Eating disorders and suicide risk factors in adolescents: an Italian community-based study

Problematic Use of the Internet Mediates the Association between Reduced Mentalization and Suicidal Ideation: A Cross-Sectional Study in Young Adults

Suicide is a major public health problem, and it is urgent to investigate its underlying clinical and psychological concomitants. It has been suggested that low mentalization skills and problematic use of the internet (PUI) are factors that can play a role in suicidal behaviors. It is possible that poor mentalization skills contribute to leading to forms of PUI, which, in turn, can represent triggers for suicidal ideation (SI). We tested this hypothesis through a quantitative and cross-sectional study on a sample (n = 623) of young adults (age range: 18−34). Self-report measures investigating symptoms related to Social Media Addiction (SMA), Internet Gaming Disorder (IGD), mentalization capacity, and SI were used. A single mediation analysis with two mediators was carried out to evaluate the direct and indirect effects of mentalization on SI through the mediating role of SMA- and IGD-related symptoms, controlling for potential confounding factors (e.g., socio-demographic and addiction-related variables). The four explored variables were significantly associated with each other (all p < 0.001) across all subjects; the mediational model showed that the total effect of mentalization on SI was significant (B = −0.821, SE = 0.092 (95% CI: −1.001; −0.641)) and that both SMA- (B = −0.073, SE = 0.034 (95% CI: −0.145; −0.008)) and IGD-related symptoms (B = 0.046, SE = 0.027 (95% CI: −0.107; −0.001)) were significant mediators of such association. Our findings support the possibility that PUI severity plays a relevant role in mediating the association between low mentalization skills and levels of SI.

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours

This study examined whether self-disgust added incremental variance to and mediated the multivariate association between measures of body image disturbance and suicidal thoughts and behaviours. We hypothesized that self-disgust would be associated with suicidal ideation above the effects of body image disturbance, and that self-disgust would mediate the relationship between body image disturbance and suicidal ideation. A total of N=728 participants completed The Body Image Disturbance Questionnaire, The Self-Disgust Scale, and the Suicidal Behaviours Questionnaire-Revised. Suicidality was significantly related to increased levels of self-disgust and body image disturbance, whereas self-disgust was associated with greater body image disturbance. Linear regression analysis showed that self-disgust was associated with suicidal thoughts and behaviours, over and above the effects of body image disturbance. Multiple mediation modelling further showed that self-disgust mediated the relationship between body image disturbance and suicidal thoughts and behaviours. Our findings highlight the role of self-disgust in the context of body image disturbance and support the notion that body image disturbance is associated with aversive self-conscious emotions. Interventions aiming to reduce the risk of suicidality in people with body image disturbance may address self-disgust and negative self-conscious emotions.

Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study

BACKGROUND

Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States.

OBJECTIVE

The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors.

METHODS

Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012.

RESULTS

The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F_15,4966=105.8; P<.001).

CONCLUSIONS

This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex.

A Comparison between Severe Suicidality and Nonsuicidal Self-Injury Behaviors in Bipolar Adolescents Referred to a Psychiatric Emergency Unit

Background: Severe suicide ideation or attempts and non-suicidal self-injury (NSSI) present both differences and relevant overlaps, including frequent co-occurrence and shared risk factors. Specific categorical diagnoses, namely bipolar disorder (BD), may affect clinical features and natural histories of suicidal or not suicidal self-harm behaviour. Our study aimed to compare suicidality (severe suicidal ideation or suicidal attempts) and NSSI in referred bipolar adolescents. Methods: The sample included 95 bipolar adolescents (32 males, 63 females) aged 11 to 18 years. Thirty adolescents with suicide attempts/suicidal ideation and BD (SASIB) were compared with structured measures to 35 adolescents with NSSI and BD, without suicidal ideation or attempts (NSSIB), and to 30 adolescents with BD, without suicidal ideation or attempts or NSSI (CB). Results: Compared to CB, suicidality and NSSI were both associated with female sex, borderline personality disorder and self-reported internalizing disorders, anxiety/depression and thought disorders. The NSSI were specifically associated with somatic problems. Severe suicidal ideation and suicide attempts were associated with adverse life events, immigration, bullying, eating disorders, social problems, depressive feelings, performance and social anxiety, and feelings of rejection. Conclusions: Both shared and differential features between suicidal and not suicidal adolescents may represent possible targets for diagnostic and preventative interventions.

Suicidal ideation and time perspective in high school students

Objective

Many studies have enlightened the relevance of deepening our knowledge of suicidal ideation among adolescents. However, research has given insufficient attention to the impact of time perspective on suicidal ideation: the present study confirms this relationship in a large sample of adolescents.

