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Ying WK, Rahman MM, Kiyu A. Suicide risk among adolescents in Sarawak, Malaysia: prevalence and determining factors. Int J Adolesc Med Health 2024; 0:ijamh-2024-0081. [PMID: 38997223 DOI: 10.1515/ijamh-2024-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES Adolescent suicide is a significant global public health concern. Although numerous studies have investigated factors that influence the risk of suicide among adolescents around the world, limited data are available in the Malaysian context, especially among the diverse ethnic communities of Sarawak. This study aimed to determine the factors associated with the risk of suicide among adolescents in Sarawak, Malaysia. METHODS A community-based cross-sectional study was conducted among 1,344 adolescents in Sarawak using face-to-face interviews. Hierarchical binary logistic regression analysis was performed to identify factors that determine the risk of suicide among adolescents. RESULTS Two predictive models were constructed. Both models revealed that being female (OR=1.578, 95 % CI: 1.191, 2.092, p=0.001), having Malay ethnicity (OR=1.733, 95 % CI: 1.236, 2.429, p=0.001) and having a disease significantly increased the risk of suicide (OR=1.895, 95 % CI: 1.221, 2.942, p=0.004). In particular, Model 2, which showed a better fit, found that occasional religious practice (OR=1.610, 95 % CI: 1.126, 2.303, p=0.009), poor parental relationships (OR=1.739, 95 % CI: 1.035, 2.922, p=0.037) and higher addiction (OR=1.015, 95 % CI: 1.008, 1.022, p=0.001), depression (OR=1.919, 95 % CI: 1.241, 2.968, p=0.003), and stress (OR=2.707, 95 % CI: 1.689, 4.340, p=0.001) scores were significantly associated with an increased risk of suicide. CONCLUSIONS This study sheds light on multiple factors that contribute to the risk of suicide among adolescents in Sarawak. These findings underscore the importance of holistic prevention strategies, including psychological and social dimensions, to mitigate the risk of suicide in this population. Further research is warranted to understand the complex interplay of these factors and guide the development of targeted interventions.
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Affiliation(s)
| | - Md Mizanur Rahman
- Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak 54706 , Kota Samarahan, Malaysia
| | - Andrew Kiyu
- Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
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Dosal A, Denhardt B, Diaz R, Obleada K, Feldman M, Reese J, Sobalvarro S. Cross-sectional and longitudinal changes in body composition, anxiety, and depression in a clinical sample of adolescents with anorexia nervosa. J Pediatr Psychol 2024; 49:340-347. [PMID: 38452291 DOI: 10.1093/jpepsy/jsae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE Eating disorders among children and adolescents have increased in prevalence, and mortality rates for anorexia nervosa are among the highest for any psychiatric disorder. Our current study aimed to (a) examine the cross-sectional relationship between body composition and anxiety/depressive symptoms among 97 adolescents and young adults who have been diagnosed with anorexia nervosa, (b) examine the longitudinal changes in body composition and anxiety/depressive symptoms over three months (from baseline to follow-up visit), and (c) examine the longitudinal relationship between change in body composition and change in anxiety/depression over three months. METHOD A retrospective chart review was conducted within an interdisciplinary eating disorder clinic between August 2019 and December 2021. In total, 97 adolescents aged 11-20 years old with diagnoses of anorexia nervosa were included in the analyses. Body composition data were collected at each visit along with parent- and youth-report measures of symptoms of anxiety/depression symptoms. RESULTS Findings indicated adolescents demonstrated some improvement in body composition, as well as parent-reported reductions in anxiety/depression symptoms. Based on parent reports, increased BMI percentile was associated with improvements in anxiety/depression symptoms. On the other hand, youth did not report significant changes in anxiety/depressive symptoms. Additionally, there were no associated improvements with body composition measures, which may be associated with continued body dissatisfaction or symptoms of anxiety and depression predating the eating disorder. CONCLUSIONS These results suggest the importance of including interventions addressing depression, anxiety, and body image as part of treatment.
