | - Tracey Wade
- School of Psychology; Flinders University; Adelaide South Australia Australia
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Asselmann E, Wittchen HU, Lieb R, Beesdo-Baum K. Sociodemographic, clinical, and functional long-term outcomes in adolescents and young adults with mental disorders. Acta Psychiatr Scand 2018; 137:6-17. [PMID: 28861892 DOI: 10.1111/acps.12792] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine unfavorable sociodemographic, clinical, and functional long-term outcomes for a range of adolescent mental disorders. METHODS A total number of 2210 adolescents and young adults (14-24 years at baseline, T0) from a representative community sample were prospectively followed up (T1-T3) over 10 years. DSM-IV mental disorders, sociodemographic, clinical, and functional outcomes were assessed using the DIA-X/M-CIDI and its embedded assessment modules. RESULTS In (multinomial) logistic regressions adjusted for sex, age, other baseline disorders and sociodemographics, baseline anxiety, affective, substance use, somatoform and eating disorders (lifetime) predicted various unfavorable sociodemographic, clinical, and functional outcomes at T3. Particularly, strong associations were found between baseline disorders and adverse clinical outcomes at T3 (12-month diagnosis of the same/other disorder(s), drug use, suicide attempts, and help-seeking due to psychological problems). While substance use disorders were primarily associated with unfavorable sociodemographic and educational outcomes, anxiety and eating disorders were associated with unfavorable interpersonal outcomes, affective disorders with pregnancy-/childbirth-related complications and financial issues, and somatoform disorders with unfavorable educational/occupational and interpersonal outcomes. The risk of unfavorable outcomes increased with clinical severity, especially a higher number of baseline diagnoses. CONCLUSIONS Our findings emphasize the importance of effective treatment of mental disorders to prevent unfavorable long-term outcomes in various life domains.
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Affiliation(s)
- E Asselmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - R Lieb
- Max Planck Institute of Psychiatry, Munich, Germany.,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - K Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
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Mason TB, Crosby RD, Kolotkin RL, Grilo CM, Mitchell JE, Wonderlich SA, Crow SJ, Peterson CB. Correlates of weight-related quality of life among individuals with binge eating disorder before and after cognitive behavioral therapy. Eat Behav 2017; 27:1-6. [PMID: 28843136 PMCID: PMC5700842 DOI: 10.1016/j.eatbeh.2017.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 01/12/2023]
Abstract
Individuals with obesity and binge eating disorder (BED) report poorer weight-related quality of life (WRQOL) compared to individuals with obesity alone. Cognitive behavioral therapy (CBT), the best available treatment for BED, does not consistently produce weight loss or improvements in weight QOL. The purpose of the current study was to examine baseline and longitudinal associations between eating-related and psychosocial variables and dimensions of weight QOL. We examined associations between predictor variables, including body mass index (BMI), eating disorder (ED) psychopathology, and psychosocial factors, in relation to three dimensions of WRQOL among 171 patients whom received CBT for BED. Participants completed interviews and self-report measures at baseline prior to CBT and at end of treatment. At baseline the following associations were significant: BMI, ED psychopathology, and self-esteem were associated with weight-related self-esteem; gender, BMI, and self-esteem were associated with weight-related public distress (i.e., stigma and worry in public because of one's weight); and age, BMI, and ED psychopathology were associated with weight-related physical function. At end of treatment, the following associations were significant: changes in ED psychopathology and coping predicted weight-related self-esteem; changes in coping and self-esteem predicted weight-related public distress; and changes in BMI and subjective binge eating predicted weight-related physical function. Overall, changes in a number of ED and associated symptoms were associated with improvements in WRQOL.
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Affiliation(s)
- Tyler B Mason
- Department of Preventative Medicine, University of Southern California, Los Angeles, CA, United States.
