An epidemiological study on eating disorders in two high schools in Naples

The global prevalence of screen-based disordered eating and associated risk factors among high school students: systematic review, meta-analysis, and meta-regression

OBJECTIVE

Estimate the prevalence, and associated risk factors, of high school students who are considered at risk for an eating disorder based on screening measures.

METHODS

An electronic search of nine databases was completed from their inception until 1st September 2022. A random-effects meta-analysis was conducted, and confounder (moderator) analyses and meta-regressions examined whether the overall prevalence estimate for of screen-based disordered eating (SBDE) was moderated by student age, BMI, or gender, as well as culture and type of SBDE assessment.

RESULTS

The mean estimate of the prevalence of SBDE among high school students (K = 42 (66 datapoints), N = 56282] in the sample of 25 countries was 13% ([95% CI] = 10.0-16.8%, I2 = 99.0%, Cochran's Q p = 0.001). This effect was not moderated by features of the samples such as gender, BMI, or age. Among cultures, non-Western countries had a higher prevalence of SBDE prevalence than Western countries, but the difference was not significant. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged.

CONCLUSION

The estimated figure of 1 in 8 high school students with SBDE-unmoderated by gender and BMI-stands out as a problem in need of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, and educators. There is a great need for innovative, integrated policy and program development all along the spectrum of health promotion and universal, selective, and indicated prevention. Further research is also needed to validate and refine this estimate by (a) conducting basic research on the accuracy of eating disorder screening measurements in samples ages 14 through 17; (b) examining representative samples in more countries in general and Latin American countries in particular; (c) clarifying the relationships between SBDE and age throughout the different phases of late childhood, adolescence, and emerging adulthood; and (d) investigating whether there are meaningful forms of disordered eating and whether these are associated with variables such as gender, ethnicity, and BMI.

Prevalence of binge-eating disorder among children and adolescents: a systematic review and meta-analysis

The objective is to estimate the prevalence of binge-eating disorder (BED) and subclinical BED in children and adolescents. Relevant articles were searched in the databases of PubMED and PsycINFO. Articles were included if they measured BED, subclinical BED, binge eating and/or loss of control (LOC) eating in samples of up to 20 years of age or with a mean age below 20 years. Subclinical BED covers participants with < 4 OBEs but ≥ 1 OBE pr. month and studies measuring subclinical DSM-IV/DSM-5 BED, but where all criteria were not met. All study types and measuring methods were accepted, but studies were excluded if they did not assess and exclude cases of recurrent compensatory behaviors. Meta-analyses were used to obtain an overall estimate of the prevalence of BED and subclinical BED, while stratified meta-analyses were used to assess sources of heterogeneity. 39 studies measuring BED, subclinical BED and/or a low frequency of binge eating were included. Two meta-analyses resulted in an overall estimated prevalence of 1.32% BED and 3.0% subclinical BED in children and adolescents. The results were influenced by high heterogeneity. Potential sources to heterogeneity in the BED result were weight of participants and sample types as well as level of risk of bias in the included studies. BED seems to be as frequent in children and adolescents as anorexia nervosa and bulimia nervosa. Hence, treatment of BED and BED symptoms in younger populations should be prioritized on the same terms as anorexia and bulimia nervosa.

New contributions to the prevalence of eating disorders in Spanish adolescents: detection of false negatives

Background

Although the epidemiology of Eating Disorders (ED) has been highly developed in Spain, further research considering false negatives and also the prevalence of these disorders in males are needed. They were the aims of the present study.

Methods

One thousand and seventy six adolescents (500 males and 576 females) participated in a two-stage survey. At the age of 13, apart from exploring numerous clinical and psychosocial variables, they were assessed by means of self-administered screening instruments, the eating attitude test (EAT), bulimic investigatory test Edinburgh (BITE), and body shape questionnaire (BSQ). The subjects were interviewed again 2 years later. Afterwards, 159 probable cases and 150 controls were interviewed by means of the structured interview SCAN.

Results

Prevalence of ED in adolescents was 3.71% (95% CI 2.58–4.83; 6.4% of females, 0.6% of males): anorexia nervosa 0.1%, bulimia nervosa 0.75%, eating disorder not otherwise specified (EDNOS) = 2.88%. The rate of false negative was 2.6% of the control group and most of them were EDNOS.

Conclusions

The prevalence of ED obtained in our study, higher than others found in previous Spanish research, and a relatively high percentage of false negatives both indicate that up to now the prevalence of ED in Spanish adolescents could be underestimated.

Epidemiology of binge eating disorder

PURPOSE OF REVIEW

In 2013, binge eating disorder (BED) was officially recognized as a distinct eating disorder in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders. The purpose of this review is to assess the available epidemiological data to determine whether BED should be considered for inclusion in global disease burden quantification efforts, such as the Global Burden of Disease Study (GBD).