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Affiliation(s)
- Alexis Dosal
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Brenna Denhardt
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Rebekah Diaz
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Katrina Obleada
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Marissa Feldman
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Jasmine Reese
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Sarah Sobalvarro
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
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Marchili MR, Bozzola E, Guolo S, Marchesani S, Spina G, Mascolo C, Vicari S, De Jacobis IT, Raponi M, Villani A. Pediatric acute hospitalization for anorexia nervosa: an economic evaluation. Ital J Pediatr 2024; 50:33. [PMID: 38413993 PMCID: PMC10900686 DOI: 10.1186/s13052-024-01605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay. METHODS for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022). RESULTS a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden. CONCLUSIONS the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management. TRIAL REGISTRATION 2526-OPBG-2021.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Child Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvio Marchesani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Mascolo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Purvis F, Snowden J. Psychologically informed care of patients with anorexia nervosa on an acute medical ward. Nurs Stand 2024; 39:38-43. [PMID: 38152022 DOI: 10.7748/ns.2023.e12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/29/2023]
Abstract
Anorexia nervosa is a challenging and highly distressing illness associated with significant and often debilitating symptoms that affect the person's physical and mental well-being, as well as their wider social networks. Although some patients can make important steps in their recovery in the community, many will become significantly unwell and require medical stabilisation and refeeding in an acute medical ward as a result of significant weight loss. This article describes some of the challenges experienced by adult nurses when caring for patients with anorexia nervosa on acute medical wards and explores how the patient's distress may manifest and complicate the recovery process. The article also discusses the principles of psychologically informed care and therapeutic interactions that nurses can use to promote recovery and ensure optimal practice.
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Affiliation(s)
- Francesca Purvis
- Department of Nursing, Midwifery and Health, School of Health Sciences, University of Southampton, Hampshire, England
| | - Jasmine Snowden
- Department of Nursing, Midwifery and Health, School of Health Sciences, University of Southampton, Hampshire, England
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5
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Conway-Jones R, James A, Goldacre MJ, Seminog OO. Risk of self-harm in patients with eating disorders: English population-based national record-linkage study, 1999-2021. Int J Eat Disord 2024; 57:162-172. [PMID: 37949682 DOI: 10.1002/eat.24091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population. METHOD A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis. RESULTS We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH. DISCUSSION Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required. PUBLIC SIGNIFICANCE This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.
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Affiliation(s)
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - M J Goldacre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - O O Seminog
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Langjord T, Pedersen G, Bovim T, Christensen TB, Eikenæs IUM, Hove O, Kildahl AN, Mork E, Norheim AB, Ramleth RK, Ringen PA, Romm KL, Siqveland J, Schønning T, Stänicke L, Torgersen T, Pettersen M, Tveit T, Urnes Ø, Walby F, Kvarstein EH. Mental health disorders, functioning and health-related quality of life among extensively hospitalized patients due to severe self-harm - results from the Extreme Challenges project. Front Psychiatry 2023; 14:1258025. [PMID: 37920539 PMCID: PMC10619742 DOI: 10.3389/fpsyt.2023.1258025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/19/2023] [Indexed: 11/04/2023] Open
Abstract
Background Severe self-harm leading to extensive hospitalization generates extreme challenges for patients, families, and health services. Controversies regarding diagnoses and health care often follow. Most evidence-based treatments targeting self-harm are designed for borderline personality disorder (BPD). However, current knowledge about mental health status among individuals with severe self-harm is limited. Objectives To investigate psychopathology among patients extensively hospitalized due to severe or frequent self-harming behaviors. Method A cross sectional study (period 2019-2021) targeting psychiatric inpatients (>18 years) with frequent (>5) or long (>4 weeks) admissions last year due to self-harm. The target sample (N = 42, from 12 hospitals across all Norwegian health regions) was compared to individuals admitted to outpatient personality disorder (PD) treatment within specialist mental health services in the same period (N = 389). Clinicians performed interviews on self-harm and psychopathology, supplemented by self-report. Results The target sample were young adults, mainly female, with considerable hospitalization and self-harming behaviors, both significantly more extensive than the comparison group. The majority in both groups reported self-harm onset <18 years. The target sample reported increasing severity of self-harm acts and suicidal intention over time. Both samples had high levels of childhood trauma, impaired personality functioning, and a majority fulfilled criteria for PD. In the target sample, comorbid depression, PTSD, anxiety disorders, and substance use occurred more frequently and in 50%, psychosis/dissociative disorder/autism spectrum disorder/ADHD was reported (outpatient comparison sample: 9%). 35% in the target sample screened over cut-off for possible intellectual disability. The target sample reported poor psychosocial functioning and health-related quality of life - greater impairment than the outpatient comparison sample. Conclusion The study reveals that severe self-harm inpatients have complex psychopathology and highlights the importance of individualized and thorough assessment among patients with severe and/or repetitive self-harm.