Method

A survey was conducted on a sample of 3700 Italian adolescents. We obtained data using a structured questionnaire addressing suicidal ideation, mental health status, self-esteem, individual and family characteristics, and time perspective (ZTPI) in three temporal frames: the past, present and future, and the attitude related to each one of them. Data were analyzed using bivariate and multivariate analyses.

Results

Overall, 9.2% of the sample reported severe suicidal ideation during the past two weeks; 7.6% reported moderate suicidal ideation. Female adolescents were more likely to report severe suicidal ideation when compared to males (χ(2)2 = 13.38, P = .001). There were no differences regarding age (χ(1)2 = 2.81, P = .245) and SES (χ(2)2 = 8.67, P = .08).

The first discriminant function was mostly explained by psychopathological symptoms (General Global Index), self-esteem and two dimensions of the ZTPI (Negative Past and Fatalistic Present).

Conclusions

Differences in time perspective dimensions between moderate and severe ideators suggest that these groups should be considered and analyzed as two discrete groups in further research.

Self-injury, psychiatric symptoms, and defense mechanisms: Findings in an Italian nonclinical sample

Introduction

This study provides data on the rates, characteristics, and correlates of self-injury (SI) in an Italian nonclinical sample, a population previously unexamined within the SI literature. This study examined the associations between SI and defense mechanisms, as well as the differences between self-injurers (episodic and recurrent) and non self-injurers with regard to the severity and variety of their psychiatric symptoms and psychological distress.

Materials and methods

Five hundred and seventy-eight university students (82.5% female; mean age = 22.3; S.D. = 3.4) were administered a battery of self-report questionnaires, including the “Deliberate Self Harm Inventory” for SI, the Response Evaluation Measure-71 for defense mechanisms, and the “Symptom Checklist-90-Revised” for psychological distress and psychiatric symptoms.

Results

One hundred and nineteen participants (20.6%) reported having engaged in SI at least once during their lifetime. Individuals with recurrent SI (SI ≥ 5) reported significantly higher levels of all psychiatric symptoms and many maladaptive defense mechanisms than individuals without SI. Results also provided evidence for differences between individuals with recurrent and episodic SI.

Conclusion

Results suggest that recurrent self-injurers are distinguished from both episodic self-injurers and non self-injurers by their greater use of maladaptive defense mechanisms, rather than their lesser use of adaptive defenses. Further, results suggest that recurrent self-injurers differ from episodic self-injurers not in terms of the severity of their psychiatric symptoms, but the variety and number of these symptoms.

Psychological distress among bariatric surgery candidates: The roles of body image and emotional eating

The increased risk of psychological distress among bariatric surgery candidates may be attributed, at least in part, to body image dissatisfaction (BID). The aim of the present study was to test the hypotheses that body image could be correlated with the psychological distress variables, and that emotional eating behaviours could mediate the relationship between body image and psychological distress. A sample of consecutive participants seeking bariatric surgery (N = 169, 67% females, mean age, 41.8 years [SD = 11.46], mean body mass index 42.0 kg/m² [SD = 11.0]) was recruited from a university-based bariatric centre, a week prior to scheduled surgery. Results showed that BID was positively correlated with suicidality (r = 0.18, P < 0.05), depression (r = 0.39, P < 0.01) and anxiety (r = 0.20, P < 0.05). The relation between BID and depression was partially mediated by emotional eating, whereas the relation between BID and suicidality was fully mediated by emotional eating. Physicians and other health professionals who treat bariatric surgery patients should be encouraged to detect behaviours indicating emotional eating, as these could be an indicator of psychological distress resulting from poor body image.

The moderating effect of gender role on the relationships between gender and attitudes about body and eating in a sample of Italian adolescents

PURPOSE

The differential prevalence of eating disorders in males and females can be explained by the impact of gender-role orientations. Inside the Italian socio-cultural context, gender socialization can be influenced by stereotypical gender beliefs, and this may contribute to the psychological distress of individuals who identify with discrepant gender roles from their biological sex. Our study explored, within the Italian context, the potential moderating effect of masculinity and femininity on the relationships between gender and attitudes about body and eating.

METHODS

Nine hundred and twenty Italian male and female adolescents (M = 427, F = 493; age 14-21 years) completed the Eating Disorder Inventory-2 (EDI-2) and the Bem Sex-Role Inventory (BSRI).

RESULTS

A moderating effect of gender role on the relationship between gender and bulimia, and drive of thinness emerged. Girls with higher levels of masculinity scored higher on bulimia than did their counterparts with lower levels, and boys with higher levels of femininity scored higher on bulimia and on drive for thinness than did their counterparts with lower levels. Data did not reveal a moderating effect of gender role on the relationship between gender and body satisfaction.

CONCLUSIONS

Our data suggest that adolescents who endorsed a gender role that is socially considered discrepant from their biological sex (girls with higher levels of masculinity and boys with higher levels of femininity) are more likely to show higher level of bulimia and drive of thinness. This suggests the need for prevention and treatment programmes for eating disorders that take into account individuals' gender-role orientation and the influence that culturally dominant gender beliefs can exert on it.

