Depression and coping in subthreshold eating disorders

"Good food equals good health": a focus group study of adolescent boys' perceptions of eating and weight

BACKGROUND

Disordered eating refers to unhealthy, sometimes excessive eating including so-called compensatory behaviours such as extreme dieting or voluntary vomiting. Between 24% and 30% of adolescent boys are suggested to engage in disordered eating, making it a significant public health issue. However, current instruments for assessing disordered eating among adolescents have been primarily developed and validated for girls and women, which may make for flawed assessment of boys. The aim of this study is to shed light on adolescent boys' perceptions of eating, weight, and food intake to better understand their perspectives in service of disordered eating research.

METHODS

This exploratory study was conducted from May to November 2022 using focus groups with a total of 39 adolescent boys (aged 12-19 years) who attended 7th to 12th grade in one of four schools in Southern Sweden. In addition, participants completed a form with questions on background demographics and eating habits. The transcripts of the focus group discussions were analysed using thematic analysis.

RESULTS

The quantitative data showed that around one third of the adolescent boys were overweight or obese. They ate at least one meal per day with the family and ate healthy food about five days per week and unhealthy food about three. Analysis of the qualitative data yielded six themes: The intertwined relationship between food and one's health, "Don't worry, food makes you happy," "To be hungry or not. That is the question," Boys DO care about appearances, Dieting and weight gain, and Disordered eating is a tricky matter.

CONCLUSION

Adolescent boys appeared to have a good understanding of food and healthy eating. They also experienced body positivity and seemed to have only minor issues regarding their weight. The primarily pathological perspective used to measure disordered eating among girls seems in need of revision to adhere to boys' thoughts and ideas regarding eating and weight.

Validation of a shortened version of the Eating Attitude Test (EAT-7) in the Arabic language

BACKGROUND

Eating disorders are quite common around the world, disabling, and potentially lethal; but they remain so far under-captured and subject to substantial delays in treatment. We propose through this study to develop and validate a shortened version of the Eating Attitude Test (EAT) in the Arabic language among non-clinical Arabic-speaking Lebanese participants from the general population.

METHODS

1175 participants enrolled in this cross-sectional study, based on an online survey. The Eating Attitude Test-26 items, Drunkorexia Motives and Behaviors Scales and Lebanese Anxiety Scale were used to answer our objectives.

RESULTS

Our results confirmed validity and reliability of the questionnaire. Exploratory Factor Analyses showed that all items converged over a one-factor solution, with an excellent Cronbach's alpha (> 0.9). Confirmatory Factor Analyses found that the 7-item-version yielded excellent model fit. The instrument also revealed strong evidence of divergent validity, being highly correlated with measures of anxiety and drunkorexia motives and behaviors.

DISCUSSION

Findings provided evidence supporting that the Arabic seven-item one-factor structure of the scale (EAT-7) is valid, reliable, and can be used in clinical practice, preventive interventions and future eating disorders research in Arab settings.

Prediction model for abnormal eating behaviour among hospital nurses: A structural equation modelling approach

BACKGROUND

Nurses are at a high risk of developing abnormal eating behaviour. However, few studies have attempted to identify the factors that influence such behaviour.

AIM

This study identifies factors that can predict abnormal eating behaviour in hospital nurses.

DESIGN

This study adopted a cross-sectional, descriptive correlational research design.

METHODS

A literature review was used to establish a hypothetical model, comprising the eight factors of shift work, job stress, depression, sleep quality, fatigue, coping strategy (active coping and passive coping) and abnormal eating behaviour. A convenience sample of 298 nurses aged less than 45 was recruited from two university hospitals, and structured questionnaire was administered between March and April 2017. The hypothesized model was tested using structural equation modelling.

RESULTS

Sleep quality and passive coping directly affect abnormal eating behaviour, which implies that poor sleep quality and increased passive coping worsens the behaviour. Shift work and depression indirectly affect abnormal eating behaviours.