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Affiliation(s)
- Tuva Langjord
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Geir Pedersen
- Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Tone Bovim
- Regional Centre – Violence, Trauma and Suicide Prevention, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Ingeborg Ulltveit-Moe Eikenæs
- National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Oddbjørn Hove
- Department of Research and Innovation, Helse Fonna Health Trust, Haugesund, Norway
| | - Arvid Nikolai Kildahl
- Norwegian Centre of Competence for Intellectual Disabilities and Mental Health, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Nevsom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Erlend Mork
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ruth Kari Ramleth
- Department for Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petter Andreas Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department for Research, Division of Mental Health and Addiction, Akershus University Hospital, Oslo, Norway
| | | | - Line Stänicke
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Child and Adolescent Psychiatry, Nic Waal Institute, Lovisenberg Hospital, Oslo, Norway
| | - Terje Torgersen
- Department of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona Pettersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tone Tveit
- Division of Mental Health and Addiction, Bergen University Hospital, Bergen, Norway
| | - Øyvind Urnes
- National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Fredrik Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Li Z, Leppanen J, Webb J, Croft P, Byford S, Tchanturia K. Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators. Psychiatry Res 2023; 326:115272. [PMID: 37276647 PMCID: PMC10790244 DOI: 10.1016/j.psychres.2023.115272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
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Affiliation(s)
- Zhuo Li
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Croft
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK; National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia.
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Duriez P, Goueslard K, Treasure J, Quantin C, Jollant F. Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study. Int J Eat Disord 2023; 56:1534-1543. [PMID: 37092760 DOI: 10.1002/eat.23974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Eating disorders (ED) are associated with high rates of suicide attempts and premature mortality. However, data in large samples of adolescents and young adults are limited. This study aims to assess the risk of self-harm and premature mortality in young people hospitalized with an ED. METHODS Individuals aged 12 to 25 years old hospitalized in 2013-2014 in France with anorexia nervosa and/or bulimia nervosa as a primary or associated diagnosis were identified from French national health records. They were compared to two control groups with no mental disorders, and with any other mental disorder than ED. The main outcomes were any hospitalization for deliberate self-harm and mortality in the 3 years following hospitalization. Logistic regression models were used. RESULTS This study included 5, 452 patients hospitalized with an ED, 14,967 controls with no mental disorder, and 14,242 controls with a mental disorder other than an ED. During the three-year follow-up, 13.0% were hospitalized for deliberate self-harm (vs. 0.2 and 22.0%, respectively) and 0.8% died (vs. 0.03 and 0.4%). After adjustment, hospitalization with an ED was associated with more self-harm hospitalizations (hazard ratio [HR] = 46.0, 95% confidence interval [32.3-65.3]) and higher all-cause mortality (HR = 12.6 [4.3-37.3]) relative to youths without any mental disorder; less self-harm hospitalizations (HR = 0.5 [0.5-0.6]) but higher mortality (HR = 1.6 [1.0-2.4]) when compared to youths with any other mental disorder. CONCLUSION Young patients hospitalized with an ED are at high risk of self-harm and premature mortality. It is urgent to evaluate and implement the best strategies for post-discharge care and follow-up. PUBLIC SIGNIFICANCE We found that the risk of being hospitalized for a suicide attempt is 46 times higher and mortality 13 times higher than the general population in adolescents and young adults during the 3 years following hospitalization with an eating disorder. Eating disorders are also associated with a 1.5 higher risk of premature mortality relative to other mental disorders. This risk is particularly high in the 6 months following hospitalization. It is therefore crucial to implement careful post-discharge follow-up in patients hospitalized for eating disorders.