Subjective incompetence as a predictor of treatment outcomes in eating disorder outpatients

Eating disorder (ED) patients are frequently characterized by feelings of inefficacy. The aims of the present study were to investigate subjective incompetence and whether its early modification in therapy is associated with treatment response in terms of both psychological distress and well-being. Sixty female ED outpatients undergoing cognitive-behaviorally-based treatment integrated with nutritional rehabilitation were evaluated using: Subjective Incompetence Scale (SIS), Eating Attitudes Test (EAT), Beck Depression Inventory (BDI-II), and Psychological Well-being Scales (PWB). Repeated measures analysis of variance to test changes in variables and hierarchical regression analyses to test the predictive role of SIS were conducted. Significant improvements in SIS, and in distress measures (EAT, BDI-II) and well-being (PWB) were observed by mid-treatment. Early SIS reductions in patients significantly predicted reductions in EAT-food and bulimic preoccupations, EAT-oral control and EAT-dietary restraint scores, independently of initial depressive symptomatology and illness severity. Gains in three PWB dimensions (environmental mastery, purpose in life, self-acceptance) were also predicted by changes in subjective incompetence. Treatment response might be enhanced by targeting more specifically persistent feelings of incompetence associated with ED symptomatology and compromised psychological well-being dimensions. Such paucities in positive functioning are central themes in EDs and if left untreated might represent obstacles to recovery.

Impact of Depressive Symptoms and Alcohol Use on Disordered Eating and Suicidality: A Moderated Mediation Study

While previous studies have tested the mediating or moderating effects of select factors on disordered eating pathologies, no empirical studies have examined a moderated mediation model. Thus, filling a gap in the literature base, the current study examined a moderated mediation model to test the associations among disordered eating, depressive symptoms, alcohol use, and suicidality. The current study sample included 1,598 students (mean age 21.3 years; 80.9% female) across major universities in the United States. Results showed that disordered eating was significantly associated with suicidality, and the association was mediated by depressive symptoms. Further, the indirect effect of disordered eating via depressive symptoms varied in magnitude as a function of alcohol use. Findings suggest that clinical mental health counselors and other providers working with emerging adults should be vigilant in recognizing behaviors and thoughts associated with disordered eating and related signs and symptoms, including depressive symptoms and alcohol use.

Objectified Body Consciousness (OBC) in Eating Psychopathology

Objectified body consciousness (OBC) appears to play a crucial role in eating and body-related disturbances, which typically emerge during adolescence. The 24-item OBC Scale (OBCS) has been employed in eating disorder (ED) research and school-based adolescent samples, but evidence for its psychometric proprieties exists only in adult (nonclinical) populations. We evaluated (a) the construct validity and reliability of the 24-item OBCS with data collected from 1,259 adolescent girls and boys from the community (Study 1) and 643 adolescents of both genders with an ED (Study 2) and (b) whether the instrument functions similarly and equivalently measures the underlying construct(s) across gender and samples (i.e., test of measurement equivalence/invariance; Study 3). Results upheld the three-factor structure and measurement equivalence/invariance of the 24-item OBCS across gender and samples. OBCS subscale scores were internally consistent and stable over a 4-week period. OBCS subscales discriminated community participants with high and low ED symptom levels with fair accuracy, as well as community participants from those with an ED. They were also associated with five constructs closely related to both OBC and ED psychopathology. Latent mean comparisons across samples and gender were performed and discussed. Implications and directions for future research are also outlined.

Extreme Weight-Control Behaviors and Suicide Risk Among High School Students

BACKGROUND

Suicide is the third leading cause of death for people ages 15-19. Research has established an association across numerous risk factors and suicide, including depression, substance abuse, bullying victimization, and feelings of alienation. However, the connection between disordered eating as manifested in extreme weight-control behaviors (EWCB), and suicidal thoughts, ideation, and attempts among adolescents is less understood. Given the prevalence of adolescent suicide, this investigation examined associations between EWCB and suicide risk among high school students.

METHODS

Data were collected from a convenience sample of 4178 students in grades 9-12 attending 5 public high schools using the Youth Risk Behavior Survey (YRBS) questionnaire. Logistic regressions were used to estimate associations between EWCB and suicide controlling for grade level and race, reported separately by sex.

RESULTS

Students who reported seriously considering suicide had higher odds of exhibiting all 3 EWCBs [adjusted odds ratio (AOR)(male) = 3.0 (confidence interval (CI): 1.4, 6.5); AOR(female) = 4.5 (CI: 2.5, 8.3)]. Moreover, students who reported they made plans about suicide were also more likely to exhibit all EWCBs [AOR(male) = 3.7 (CI: 1.7, 7.9); AOR(female) = 4.2 (CI: 2.3, 7.7)].