CONCLUSION

Nursing managers and health policy makers should adopt strategies such as improving the shift-work pattern, providing adequate rest time after a night shift and enabling coping strategies by providing educational programs for hospital nurses.

Disordered eating in the postpartum period: Role of psychological distress, body dissatisfaction, dysfunctional maternal beliefs and self-compassion

The present cross-sectional study tested the affect regulation model of disordered eating for women in the postpartum period, whereby disordered eating is used to cope with psychological distress. Two hundred and two women who had given birth in the last two years completed an online survey of self-report measures of study variables. Path analyses supported the primary hypothesis: negative affect mediated relationships between body dissatisfaction, dysfunctional maternal beliefs, negative components of self-compassion and disordered eating behaviours, particularly binge eating. Results suggest that negative affect plays a central role in postpartum disordered eating. Interventions to address maladaptive emotion regulation strategies, specifically targeting body image distress and self-critical maternal thoughts may improve eating behaviours for this population.

Coping strategies and stress-induced natural killer cell redistribution in women with eating disorders

BACKGROUND

Patients with eating disorders (ED) are very sensitive and responsive to psychosocial stress. Stress response includes changes in immune cell distribution and may be modulated by the capability to cope with stressors. Thus, the present study sought to analyze the association between coping strategies and immune response (natural killer [NK] cell redistribution following psychosocial stress) in patients with anorexia nervosa (AN) and bulimia nervosa (BN) and healthy controls (HC).

METHOD

Twenty-four AN patients, 29 BN patients, and 58 HC were studied. A multidimensional assessment tool, the COPE Inventory, was used to assess coping strategies. The number of NK cells was quantified in peripheral blood before and after the application of the Trier Social Stress Test (TSST). Potentially mediating variables, such as weight status, severity of eating pathology, depression, anxiety, and impulsivity were controlled.

RESULTS

The three groups differed in intensity and direction of cell redistribution: The TSST was followed in BN patients by a significant decrease in the number of NK cells, whereas HC displayed a moderate decrease and AN a clear increase. Specific correlations between coping strategies and NK cell mobilization were found, especially in BN patients (positive for "planning" and negative for "substance abuse").

CONCLUSION

Recognition and subsequent modification of the dysfunctional coping strategies used by patients with ED could contribute to improving their immune status, strengthening their resilience and increasing their ability to overcome the disease.

Examining social support, rumination, and optimism in relation to binge eating among Caucasian and African-American college women

PURPOSE

Binge eating is a significant concern among college age women-both Caucasian and African-American women. Research has shown that social support, coping, and optimism are associated with engaging in fewer negative health behaviors including binge eating among college students. However, the impact of sources of social support (i.e., support from family, friends, and a special person), rumination, and optimism on binge eating as a function of race/ethnicity has received less attention. The purpose of this study was to examine the association between social support, rumination, and optimism and binge eating among Caucasian and American-American women, separately.

METHOD

Caucasian (n = 100) and African-American (n = 84) women from a university in the Mid-Atlantic US completed an online survey about eating behaviors and psychosocial health.

RESULTS

Social support from friends was associated with less likelihood of binge eating among Caucasian women. Social support from family was associated with less likelihood of binge eating among African-American women, but greater likelihood of binge eating among Caucasian women. Rumination was associated with greater likelihood of binge eating among Caucasian and African-American women. Optimism was associated with less likelihood of binge eating among African-American women.

CONCLUSIONS

These results demonstrate similarities and differences in correlates of binge eating as a function of race/ethnicity.

Disordered eating and emotion dysregulation among adolescents and their parents

Background

Research on the relationships between adolescent and parental disordered eating (DE) and emotion dysregulation is scarce. Thus, the aim of this study was to explore whether mothers’ and fathers’ own DE, as measured by SCOFF questionnaire, and emotion dysregulation, as measured by the difficulties in emotion regulation scale (DERS), were associated with their daughters’ or sons’ DE and emotion dysregulation. Furthermore, the importance of shared family meals and possible parent-related predictors of adolescent DE were explored.