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Affiliation(s)
- Philibert Duriez
- CMME, Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris, France
- UMR_S1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm, Paris, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Karine Goueslard
- Service de Biostatistiques et d'Information Médicale (DIM), CHRU Dijon, Dijon, France
| | - Janet Treasure
- Psychology and Neuroscience, Section of Eating Disorders, Institute of Psychiatry, London, UK
| | - Catherine Quantin
- CIC 1432, INSERM, Dijon, France
- Clinical Epidemiology Clinical Trials Unit, Clinical Investigation Center, CHU Dijon, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Fabrice Jollant
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU de Nîmes, Nîmes, France
- Department of Psychiatry, Faculty of Medicine, and McGill Group For Suicide Studies, McGill University, Montréal, Québec, Canada
- Team MOODS, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Confirmatory factor analysis of Acute Suicidal Affective Disturbance in a sample of treatment-seeking eating disorder patients. J Affect Disord 2023; 326:155-162. [PMID: 36724842 DOI: 10.1016/j.jad.2023.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We examined the factor structure of Acute Suicidal Affective Disturbance (ASAD) in individuals with eating disorders. ASAD is a proposed diagnosis with four symptoms: rapidly increasing suicidal intent, social or self-alienation, hopelessness regarding the previous symptoms, and overarousal. METHODS Patients with eating disorders (N = 378) completed self-report symptom questionnaires at admission to a partial hospitalization program for eating disorders. Using proxy measures, we conducted a confirmatory factor analysis (CFA) of the one-factor model of ASAD. RESULTS Initial model fit was poor. We iteratively revised the model to include theoretically-justified correlated residuals (i.e., those between items intended to measure the same ASAD symptom). After these modifications, model fit remained mediocre. We next conducted a multiple-group CFA to compare ASAD between individuals with the restricting subtype of anorexia nervosa (the "ANR" model, n = 145) and individuals with binge/purge disorders (i.e., bulimia nervosa and the binge-purge subtype of anorexia nervosa; the "BP" model, n = 234). The final model had mediocre fit with partial invariance between subgroups; the ASAD factor mean was higher in the BP model. We additionally tested a bifactor model, with similar findings. LIMITATIONS Our use of proxy measures of ASAD items may have resulted in imprecise measurement of ASAD symptoms, pointing to the importance of future research using validated measures of ASAD. CONCLUSIONS We found moderate support for ASAD in an eating disorder sample, with invariance between eating disorder phenotypes. Our findings suggest that the ASAD diagnosis may not fully generalize to eating disorder samples.
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Arnold S, Correll CU, Jaite C. Frequency and correlates of lifetime suicidal ideation and suicide attempts among consecutively hospitalized youth with anorexia nervosa and bulimia nervosa: results from a retrospective chart review. Borderline Personal Disord Emot Dysregul 2023; 10:10. [PMID: 36998054 PMCID: PMC10064676 DOI: 10.1186/s40479-023-00216-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/25/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Youth with eating disorders (EDs) face an increased risk of a premature suicide death. Precursors of completed suicide are suicidal ideation and suicide attempts, which need to be well understood to prevent suicide. However, epidemiological data on the lifetime prevalence and clinical correlates of suicidal ideation and suicide attempts (i.e., "suicidality") are lacking for the vulnerable group of inpatient ED youth. METHODS This retrospective chart review was conducted at a psychiatric child and adolescent inpatient department, covering a 25-year period. Consecutively hospitalized youth with an ICD-10 diagnosis of anorexia nervosa (AN), restricting type (AN-R), binge-purging type (AN-BP), and bulimia nervosa (BN) were included. Data extraction and coding were standardized with trained raters extracting information from patient records according to a procedural manual and using a piloted data extraction template. The lifetime prevalence of suicidal ideation and suicide attempts was calculated for each ED subgroup, and clinical correlates of suicidality were analyzed via multivariable regression analyses. RESULTS In the sample of 382 inpatients aged 9-18 years (median age = 15.6, females = 97.1%; AN-R: n = 242, BN: n = 84, AN-BP: n = 56), 30.6% of patients had lifetime suicidal ideation (BN:52.4% ≈ AN-BP:44.6% > AN-R:19.8%, χ2(2,382) = 37.2, p < 0.001, Φ = 0.31), and 3.4% of patients reported a history of suicide attempts (AN-BP:8.9% ≈ BN:4.8% > AN-R:1.7%, χ2(2,382) = 7.9, p = 0.019, Φ = 0.14). Independent clinical correlates of suicidality were i) for AN-R a higher number of psychiatric comorbidities (OR = 3.02 [1.90, 4.81], p < 0.001), and body weight < 1st BMI percentile at hospital admission (OR = 1.25 [1.07,1.47], p = 0.005) (r2 = 0.20); ii) for AN-BP patients a higher number of psychiatric comorbidities (OR = 3.68 [1.50, 9.04], p = 0.004) and history of childhood abuse (OR = 0.16 [0.03, 0.96], p = 0.045) (r2 = 0.36), and iii) for BN patients a higher prevalence of non-suicidal self-injury (NSSI)(OR = 3.06 [1.37, 6.83], p = 0.006) (r2 = 0.13). CONCLUSIONS About half of youth inpatients with AN-BP and BN had lifetime suicidal ideation, and one-tenth of patients with AN-BP had attempted suicide. Treatment programs need to address specific clinical correlates of suicidality, namely, low body weight, psychiatric comorbidities, history of childhood abuse, and NSSI. TRIAL REGISTRATION This study was not a clinical trial but a retrospective chart review based on routinely assessed clinical parameters. The study includes data from human participants; however: (1) no intervention and no prospective assignment to interventions were performed, and (2) no evaluation of intervention in participants was accomplished.