CONCLUSIONS

EWCBs were significantly associated with suicide risk, furthering the evidence suggesting a link between disordered eating and suicide. Findings demonstrated the need for school health services that address disordered eating in the effort to reduce adolescent suicide.

Alterations in circadian/seasonal rhythms and vegetative functions are related to suicidality in DSM-5 PTSD

BACKGROUND

Alterations in rhythmicity and vegetative functions have been reported as correlates of suicidality, particularly in patients with mood disorders. No investigation has addressed their impact on patients with post-traumatic stress disorder (PTSD). Aim of the present study was to fulfill this gap.

METHODS

Sixty-five out- and inpatients with DSM-5 PTSD were assessed by using the Mood Spectrum-Self Report-Lifetime Version (MOODS-SR), a questionnaire for lifetime mood spectrum symptomatology including alterations in circadian/seasonal rhythms and vegetative functions. Six items of the MOODS-SR were combined and dichotomized to assess suicidal ideation and/or attempts.

RESULTS

Significant and positive associations were found between symptoms of lifetime dysregulations in rhythmicity and vegetative functions and suicidal ideation and/or attempts. All MOODS-SR sub-domains (rhythmicity, sleep, appetite/weight, sexual function, physical symptoms) were associated with an increased likelihood of suicidal ideation, but only changes in appetite/weight were associated with greater odd ratios of suicide attempts (OR = 2.099, 95% CI 1.148-3.841).

CONCLUSIONS

Our results suggest that lifetime dysregulations in rhythmicity and vegetative functions may represent correlates of suicidality in patients with DSM-5 PTSD.

Correlates of suicide ideation and attempts in children and adolescents with eating disorders

This is the first study determining correlates of suicide behavior in children with eating disorders using multiple sleep, psychological, and demographic variables. Mothers rated suicide ideation and attempts in 90 children ages 7-18 with bulimia nervosa or anorexia nervosa. Suicide ideation was more prevalent in children with bulimia nervosa (43%) than children with anorexia nervosa (20%). All children with bulimia nervosa who experienced ideation attempted suicide, whereas only 3% of children with anorexia nervosa attempted suicide. Correlates of ideation were externalizing behavior problems and sleep disturbances. Correlates of attempts were bulimia nervosa, self-induced vomiting, nightmares, and physical or sexual abuse. These problems should be assessed and targeted for intervention because of their association with suicide behavior.

An examination of the relationship between body image factors and non-suicidal self-injury in young adults: the mediating influence of emotion dysregulation

The current study explored the differential roles of dimensions of body image (i.e., affective, cognitive, and behavioral) among a sample of 101 young adults (72.3% female, M=19.45; S.D.=1.28) who reported having engaged in non-suicidal self-injury (NSSI), and a matched comparison group of young adults who did not. A mediational model of NSSI was tested, based on the hypothesis that emotion dysregulation would mediate the relationship between dimensions of body image and engagement in NSSI. Preliminary examination of the variables revealed that negative attitudes, suicide-related rumination, and behavioral practices associated with physical appearance significantly differentiated young adults who reported having engaged in NSSI and those who did not, regardless of gender. Path analytic modeling provided partial support for the proposed mediational model, with significant direct and indirect effects between dimensions of body image and NSSI through emotion dysregulation. Discussion focuses on the importance of understanding the differential roles of dimensions of body image and emotion dysregulation as intrapersonal risk factors related to NSSI engagement.

O que é comportamento de risco para transtornos alimentares em adolescentes?

OBJETIVO: Caracterizar comportamento de risco para transtornos alimentares (TA) e sua frequência entre adolescentes em uma revisão da literatura nacional e internacional. MÉTODOS: Foi realizada uma busca bibliográfica por meio de uma revisão integrativa nas bases de dados PubMed (US National Library of Medicine)e Lilacs e no portal SciELO,utilizando-se os descritores relacionados à "eating disorder risk behavior". Foram selecionados artigos publicados nos últimos 10 anos, nos idiomas português, espanhol e inglês, e especificamente com adolescentes. Foram avaliados 76 artigos e analisados a nomenclatura e os instrumentos utilizados para avaliar comportamento de risco para TA e sua prevalência. RESULTADOS: Encontrou-se uma série de termos para avaliar risco para TA. A metodologia mais utilizada foi a de questionários e escalas, destacando-se o EAT-26 ou 40 e o BITE, dentre os mais frequentes; a prevalência de risco variou de 0,24% a 58,4%. CONCLUSÃO: Diferentes nomenclaturas e instrumentos são utilizados para avaliar comportamento de risco para TA entre adolescentes, com grande amplitude nos resultados de prevalência. Maior padronização de termos e metodologia de avaliação permitiriam melhor comparação entre estudos epidemiológicos em diferentes localidades.