| | - Ross D Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, United States; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - Ronette L Kolotkin
- Quality of Life Consulting, Durham, NC, United States; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, United States; Western Norway University of Applied Sciences, Førde, Norway; Centre of Health Research, Førde Hospital Trust, Førde, Norway; Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - Carlos M Grilo
- Yale University School of Medicine, New Haven, CT, United States
| | - James E Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, United States; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - Stephen A Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, United States; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - Scott J Crow
- University of Minnesota Medical School, Minneapolis, MN, United States; The Emily Program, St. Paul, MN, United States
| | - Carol B Peterson
- University of Minnesota Medical School, Minneapolis, MN, United States; The Emily Program, St. Paul, MN, United States
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Peckmezian T, Hay P. A systematic review and narrative synthesis of interventions for uncomplicated obesity: weight loss, well-being and impact on eating disorders. J Eat Disord 2017; 5:15. [PMID: 28469914 PMCID: PMC5410702 DOI: 10.1186/s40337-017-0143-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Most weight loss research focuses on weight as the primary outcome, often to the exclusion of other physiological or psychological measures. This study aims to provide a holistic evaluation of the effects from weight loss interventions for individuals with obesity by examining the physiological, psychological and eating disorders outcomes from these interventions. METHODS Databases Medline, PsycInfo and Cochrane Library (2011-2016) were searched for randomised controlled trials and systematic reviews of obesity treatments (dietary, exercise, behavioural, psychological, pharmacological or surgical). Data extracted included study features, risk of bias, study outcomes, and an assessment of treatment impacts on physical, psychological or eating disorder outcomes. RESULTS From 3628 novel records, 134 studies met all inclusion criteria and were evaluated in this review. Lifestyle interventions had the strongest evidence base as a first-line approach, with escalation to pharmacotherapy and bariatric surgery in more severe or complicated cases. Quality of life was the most common psychological outcome measure, and improved in all cases where it was assessed, across all intervention types. Behavioural, psychological and lifestyle interventions for weight loss led to improvements in cognitive restraint, control over eating and binge eating, while bariatric surgery led to improvements in eating behaviour and body image that were not sustained over the long-term. DISCUSSION Numerous treatment strategies have been trialled to assist people to lose weight and many of these are effective over the short-term. Quality of life, and to a lesser degree depression, anxiety and psychosocial function, often improve alongside weight loss. Weight loss is also associated with improvements in eating disorder psychopathology and related measures, although overall, eating disorder outcomes are rarely assessed. Further research and between-sector collaboration is required to address the significant overlap in risk factors, diagnoses and treatment outcomes between obesity and eating disorders.
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Affiliation(s)
| | - Phillipa Hay
- Foundation Chair of Mental Health and Centre for Health Research, School of Medicine, Western Sydney University, Parramatta, Australia
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Quality of life in eating disorders: a meta-analysis. Psychiatry Res 2014; 219:1-9. [PMID: 24857566 DOI: 10.1016/j.psychres.2014.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 05/01/2014] [Accepted: 05/03/2014] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) comprise a variety of symptoms and have a profound impact on everyday life. They are associated with high morbidity and mortality. The objective of this study was to analyse published data on health-related quality of life (HRQoL) in EDs so as to compare the results to general population norm data and to investigate potential differences between ED diagnostic groups. A systematic review of the current literature was conducted using a keyword-based search in PubMed and PsychInfo. The search covered anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) and used the Medical Outcomes Study Short Form-36 Health Survey (SF-36) as a measure of HRQoL. Of the 102 citations identified, 85 abstracts were reviewed and seven studies were included in the meta-analysis. AN patients were included in five studies (n=227), BN in four studies (n=216), EDNOS in two studies (n=166) and BED in four studies (n=148). We tested for between-study variation and significant differences between the diagnostic groups. The results confirmed a significantly lower level of HRQoL in all EDs compared to a population mean. It was not possible to establish any differences between the diagnostic groups.
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Hay P, Williams SE. Exploring relationships over time between psychological distress, perceived stress, life events and immature defense style on disordered eating pathology. BMC Psychol 2013; 1:27. [PMID: 25566375 PMCID: PMC4270025 DOI: 10.1186/2050-7283-1-27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 11/27/2013] [Indexed: 11/21/2022] Open
Abstract
Background Perceived stress, immature defense style, depression and anxiety and negative life events all are known to be associated with eating disorders. The present study aimed to investigate the relationships between these factors and their relative strength of association with eating disorder symptoms over time. Methods This research was embedded in a longitudinal study of adult women with varying levels of eating disorder symptoms and who were initially recruited from tertiary educational institutions in two Australian states. Four years from initial recruitment, 371 participants completed the Eating Disorder Examination- Questionnaire (EDE-Q) for eating disorder symptoms. Kessler-10 Psychological Distress Scale (K-10) as a measure of depression and anxiety, a Life Events Checklist as a measure of previous exposure to potentially traumatic events, the Defense Style Questionnaire (DSQ) and the Perceived Stress Scale (PSS) to determine perceived stress. One year later, in year 5, 295 (878.7%) completed follow-up assessments including the EDE-Q. The questionnaires were completed online or returned via reply paid post. Results All four independent factors were found to correlate significantly with the global EDE-Q score in cross-sectional analyses (all Spearman rho (rs) >0.18, p < 0.01) and at one year follow-up (all rs > 0.15, all p < 0.05). In multivariate linear regression modeling adjusted for age and year 4 global EDE-Q scores, perceived stress and psychological distress scores were significantly associated with year 5 global EDE-Q scores (p = 0.046 and <0.001 respectively). Conclusions Psychological distress, and to a lesser degree perceived stress had the strongest association with eating disorder symptoms over time The findings support further investigation of interventions to reduce distress and perceived stress in adult females with disordered eating.