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Affiliation(s)
- Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
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12
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Kinkel-Ram SS, Grunewald W, Bodell LP, Smith AR. Unsound sleep, wound-up mind: a longitudinal examination of acute suicidal affective disturbance features among an eating disorder sample. Psychol Med 2023; 53:1518-1526. [PMID: 34348803 DOI: 10.1017/s003329172100310x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders. METHODS Women (N = 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment. RESULTS There was a significant interaction between within-person agitation and sleep quality on suicidal ideation [B(s.e.) = -0.02(0.01), p < 0.05], such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation. CONCLUSIONS This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.
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Affiliation(s)
| | | | - Lindsay P Bodell
- Department of Psychology, Western University, London, Ontario, Canada
| | - April R Smith
- Department of Psychology, Auburn University, Auburn, Alabama, USA
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13
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Katsuki F, Yamada A, Kondo M, Sawada H, Watanabe N, Akechi T. Association between social support for mothers of patients with eating disorders and mothers' active listening attitude: a cohort study. Biopsychosoc Med 2023; 17:4. [PMID: 36782255 PMCID: PMC9926733 DOI: 10.1186/s13030-023-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Family members of patients with eating disorders, especially their mothers, experience heavy caregiving burdens associated with supporting the patient. We predict that increasing caregivers' support will have a positive effect on their active listening attitudes, mental health, loneliness, and self-efficacy. This study aimed to investigate differences in mothers' active listening attitudes, mental health, loneliness, and self-efficacy improvements between mothers who did and did not experience increased perceived social support. MAIN BODY Participants were mothers of patients with eating disorders. Questionnaires for this cohort study were sent to the participants' homes at three time points (baseline, 9 months, and 18 months). The Japanese version of the Social Provision Scale (SPS-10) was used to evaluate social support, the Active Listening Attitude Scale (ALAS) for listening attitude, the UCLA Loneliness Scale (ULS) for loneliness, the General Self-Efficacy Scale (GSES) for self-efficacy, the Beck Depression Inventory (BDI-II) for depression symptoms, and the K6 for psychological distress. An unpaired t-test was used to determine whether participants' status differed between the groups that did and did not experience increased perceived social support. The mean age of the participants was 55.1 ± 6.7 (mean ± SD) years. The duration of their children's eating disorders was 7.6 ± 5.5 years. The degree of improvement for each variable (active listening attitude, loneliness, self-efficacy, depressive symptoms, and mental health) was the difference in each score (ALAS, ULS, GSES, BDI-II, and K6) from T1 to T3. The degree of improvement in active listening attitude and loneliness was significantly greater in the improved social support group than in the non-improved social support group (p < 0.002 and p < 0.012, respectively). CONCLUSIONS Our findings indicate that increasing mothers' perceptions of social support will be associated with improving their active listening attitudes and loneliness.