How often, or how many ways: clarifying the relationship between non-suicidal self-injury and suicidality

This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.

Psychometric evaluation of the body investment scale for use with adolescents

We conducted two studies to examine the psychometric properties of the Body Investment Scale (BIS; Orbach & Mikulincer, 1998) in U.S. adolescent samples. The BIS was designed to assess bodily experiences that are associated with suicide-related behaviors. In Study 1, confirmatory factor analysis (CFA) with data from a combined sample of 204 high school adolescents (83 boys, 121 girls) and 197 psychiatric inpatient (101 boys, 96 girls) adolescents provided moderate support for the oblique four-factor solution: Body Feelings (rho=.86, 95% CI=.83-.89), Body Touch (rho=.71, 95% CI=.65-.76), Body Care (rho=.78, 95% CI=.71-.81), and Body Protection (rho=.78, 95% CI=.73-.82); robust comparative fit index=.88 and the robust Tucker Lewis Index=.83. The second-order factor model also provided moderate fit to the data. In Study 2, results of the CFA with data from adolescent psychiatric inpatients (N=205; 101 boys, 104 girls) provided additional support for the four-factor solution. In addition, results of the receiver operating characteristic and logistic regression analyses showed that scores on the Body Feelings and Body Protection scales were most useful in differentiating the responses of suicidal and nonsuicidal adolescents, all Cohen's d values >.30. The study also examined associations between scores on the BIS scales and the validation self-report measures of hopelessness, suicide-related behavior, and reasons for living.

Eating disorder psychopathology as a marker of psychosocial distress and suicide risk in female and male adolescent psychiatric inpatients

OBJECTIVE

The aim of this study was to examine psychosocial correlates of specific aspects of eating disorder (ED) psychopathology (ie, dietary restriction, body dissatisfaction, binge eating, and self-induced vomiting) in psychiatrically hospitalized adolescent girls and boys.

METHOD

A total of 492 psychiatric inpatients (286 adolescent girls and 206 adolescent boys), aged 12 to 19 years, completed self-report measures of psychosocial and behavioral functioning, including measures of suicide risk and ED psychopathology. Associations between ED psychopathology and psychosocial functioning were examined separately by sex and after controlling for depressive/negative affect using Beck Depression Inventory scores.

RESULTS

Among the adolescent boys and girls, after controlling for depressive/negative affect, ED psychopathology was significantly associated with anxiety, low self-esteem, and current distress regarding childhood abuse. Among adolescent girls, after controlling for depressive/negative affect, ED psychopathology was significantly related to hopelessness and suicidality. Among adolescent boys, after controlling for depressive/negative affect, ED psychopathology was positively related to self-reported history of sexual abuse and various externalizing problems (drug abuse, violence, and impulsivity).

CONCLUSION

In psychiatrically hospitalized adolescents, ED psychopathology may be an important marker of broad psychosocial distress and behavioral problems among girls and boys, although the nature of the specific associations differs by sex.

Body investment, depression, and alcohol use as risk factors for suicide proneness in college students

BACKGROUND

Individuals who are less invested in their bodies, experiencing symptoms of depression, and consuming alcohol are at increased risk for engaging in suicidal behaviors.

AIMS

This study examined the relationships among three risk factors - body investment, depression, and alcohol use - and suicide proneness as measured by the Life Attitudes Schedule - Short Form (LAS-SF) in college students (N = 318).

METHODS

Path analysis was used to construct a causal model of suicide proneness. The Body Investment Scale (BIS) subscales were assumed to be causally prior to depression, which was in turn modeled as occurring prior to alcohol use, which was in turn modeled as prior to suicide proneness.

RESULTS

As expected, suicide proneness was positively predicted by alcohol use, alcohol use was positively predicted by depression, and depression was negatively predicted by the body image component of the BIS. Additionally, the body image-suicide proneness link was significantly mediated by depression and its direct effect on suicide proneness as well as by the two-mediator path of body image on depression on drinking on suicide proneness.

CONCLUSIONS

Implications are offered for the improved identification and treatment of young adults at risk for suicidal and health-diminishing behaviors.

Eating disorders in adolescents and their repercussions in oral health

OBJECTIVE

To examine the prevalence of oral alterations related to eating disorders and associated factors.

METHOD

A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination.

RESULTS

Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders.