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Affiliation(s)
- Phillipa Hay
- School of Medicine, University of Western Sydney, Sydney, Australia ; School of Medicine, James Cook University, Townsville, Australia
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Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1083-96. [DOI: 10.1007/s10802-013-9747-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Watson HJ, Allen K, Fursland A, Byrne SM, Nathan PR. Does enhanced cognitive behaviour therapy for eating disorders improve quality of life? EUROPEAN EATING DISORDERS REVIEW 2012; 20:393-9. [PMID: 22730260 DOI: 10.1002/erv.2186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients (n = 196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief.
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Affiliation(s)
- Hunna J Watson
- Centre for Clinical Interventions, Perth, Western Australia, Australia.
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Hay PJ, Buettner P, Mond J, Paxton SJ, Quirk F, Rodgers B. A community-based study of enduring eating features in young women. Nutrients 2012; 4:413-24. [PMID: 22690324 PMCID: PMC3367265 DOI: 10.3390/nu4050413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/05/2012] [Accepted: 05/18/2012] [Indexed: 12/04/2022] Open
Abstract
We conducted a prospective exploration of the temporal course of eating disorder (ED) symptoms in two cohorts of community women. One hundred and twenty-two young women (Cohort 1) identified in a general population based survey with ED symptoms of clinical severity agreed to participate in a 5-year follow-up study. A comparative sample (Cohort 2) of 706 similar aged self-selected college women (221 with disordered eating) was recruited one year later. Both ED groups were given a health literacy package in the first year. ED symptoms, health related quality of life, and psychological distress were assessed annually with the Eating Disorder Examination Questionnaire, the Short Form-12 Health Survey and the Kessler Psychological Distress Scale, respectively. Forty percent (Cohort 1) and 30.3% (Cohort 2) completed questionnaires at each year of follow-up. In both groups, there was early improvement in ED symptoms which plateaued after the first year, and participants retained high EDE-Q scores at 5 years. BMI increased as expected. Mental health related quality of life scores did not change but there were small improvements in psychological distress scores. The findings suggest little likelihood of spontaneous remission of ED problems in community women.
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Affiliation(s)
- Phillipa J. Hay
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751, Australia
- School of Medicine, James Cook University, Townsville QLD 4811, Australia; (P.B.); (F.Q.)
| | - Petra Buettner
- School of Medicine, James Cook University, Townsville QLD 4811, Australia; (P.B.); (F.Q.)
| | - Jonathan Mond
- School of Public Health, James Cook University, Townsville QLD 4811, Australia;
| | - Susan J. Paxton
- School of Psychological Sciences, La Trobe University, Melbourne VIC 3086, Australia;
| | - Frances Quirk
- School of Medicine, James Cook University, Townsville QLD 4811, Australia; (P.B.); (F.Q.)
| | - Bryan Rodgers
- Australian Demographic and Social Research Institute, The Australian National University, Canberra ACT 0200, Australia;
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Evans EJ, Hay PJ, Mond J, Paxton SJ, Quirk F, Rodgers B, Jhajj AK, Sawoniewska MA. Barriers to help-seeking in young women with eating disorders: a qualitative exploration in a longitudinal community survey. Eat Disord 2011; 19:270-85. [PMID: 21516551 DOI: 10.1080/10640266.2011.566152] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Few with eating disorders (EDs) access evidence-based treatments. We conducted a prospective exploration of help-seeking by 57 community women with bulimic-type EDs using the Framework approach of familiarization, identifying themes, indexing, charting and mapping and interpretation. The mean age of the sample was 33 years. Results found women sought help for concerns regarding perceived (over) weight rather than for eating, although many women would have welcomed questions from professionals regarding eating behaviours. Empathy, providing information and hope were considered important features of health professionals to provide a positive experience of help-seeking. Specific personal barriers to treatment included low motivation, fear of stigma, and cost. Greater clinician and community awareness of and action on these issues would likely help close "the gap" for effective help-seeking by those with EDs.
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Affiliation(s)
- Elizabeth J Evans
- Department of Developmental Disability and Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
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