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Affiliation(s)
- Fujika Katsuki
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Japan.
| | - Atsurou Yamada
- grid.260433.00000 0001 0728 1069Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Japan
| | - Masaki Kondo
- grid.260433.00000 0001 0728 1069Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Japan
| | - Hanayo Sawada
- grid.260433.00000 0001 0728 1069Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, 101 Shimotoba, Hiroosa-Machi, Fushimiku, Kyoto Japan
| | - Tatsuo Akechi
- grid.260433.00000 0001 0728 1069Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Japan
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14
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Reas DL, Wisting L, Lindvall Dahlgren C. Co-occurrence of nonsuicidal self-injury and eating disorder pathology in adolescents. Int J Eat Disord 2023; 56:439-445. [PMID: 36524669 PMCID: PMC10107669 DOI: 10.1002/eat.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Little is known about the co-occurrence of nonsuicidal self-injurious (NSSI) behaviors and eating disorder (ED) pathology in community samples of adolescents. METHODS A total of 1558 Norwegian upper secondary school students (Grades 11, 12, and 13) completed the Deliberate Self-Harm Inventory and a measure of ED pathology. RESULTS Adolescents (53.1% F, 46.9% M) were a mean age of 17.1 years. A higher level of ED pathology was reported (12.1 vs. 5.3, p < .001) among adolescents who had a history of NSSI. Significantly higher levels of ED pathology were found among females who reported hitting themselves until bruised, head banging, severe scratching, and burning with a lighter, but not cutting, or the other forms of self-injury. Of adolescents with a history of NSSI, 60% of females and 15% of males scored above a cutoff for ED pathology. Of adolescents scoring above a cutoff for ED pathology, 42.5% of females and 37.1% of males had engaged in lifetime NSSI. DISCUSSION Adolescents-in particular, females- with a history of NSSI reported significantly greater ED pathology. Notably, a higher proportion of males with ED pathology reported lifetime self-injury than vice versa, underscoring the importance of carefully screening for the presence of self-harm among males with ED pathology. PUBLIC SIGNIFICANCE STATEMENT Over 1500 upper secondary school students with an average age of 17 years completed an online survey assessing current ED pathology and lifetime NSSI. Adolescents, particularly females, with a history of self-harm reported significantly more ED pathology. Findings also indicated the need to carefully screen for self-harm among males with ED pathology. Parents, schools, and health professionals should be aware that self-harm and ED pathology commonly co-occur and warrant assessment.
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Affiliation(s)
- Deborah Lynn Reas
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Line Wisting
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Oslo New University College, Oslo, Norway
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Khoubaeva D, Dimick M, Timmins VH, Fiksenbaum LM, Mitchell RHB, Schaffer A, Sinyor M, Goldstein BI. Clinical correlates of suicidality and self-injurious behaviour among Canadian adolescents with bipolar disorder. Eur Child Adolesc Psychiatry 2023; 32:41-51. [PMID: 34028609 DOI: 10.1007/s00787-021-01803-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
There is high risk of suicidality in bipolar disorder (BD), particularly in early onset cases. The literature regarding correlates and putative predictors of suicide attempts (SA), non-suicidal self-injury (NSSI) and suicidal ideation (SI) among youth with BD remains sparse. Participants included 197 adolescents with BD, divided into 4 groups: SA (with or without NSSI), NSSI (with or without SI), SI only, and comparison group (CG; no SA/NSSI/SI). Diagnoses, treatment, and suicidality measures were determined via semi-structured interviews, conducted between 2009 and 2017. Univariate analyses were followed by multinomial regression. Overall, 73.6% of participants had history of SA, NSSI, and/or SI. In comparison to CG, SA and NSSI were each associated with BD-II/-NOS (odds ratio [OR] = 15.99, p = 0.002; OR = 16.76, p = 0.003), female sex (OR = 6.89, p = 0.006; OR = 3.76, p = 0.02), and emotion dysregulation (OR = 1.10, p < 0.001; OR = 1.07, p = 0.004). NSSI and SI were each associated with most severe lifetime depression (OR = 1.10, p = 0.01; OR = 1.10, p = 0.01). SA and SI were associated with psychiatric hospitalization (OR = 19.45, p = 0.001; OR = 6.09, p = 0.03). SA was associated with poorer global functioning at most severe episode (OR = 0.88, p = 0.008). NSSI was associated with not living with both natural parents (OR = 0.22, p = 0.009). Study limitations include cross-sectional and retrospective design, stringent cut-offs for SA and NSSI, and recruitment from a tertiary clinical setting. Three quarters of adolescents with BD have had suicidality and/or self-injury. SA and NSSI were most similar to one another, and most different from CG, supporting the broader construct of self-harm. Future research should address the gap in knowledge regarding how sex differences and neurobiology are associated with the observed clinical differences.