DISCUSSION

Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Differences in non-suicidal self-injury and suicide attempts in adolescents

As suicide attempts and self-injury remain predominant health risks among adolescents, it is increasingly important to be able to distinguish features of self-harming adolescents from those who are at risk for suicidal behaviors. The current study examined differences between groups of adolescents with varying levels of self-harmful behavior in a sample of 373 high school students with a mean age of 15.04 (SD = 1.05). The sample was 48% female and the distribution of ethnicity was as follows: 35% Caucasian, 37.2% African-American, 16% Multi-ethnic, 9.2% Hispanic, and 2.3% Asian. The sample was divided into three groups: no history of self-harm, non-suicidal self-injury (NSSI) only, and NSSI in addition to a suicide attempt. Differences in depressive symptoms, suicidal ideation, social support, self-esteem, body satisfaction, and disordered eating were explored. Results indicated significant differences between the three groups on all variables, with the no self-harm group reporting the lowest levels of risk factors and highest levels of protective factors. Further analyses were conducted to examine specific differences between the two self-harm groups. Adolescents in the NSSI group were found to have fewer depressive symptoms, lower suicidal ideation, and greater self-esteem and parental support than the group that also had attempted suicide. The clinical implications of assessing these specific psychosocial correlates for at-risk adolescents are discussed.

Body-image dissatisfaction as a predictor of suicidal ideation among Korean boys and girls in different stages of adolescence: a two-year longitudinal study

PURPOSE

To descriptively examine trends in body dissatisfaction and suicidal ideation during adolescence, and to investigate whether body dissatisfaction at an early stage (Time 1) predicts suicidal ideation at a later stage (Time 2) among boys and girls in different stages of adolescence (early and midadolescence), controlling for Time 1 of relevant variables, including suicidal ideation, depressed mood, and self-esteem.

METHODS

Data were obtained from Korea Youth Panel Survey data sets for early adolescents (1380 boys and 1209 girls, Time 1 mean age 10 years) and midadolescents (1429 boys and 1437 girls, Time 1 mean age 15 years) and from follow-up surveys of the same individuals after 2 years. Multivariate logistic analyses were carried out to assess the relationship of Time 1 body dissatisfaction to Time 2 suicidal ideation.

RESULTS

For both genders, body dissatisfaction and suicidal ideation progressively increased until peaking at midadolescence and slightly decreasing thereafter. After controlling for psychological problems and other possible variables, body dissatisfaction prospectively predicted the risk of suicidal ideation in early-adolescent girls and midadolescent boys, but not in early-adolescent boys or midadolescent girls.

CONCLUSIONS

The results underscore that programs aimed at adolescents with body dissatisfaction should contain different material according to their gender and stage of adolescence. Such differential interventions may reduce suicide risk in adolescents.

Are body dissatisfaction, eating disturbance, and body mass index predictors of suicidal behavior in adolescents? A longitudinal study

Disordered eating, body dissatisfaction, and obesity have been associated cross sectionally with suicidal behavior in adolescents. To determine the extent to which these variables predicted suicidal ideation and attempts, the authors examined these relationships in a longitudinal design. The study population included 2,516 older adolescents and young adults who completed surveys for Project EAT-II (Time 2), a 5-year follow-up study of adolescents who had taken part in Project EAT (Time 1). Odds ratios for suicidal behaviors at Time 2 were estimated with multiple logistic regression. Predictor variables included Time 1 extreme and unhealthy weight control behaviors (EWCB and UWCB), body dissatisfaction, and body mass index percentile. Suicidal ideation was reported by 15.2% of young men and 21.6% of young women, and suicide attempts were reported by 3.5% of young men and 8.7% of young women. For young women, suicidal ideation at Time 2 was predicted by Time 1 EWCB. The odds ratio for suicide attempts was similarly elevated in young women who had reported EWCB at Time 1. These odds ratios for both suicidal ideation and suicide attempts remained elevated even after controlling for Time 2 depressive symptoms. In young men, EWCB was not associated with suicidal ideation or suicide attempts 5 years later. Body mass index and body dissatisfaction did not predict suicidal ideation or suicide attempts in young men or young women. These results emphasize the importance of EWCB.

The role of body image and disordered eating as risk factors for depression and suicidal ideation in adolescents

There is much empirical literature on factors for adolescent suicide risk, but body image and disordered eating are rarely included in these models. In the current study, disordered eating and body image were examined as risk factors for suicide ideation since these factors are prevalent in adolescence, particularly for females. It was hypothesized that disordered eating and body image, in addition to depressive symptoms, would contribute to suicide ideation. It was also hypothesized that these relationships would be stronger for females than for males. Structural equation modeling was used to test a model of risk for suicide ideation incorporating the above factors in a sample of 392 high school students. Results indicated that disordered eating contributed to both suicide ideation and depressive symptoms, while body image only contributed to depressive symptoms. Depressive symptoms contributed to suicide ideation. The model was found to be cross-validated with males and females, and no gender differences emerged. Implications of these findings and their importance in constructing future models of adolescent suicide risk are discussed.