RECENT FINDINGS

A systematic search of three electronic databases (PubMed, EMBASE, and PsycINFO) found 32 studes meeting GBD inclusion criteria. The global pooled prevalence of BED was 0.9% (95% confidence intervals: 0.7-1.0%). Although women (1.4%, 1.1-1.7%) had higher prevalence than men (0.4%, 0.3-0.6%), no significant difference in prevalence was found between high-income countries (0.9%, 0.8-1.1%) and low- and middle-income countries (0.7%, 0.3-1.1%).

SUMMARY

The current article presents the findings of a recent systematic review of the epidemiology of BED and discusses the case for including BED as a new cause in future iterations of GBD.

Prevalence and comorbidity of eating disorders among a community sample of adolescents: 2-year follow-up

The previous literature about comorbidity between eating disorders (ED) and other DSM-IV psychiatric disorders in adolescence has employed cross-sectional studies with clinical samples, where the comorbid disorders were diagnosed retrospectively. The present study aims to overcome these limitations by the analysis of comorbidity in a community population during 2-year follow-up. A semi-structured interview was applied to a teenager sample. Firstly, a cross-sectional and non-randomized study on psychiatric morbidity was conducted with 993 teenagers between the ages of 12 and 16 from five schools. Secondly, 326 students between 14 and 17 years old of one school were reassessed 2 years later in order to detect ED new cases and find associations with previous psychiatric disorders. The ED prevalence was 3.6%. Cross-sectional analysis revealed that 62.9% of individuals with an ED had comorbid disorders: anxiety disorders (51.4%), Attention Deficit Hyperactivity Disorder (31.4%), oppositional defiant disorder (11.4%), and obsessive compulsive disorder (8.6%). Prospective longitudinal analysis showed an ED incidence rate of 2.76% over the course of 2 years. 22.2% of new cases had received previous psychiatric diagnoses, of which all were anxiety disorders. Thus, ED exhibited a high comorbidity rate among adolescent populations and anxiety disorders were the most common comorbid diagnosis.

A Meta-Analysis of the Diagnostic Accuracy of the SCOFF

A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF. The 15 selected studies represented a total of 882 cases and 4350 controls. The main criterion for inclusion was that the primary study had provided diagnostic classification with both a diagnostic reference and with the SCOFF (with five items and a cut-off point of two). The pooled estimates were .80 (sensitivity) and .93 (specificity). The moderator variables gender and type of measure for the diagnostic reference (interview versus psychometric tests) account for part of the observed variability. For diagnostic references based on interviews the estimate of the efficacy improves significantly. For the studies that match this criterion the sensitivity is .882 and the specificity .925 (diagnostic odds ratio, 92.19). The main conclusion was that the five questions of the SCOFF constitute a very useful screening tool, in several languages; it is highly recommended for screening purposes.

Children's eating attitudes test: validation in a sample of Spanish schoolchildren

OBJECTIVE

To validate the Spanish version of the Children's Eating Attitudes Test (ChEAT).

METHOD

The factor structure and other psychometric characteristics of the questionnaire were examined using the answers of 38,554 schoolchildren. Diagnostic efficiency was based on a standardized clinical interview of 968 schoolchildren who had previously completed the questionnaire.

RESULTS

Five factors ("preoccupation with thinness," "dieting," "social pressure to eat," "purging," and "preoccupation with food and oral control") explained 46% of the variance. Cronbach's α was .858 for the total scale. The area under the receiver operating characteristic curve was .851. Sensitivity (SE) was 27% and specificity (SP) 96% for a cut-off of 20. A more appropriate cut-off was 15, where SE and SP were 62% and 90% respectively, and the positive and negative predictive values 27 and 98%.

DISCUSSION

The ChEAT psychometric characteristics are adequate. The questionnaire is valid. A cut-off point of 15 is recommended for adolescents.

Influence of stress in the onset of eating disorders: data from a two-stage epidemiologic controlled study

BACKGROUND

We explore the role of stress in the onset of eating disorders (EDs) in a community sample of adolescents, the mediating role of psychiatric comorbidity and the quantitative evolution of stress in the year preceding the onset of an ED.

METHODS

The Life Events and Difficulties Schedule interview was applied to a sample with 32 cases and 32 controls selected from a two-phase epidemiologic study among a representative population of adolescents, followed by a decay model to assess acute and chronic stress in the year preceding the onset of ED. Psychiatric comorbidity was assessed using the SCAN interview.

RESULTS

Cases (46.9%) and 9.4% of controls were found to have associated psychiatric comorbidity (chi2 = 11.74, p = .001). Of cases, 6.3% and none of the controls had at least one severe stressful event (N.S). Of cases, 18.8% and 3.1% of controls had at least one major difficulty (Fisher exact test = 0.05). Of cases, 25% and 3.1% of controls had a provoking stressful agent (Fisher exact test = 0.026). Psychiatric comorbidity partially mediated the relationship between stress and EDs. The Structural Equation Modeling Analysis shows that chronic stress is strongly associated with the onset of EDs, both directly (r(2) = 0.38) and indirectly, through psychiatric comorbidity (r2 = 0.56).