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Affiliation(s)
- Diana Khoubaeva
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Mikaela Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Vanessa H Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | | | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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16
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Drzał E, Banaszek A, Stanicki P, Wingralek Z. Self-mutilation in people with psychiatric diagnosis - literature review. CURRENT PROBLEMS OF PSYCHIATRY 2023. [DOI: 10.12923/2353-8627/2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Introduction: Self-mutilation is of an auto-aggressive nature. They take many forms. Usually they do not occur as an isolated phenomenon. Self-injuring persons often have a diagnosed mental disorder, and a psychiatric diagnosis is one of the risk factors for the occurrence of self-harm.
Material and method: In this study, articles were analyzed that contained information on the occurrence of various mental disorders. These articles searched for information on the occurrence of self-mutilation, its type, origin and causes.
Discussion: Self-mutilation is common in patients with a psychiatric diagnosis. The frequency of such behaviors can range from 33% to 50% in people with autism, up to 22%, and even 49% in people diagnosed with psychotic disorders. Acts of selfharm may affect 50-78% of people diagnosed with border-line personality disorder. In adolescents with eating disorders, 41% of patients report self-harm. In the group of people diagnosed with bipolar disorder, it may be as high as 77.3%. People with depression are also a large self-injuring group. It is reported that it may be up to 71.2% of patients with unipolar disorder.
Conclusions: Self-mutilation is a phenomenon that is more and more topical and common not only in the adolescent population. This is a multi-factorial issue. One of the risk factors are mental disorders. Self-mutineers choose various methods, and this choice depends, among others, on from recognition. The size of the phenomenon and its evolution make it necessary to study it in order to increase the level of knowledge, update information and, consequently, the ability to help people at risk of NSSI.
Keywords: self-mutilation, autism spectrum disorder, schizophrenia, bipolar disorder, personality disorders
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Affiliation(s)
- Ewelina Drzał
- I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
| | - Agnieszka Banaszek
- Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
| | - Paweł Stanicki
- Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
| | - Zuzanna Wingralek
- Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
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Unique and shared correlates of disordered eating and non-suicidal self-injury among school-based adolescents. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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18
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Yang P, Wang T, Herold F, Müller NG, Taylor A, Szabo A, Granziol U, Cook B, Landolfi E, Solmi M, Zou L. Relationships between personality traits and disordered eating among Chinese female exercisers: the role of symptoms of exercise dependence and obsessive-compulsiveness. J Eat Disord 2022; 10:169. [PMID: 36397179 PMCID: PMC9670462 DOI: 10.1186/s40337-022-00679-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although numerous studies have examined associations between personality traits and eating disorders in females, few studies have been conducted on female exercisers. Given the high risk of disordered eating in female exercisers, this study investigated the associations between the Big Five personality traits and disordered eating in female exercisers, and further explored the potential mediators, namely exercise dependence symptoms, and obsessive-compulsive symptoms underlying this association. METHODS A total of 295 female exercisers aged between 18 to 67 years (M = 22.11, SD = 6.65) participated in this study. RESULTS Negative and statistically significant correlations between conscientiousness (r = - 0.17, p < 0.01), emotional stability (r = - 0.27, p < 0.001) and agreeableness (r = - 0.18, p < 0.01) and disordered eating were observed in our sample of female exercisers. The multiple mediation analyses revealed that exercise dependence symptoms and obsessive-compulsive symptoms mediate the relationship between conscientiousness (β = 0.016, CI = [0.003, 0.031]), emotional stability (β = -0.012, CI = [- 0.028, - 0.002]), and disordered eating in female exercisers, whereas obsessive-compulsive symptoms (β = - 0.041, CI = [- 0.088, - 0.001]) but not exercise dependence symptoms are a mediator of the relationship between agreeableness and disordered eating. CONCLUSIONS Our findings can be used to improve the screening procedures for eating disorders in female exercisers as they contribute to a better understanding of the psychological mechanisms that underlie the associations between the Big Five personality traits and disordered eating.