Suicidal behavior in adolescents: relationship to weight status, weight control behaviors, and body dissatisfaction

OBJECTIVE

Suicide is associated with full syndromal eating disorders, but it is unclear whether subsyndromal eating disorders carry the same risk. This study examined associations between suicidal behaviors and extreme and less extreme weight control behaviors (EWCB and LWCB, such as fasting, vomiting, meal skipping, etc.), body dissatisfaction, and weight status in adolescents.

METHOD

Data on body dissatisfaction, depressive symptoms, suicidal ideation and attempts, and body mass index (BMI) were drawn from Project EAT, a survey of 4,746 7th-12th grade students. Multivariate logistic regression examined associations between eating- and weight-related variables and suicidality.

RESULTS

Suicidal ideation and suicide attempts were more commonly observed in adolescents with EWCB (boys: ideation OR = 2.12, attempts OR = 4.10; girls: ideation OR = 1.66, attempts OR = 2.29), LWCB (boys: ideation OR = 1.33, attempts OR = 1.76; girls: ideation OR = 1.77, attempts OR = 1.80), as well as body dissatisfaction (boys: ideation OR = 1.75, attempts OR = 2.23; girls: ideation OR = 1.77, attempts OR = 1.81), even after controlling for depressive symptoms. No association was observed between BMI and suicidal attempts or ideation.

CONCLUSION

Thus, it appears that suicidal behavior in adolescents is associated even with low-level eating disorder symptoms.

Rural/urban differences in the distribution of eating disorder symptoms among adolescents from community samples

OBJECTIVE

Rural/urban differences in the prevalence of mental disorders have often been reported in the last 30 years, among others in the distribution of eating disorder symptoms and suicide rates. The role of sex, age and socioeconomic status in the differences by place of residence has often been neglected in past studies.

METHOD

Two independent community samples of students (mean age=17.4 years, SD=1.4), taken from among those attending high school in an urban district (Cagliari; n=817) and in a rural one (Carbonia; n=507) of south Sardinia, Italy, were invited to fill in the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Test (BAT) and the revised Hopkins Symptom checklist (SCL-90-R).

RESULTS

Female students scored higher than male students on all inventories. In male participants, the scores on the EAT were higher in the urban than in the rural sample. Conversely, in both male and female students the rural sample reported higher scores on the BITE symptoms subscale. When the comparison was confined to the fraction of those who scored higher than the suggested cut-off on the EAT and the BITE, students in the urban sample outnumbered those in the rural sample. No other differences were found. Socioeconomic status and age did not influence the differences in the reporting of eating disorder symptoms by place of residence.

CONCLUSIONS

Although caution is required when reading the findings drawn from self-report instruments, it is evident that the factors influencing the distribution of eating disorder symptoms and their psychological correlates by place of residence are far more complex than currently thought.

Body image and suicidal ideation in adolescents

Data from 231 adolescents (mean age=15.7, SD=1.39) were collected from a public school setting in the United States. Participants completed several measures, including those assessing depression, hopelessness, past suicidal behavior, body image, and current suicidal ideation. It was hypothesized that depression, hopelessness, past suicidal behavior, and body image (a risk factor seldom examined) would significantly predict current suicidal ideation and that there would be gender differences for body image. Regression analyses indicated that all risk factors including body image were significant predictors of current suicidal ideation for the whole sample. For both males and females, body image offered a unique contribution to the measurement of suicide ideation above and beyond the other risk factors, with body attitudes/feelings being the strongest predictor. Results encourage the inclusion of body image as a variable in risk models for adolescent suicidal ideation, as it likely accounts for additional variance above and beyond traditional risk factors.

Eating disorders and suicide ideation: the mediating role of depression and aggressiveness

OBJECTIVE

Symptoms of depression and aggressiveness are important antecedents and correlates of suicide ideation and completion in adolescents and adults. Among adolescents, eating disorder symptoms were also found to associate with suicidal behavior. This study was aimed at investigating the role of depression and aggressiveness as mediators in the links between eating disorder symptoms and suicide ideation among adolescents, taking into account age and sex as covariates.

METHOD

Data from the Conegliano Eating Disorders Survey were used to investigate the role of depression and aggressiveness in the links between eating disorder symptoms and suicide ideation, resorting to a bootstrapped sampling distribution model.

RESULTS

In a mixed male-female sample of 930 adolescents, eating disorder symptoms were positively related to suicide ideation, taking age and sex into account. Depression and aggressiveness acted as full mediators in the links between eating disorder symptoms and suicidality, and virtually abolished any direct influence of eating disorders on suicide ideation.

CONCLUSION

Because of the cross-sectional nature of this study and the resorting to self-report scales, no firm statement about causal association can be made. However, both suicidal behavior and eating disorder symptoms are a rather widespread occurrence among adolescents, hence the investigation on suicidal tendencies in young people might benefit from the inclusion of measures of eating disorders to prevent the worst outcomes of minor psychological distress.