Method

The total sample comprised 1,265 adolescents (M_age = 16.19, SD = 1.21; age range 13.5–19 years, 54.5% female) whose parents had received a self-report questionnaire via mail. Of these, 235 adolescents (18.6% of the total sample) whose parents completed the questionnaire were used in the analyses. Parents’ responses were matched and compared with those of their child.

Results

Adolescent girls showed greater levels of DE overall than did their parents. Furthermore, DE was associated with emotion dysregulation among both adolescents and parents. Adolescent and parental emotion dysregulation was associated, although there were gender differences in the specifics of this relationship. The frequency of shared dinner meals was the only variable that was associated to DE and emotion dysregulation among adolescents, while parental eating disorder was the only variable that enhanced the probability of adolescent DE.

Conclusion

The present study contributes to the literature by demonstrating that there are significant associations between parents and their adolescent children in terms of DE, emotion dysregulation, and shared family meals. Future studies should break down these relationships among mothers, fathers, girls, and boys to further clarify the specific associational, and possibly predictive, directions.

Chinese Version of the Healthy Lifestyle Beliefs Scale for Taiwanese Adolescents: A Psychometric Study

BACKGROUND

Taiwanese adolescents' unhealthy lifestyles (e.g., unhealthy eating and sedentary behavior) are associated with excess weight and obesity, which affect their physical and mental health (e.g., depression). Because adolescents' beliefs about healthy lifestyles predict their actual lifestyles, a valid and reliable tool to measure their beliefs about healthy lifestyles is needed.

METHODS

The Healthy Lifestyle Behavior Scale (HLBS) was translated into Chinese based on recommended guidelines. A convenience sample of 186 Taiwanese adolescents completed the Chinese version Healthy Lifestyle Behavior Scale (CHLBS) anonymously. We used Cronbach's α to determine the internal consistency of the CHLBS and exploratory and confirmatory factor analyses to examine the factor structure.

RESULTS

The Cronbach's α for the CHLBS was .94. Exploratory analysis suggested that there were two factors and explained 57% of the total variance. The confirmatory factor analysis indicated an acceptable fit.

CONCLUSION

The CHLBS is a reliable and valid scale. It can be used to gather information about Taiwanese adolescents' beliefs about healthy lifestyles, which will assist in developing culturally and developmentally relevant interventions.

Associations of neuroticism-impulsivity and coping with binge eating in a nationally representative sample of adolescents in the United States

OBJECTIVE

Binge eating behavior is a public health concern due to its negative physical and mental health consequences. Little is known about the interplay of personality traits, coping styles, and binge eating in the general adolescent population. We examined the associations among the combination of neuroticism and impulsivity (NI), maladaptive coping styles (poor problem solving, distraction, and escape-avoidance), and lifetime prevalence of binge eating in a nationally representative sample of U.S. adolescents. We also explored coping as a moderator of the NI-lifetime binge eating association and gender as a moderator of the NI-coping associations and coping-lifetime binge eating associations.

METHODS

We used data from the National Comorbidity Survey: Adolescent Supplement (NCS-A: 2001-2004), a cross-sectional nationally representative study of adolescents aged 13 to 18years (n=10,028). We studied the associations of NI and coping with lifetime binge eating using multivariate regression models.

RESULTS

High NI was significantly associated with all three coping styles, especially escape-avoidance (β=3.96, confidence interval [CI]=3.62, 4.29, p<0.001). Gender was a significant moderator of the NI-distraction coping association (β=-0.68, CI=-1.33, -0.03, p=0.041), indicating a stronger association in males (β=1.20, CI=0.81, 1.58, p<0.001) than females (β=0.53, CI=0.02, 1.03, p=0.042). Lifetime prevalence of binge eating was 1.13 times higher with increased escape-avoidance coping (CI=1.10, 1.18, p<0.001).