CONCLUSION

Chronic stress and psychiatric comorbidity are strongly associated with the onset of EDs. Psychiatric comorbidity is a partial mediating factor in the association of stress with eating disorders.

Eating disorders and attitudes in Maltese and Italian female students

BACKGROUND

No study to date has investigated the frequency of eating disorders (ED) in Malta. The aim of the present study was to provide a cross-cultural comparison between Malta and Italy as regards the frequency of ED and problematic eating attitudes among female students.

SAMPLING AND METHODS

128 Maltese and 135 Italian female students aged 16-20 were surveyed. Subjects underwent a structured clinical interview and completed some self-reported questionnaires: the Eating Attitudes Test, the Inventory for the Screening of Eating Disorders and the Eating Disorders Examination-Screening Version.

RESULTS

The rates of ED are very similar in the two samples with the exception of the frequency of binge eating disorder which is zero in the Italian sample and 4% among Maltese students. Maltese female students weighed significantly more than their Italian counterparts. They also reported more frequent dieting, fear of fatness and experience of low self-esteem related to body shape and weight.

CONCLUSIONS

Despite the fact that Maltese female students have a greater tendency to be overweight and display more problematic eating and body attitudes, their risk of developing ED, with the exception of binge eating disorder, is similar to that of their Italian counterparts.

Brief report: Psychological characteristics of less severe forms of eating disorders: an epidemiological study among 259 female adolescents

We screened a sample of 259 female students, aged 17-20 years old, by means of the Eating Disorder Inventory 2 (EDI 2) and the General Health Questionnaire (GHQ-28). Those students identified to be at risk for an eating disorder underwent a semi-structured interview to provide a diagnosis according to DSM-IV criteria. We also considered the prevalence of "not full-blown diagnosis". We found two cases of full-syndrome (0.77%), both bulimics, 9 partial-syndrome bulimia nervosa (3.47%) and 1 of partial-syndrome binge eating disorder (0.38%). Moreover, 18 (6.94%) girls met the criteria for subclinical-syndrome, of which the majority was subclinical anorexia (5.79%). We did not find statistically relevant differences between the anorexic and the bulimic samples on the psychological characteristics measured by the EDI 2 subscales. These findings suggest the hypothesis that anorexia and bulimia could have the same psychopathological core and bulimia could be considered as a "failed" anorexia.

Epidemiology and risk factors of eating disorders: a two-stage epidemiologic study in a Spanish population aged 12-18 years

OBJECTIVE

The authors studied the prevalence rates of eating disorders (ED) and their risk factors in a Spanish population aged 12-18 years.

METHOD

A two-stage epidemiologic study was conducted in the province of Valencia. Educational centers, classrooms, and individuals were selected randomly. The initial sample comprised 544 subjects. During Stage 1, subjects were screened with the 40-item Eating Attitude Test and a sociodemographic questionnaire that evaluates risk factors. During Stage 2, a semistandardized clinical interview was conducted with each participant. A random control group was paired by class, age, and sex. Comorbid psychiatric disorders and partial and subclinical forms were detected using criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

RESULTS

Using DSM-IV criteria, the morbidity rate was 2.91%, women comprised 5.17% of the sample, men comprised 0.77% of the sample, and the sex ratio was 6.71. Using DSM-IV criteria, including subclinical forms, the morbidity rate was 5.56%, women comprised 10.3% of the sample, men comprised 1.07% of the sample, and the sex ratio was 9.63. Six risk factors were isolated: psychiatric comorbidity, friend on a diet in the last year, desire to lose weight, desire to be less corpulent, sentimental problems, and diet in the last year.

DISCUSSION

This is the first Spanish two-stage epidemiologic study to include a control group and to investigate risk factors.

[Prevalence of eating disorders in a representative sample of female adolescents from Navarra (Spain)]

BACKGROUND

In spite of the social concern about eating disorders (ED), information of its prevalence in Spain is limited. Further studies in communities are needed to estimate the frequency of this problem in representative samples of the population.

SUBJECTS AND METHODS

To estimate the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and partial syndromes of the "non specified eating disorders" (NOSED) type, a representative sample of the female population of Navarre was selected using a random multistage sampling scheme. A sample of 2862 participants aged 12 to 21 was studied. The screening procedure was performed using the Eating Attitudes Test (EAT) (values over 30 as the cutoff point) and each diagnosis was confirmed using a semi-structured interview performed by a psychiatry according to DSM-IV criteria.

RESULTS

The overall prevalence of ED in this female population was 4.1% (95% CI: 3.45-4.95). The disorder specific prevalences being NOSED 3.1% (95% CI: 2.5-3.8), BN 0.8 (95% CI: 0.5-1.2) and AN 0.3 (95% CI: 0.1-0.6).

CONCLUSIONS

Our results show a slight lower prevalence than what other Spanish authors have reported, although we found higher prevalences of incomplete syndromes and suggest that a high social burden does exist and primary prevention strategies are needed.