Sexual abuse and eating disorder symptoms: the mediator role of bodily dissatisfaction

OBJECTIVE

The relationship between sexual abuse and eating disorders remains controversial; the role of intervening variables has often been neglected in past research. This study aimed at investigating the role of bodily dissatisfaction as a mediator effect on the impact of sexual abuse and the reporting of eating disorder symptoms.

METHOD

In a community sample of 126 young women aged 18 to 30 years, we investigated the links between sexual abuse and eating disorders by means of self-compiled measures, including the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, the Body Attitudes Test (BAT), and the revised Hopkins Symptom Checklist (SCL-90-R).

RESULTS

Those who reported sexual abuse in childhood scored higher at the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, and the BAT, compared with those who denied sexual abuse or experienced sexual abuse at an age after puberty. The experience of bodily dissatisfaction, as measured by the BAT, acted as an intervening variable (mediator) between sexual abuse in childhood and eating disorder symptoms.

CONCLUSION

Although caution is required when reading the conclusions that could be drawn from self-reported measures, sexual abuse before puberty could be considered as a risk factor for the development of eating disorder symptoms, inducing revulsion about the body in ways that may intermix with concerns about body shape, size, and weight.

Body of evidence: tattoos, body piercing, and eating disorder symptoms among adolescents

OBJECTIVE

Tattoos and body piercing have been linked to risk-taking behaviors, including disordered eating, but the findings have come from selected samples that were at greater risk for bias due to comorbidity. This study set out to explore concurrently the prevalence of tattoos and body piercing, and eating disorder symptoms in a representative adolescent sample of a community in Sardinia, a major island in Italy.

METHODS

A community sample of 828 students (female, 535; male, 282; mean age=17.5+/-1.4 years) among those attending high school in the district of Cagliari, Italy, were invited to take the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, and the Body Attitudes Test, alongside a short questionnaire aimed at evaluating their resorting to body modification practices, including tattooing and body piercing.

RESULTS

Females scored higher than males at all eating disorder inventories. More males than females admitted the use of tattoos (14.5% vs. 5.4%), whereas the reverse was found for body piercing (18.4% vs. 21.3%). Tattoos among females and body piercing in both genders were statistically associated with eating disorder measures related to bulimia symptoms. On the whole, the degree of association was modest.

CONCLUSIONS

Tattoos and body piecing should be seen as desires to show a subject's identity rather than as a marker of psychopathology. Greater health education, however, is needed in the wake of the growing popularity of these body modification practices.

Indicators associated with suicidal ideation and suicide attempts among 16-35-year-old Danes: a national representative population study

In this study indicators associated with suicidal ideation and suicide attempts in a nationwide representative sample (N=3184) of Danes aged 16-35 years were examined. The study was cross-sectional and had three aims: (1) to draw a profile of persons with and without suicidal tendency established on a combined quartered variable on current suicidal thoughts and/or ever attempted suicide; (2) to explore whether the different suicidal tendencies constitute a severity continuum; and (3) to identify factors of significance for suicidal tendency. Factors included were demographic characteristics, living conditions, social network, external health risks, lifestyle, health-related quality of life, symptoms, morbidity, and illness behavior. A continuum hypothesis was not supported, as the multiple logistic regression analysis showed no clear gradient in the different forms of suicidal tendency. Cohabitation status (single, p < 0.0001), exposure to violent threats (p < 0.0001), exposure to sexual abuse (p < 0.0001), being a daily smoker (p < 0.0001), doing nothing to stay healthy (p < 0.0004), poor mental health (p < 0.0001), mental symptoms within the past 2 weeks (p = 0.0003), contact with psychologist (p < 0.0001), and absence from work due to illness (p = 0.005) were indicators significantly related to suicidal tendency.

Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects

Additional psychiatric disorders in eating disorders patients may contribute to the risk of suicide and suicide attempts. The aim of this study was to examine associations between Axes I and II comorbidity and suicidality in a large sample of women currently suffering from an eating disorder (ED). In a sample of 288 women (87 anorexia nervosa, 158 bulimia nervosa, 43 eating disorders not otherwise specified) psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview for DSM-IV. Histories of attempted suicide were explored in a structured interview. Suicidal ideation was determined by means of the SCL-90. Past suicide attempts were reported by 26%. Subjects with a purging type ED more frequently had a history of attempted suicide than subjects with a nonpurging type ED. A history of suicide attempts was associated with higher levels of Axes I and II comorbidity, in particular with affective disorders and Cluster B personality disorders. Current suicidal ideation was generally linked with higher levels of all types of Axes I and II comorbidity. Eating disorders are serious psychiatric disorders associated with high levels of comorbidity and suicidality. Incorporating a comprehensive psychiatric evaluation into the clinical assessment of ED patients is important for the assessment of suicidality and for the provision of adequate treatments.