DISCUSSION

Our findings indicate significant associations among high NI, increased escape-avoidance coping, and higher lifetime prevalence of binge eating in adolescents. Findings of our study have potential to inform development of interventions that target modification of maladaptive personality traits and coping styles to reduce problematic eating.

Gender differences and correlates of extreme dieting behaviours in US adolescents

This article examined correlates of and gender differences in extreme dieting behaviours among 15,425 US adolescents from the 2011 Youth Risk Behavior Survey. Suicidal thoughts and plans and binge drinking were related to extreme dieting behaviours in females, but not in males. Suicide attempts, daily smoking and marijuana use were related to extreme dieting behaviours in males, but not females. Results suggest extreme dieting behaviours are associated with a range of negative psychosocial factors and substance use behaviours, and that these differ for boys and girls. Additional research is required to elucidate these relationships, and these results provide a focus for future research, prevention and intervention efforts.

Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample

PURPOSE

Disordered eating is common for all ages and sexes in the general population. However, only some individuals are known to develop clinically relevant eating disorders. There is a critical need of efficient, reliable and valid screening instruments to measure disordered eating for the general population. The Eating Attitudes Test was shortened into an 8-item-version to screen individuals at high risk of developing clinical eating disorders in a general population sample.

METHODS

Psychometric properties (Cronbach's α, construct and concurrent validity and factor structure), cutoff scores (with sensitivity, specificity, positive and negative predictive value) and norms were determined in a representative sample of the German population (N=2527). Factorial validity was investigated using item response modeling.

RESULTS

Results confirmed reliability and validity of the questionnaire. Internal consistency and convergent validity were good. Analysis revealed different cutoff points for male and female participants. Values for sensitivity and specificity were satisfying and the positive predictive value was higher compared to other short screening instruments for disordered eating. Factorial analysis revealed a one-factor solution with an excellent model fit. The elimination of one item was discussed. Gender- and age-specific norms are reported.

CONCLUSIONS

Overall results indicated that the EAT-8 is an efficient instrument suitable for screening purposes in large general population samples.

Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem

BACKGROUND

Using the person-oriented approach, we determined the relationships between four indicators (restraint and eating, shape, and weight concerns) of disordered eating (DE), as measured by the self-reported Eating Disorders Examination Questionnaire (EDE-Q), to identify typical DE patterns. We then related these patterns to clinical EDE-Q cut-off scores and emotion dysregulation, depression, self-esteem, and two categories of DE behaviors (≥2 or ≤1 "yes" responses on the SCOFF questionnaire).

METHOD

Typical patterns of DE were identified in a community sample of 1,265 Swedish adolescents (M_age  = 16.19, SD = 1.21; age range 13.5-19 years) using a cluster analysis. Separate analyses were performed for girls (n = 689) and boys (n = 576).

RESULTS

The cluster analysis yielded a six-cluster solution for each gender. Four of the six clusters for girls and five for boys showed scores above the clinical cut-off on at least one of the four DE indicators. For girls, the two clusters that scored above the clinical cut-offs on all four DE indicators reported severe psychological problems, including high scores on emotion dysregulation and depression and low scores on self-esteem. In contrast, for boys, although two clusters reported above the clinical cut-off on all four indicators, only the cluster with exceedingly high scores on shape and weight concerns reported high emotion dysregulation and depression, and extremely low self-esteem. Furthermore, significantly more girls and boys in the most problematic DE clusters reported ≥2 "yes" responses on the SCOFF questionnaire (as opposed to ≤1 response), indicating clear signs of DE and severe psychological difficulties.

CONCLUSION

We suspect that the various problematic DE patterns will require different paths back to a healthy diet. However, more research is needed to determine the developmental trajectories of these DE patterns and ensure more precise clinical cut-off scores, especially for boys. Comprehensive understanding of DE patterns might be of use to healthcare professionals for detecting DE before it develops into an eating disorder.

TRIAL REGISTRATION

Lund, EPN (dnr: 2012/499).