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Affiliation(s)
- Peiying Yang
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ting Wang
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Alyx Taylor
- School of Rehabilitation, Sport and Psychology, AECC University College, Bournemouth, BH5 2DF, UK
| | - Attila Szabo
- Institute of Health Promotion and Sport Science, ELTE, Eötvös Loránd Unbiversity, Budapest, Hungary
| | - Umberto Granziol
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Emilio Landolfi
- Faculty of Health Sciences, School of Kinesiology, University of the Fraser Valley, Abbotsford, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Child and Adolescent Psychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Liye Zou
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China.
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19
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Timko CA, Dennis NJ, Mears C, Rodriguez D, Fitzpatrick KK, Peebles R. Post-traumatic stress symptoms in parents of adolescents hospitalized with Anorexia nervosa. Eat Disord 2022; 31:212-224. [PMID: 35938512 DOI: 10.1080/10640266.2022.2099604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The current study was a planned secondary analysis to examine post-traumatic stress symptoms (PTSS) in parents of youth hospitalized for medical stabilization due to anorexia nervosa (AN). Questionnaires were administered to 47 parents (34 mothers, 13 fathers; 10 parental dyads) after admission; follow-up occurred at discharge and 4 weeks, 3 months, and 6 months post-discharge. PTSS were present in the majority of mothers (55.9%) and fathers (61.5%). PTSS were not associated with illness severity, but were associated with parental report of mood symptoms, avoidance, inflexibility, and symptom accommodation. Parental PTSS may negatively impact the adolescent rate of weight gain post-discharge. As hospitalization of a child for medical management of AN can be a traumatizing experience for parents, astute attention should be paid by medical staff to their needs. More work needs to be done to understand the impact of PTSS on parents of adolescents with AN.
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Affiliation(s)
- C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas J Dennis
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Connor Mears
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel Rodriguez
- Department of Public Health, LaSalle University, Philadelphia, Pennsylvania, USA
| | | | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Lydecker JA, Grilo CM, Hamilton A, Barnes RD. Digital self-harm is associated with disordered eating behaviors in adults. Eat Weight Disord 2022; 27:2129-2136. [PMID: 35066861 PMCID: PMC9288535 DOI: 10.1007/s40519-021-01355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Eating-disorder psychopathology is associated with self-harm behaviors. With much time spent and many social interactions taking place online, self-cyberbullying has emerged as a new form of self-harm that is digital. The current study examined digital self-harm in adults and its associations with eating-disorder psychopathology and behaviors. METHODS Participants were adults (N = 1794) who completed an online cross-sectional survey. Participants reported whether they had ever posted mean things about themselves online, whether they had ever anonymously bullied themselves online and completed measures of eating-disorder psychopathology and disordered eating behaviors. RESULTS Digital self-harm was reported by adults across demographic characteristics and across the lifespan, although there were some significant differences in demographic characteristics associated with reported digital self-harm. Participants who engaged in digital self-harm were younger than those denying digital self-harm. Eating-disorder psychopathology and disordered eating behaviors were significantly higher among individuals reporting digital self-harm compared with age-matched controls. CONCLUSIONS This was the first study to examine digital self-harm among adults and the first study to examine associations of digital self-harm with eating-disorder psychopathology and disordered eating behaviors. Importantly, digital self-harm is reported by adults and therefore is not limited to youth. Our findings that digital self-harm is associated with disordered eating suggests that digital self-harm is a clinically significant topic that needs further research to inform clinical practice and clinical research. LEVEL OF EVIDENCE Level III, Evidence obtained from well-designed cohort or case-controlled analytic studies.
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Affiliation(s)
- Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Antonia Hamilton
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Rachel D Barnes
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.,Health Psychology, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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21
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Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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22
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Arnold S, Wiese A, Zaid S, Correll CU, Jaite C. Lifetime prevalence and clinical correlates of nonsuicidal self-injury in youth inpatients with eating disorders: a retrospective chart review. Child Adolesc Psychiatry Ment Health 2022; 16:17. [PMID: 35227292 PMCID: PMC8884089 DOI: 10.1186/s13034-022-00446-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Youths with eating disorders (EDs) engaging in nonsuicidal self-injury (NSSI) are at higher suicide risk because EDs and NSSI are associated with suicidality. However, epidemiologic data on NSSI lacks in the vulnerable group of youth ED inpatients. METHODS This retrospective chart review included patients up to 18 years of age with an ICD-10 diagnosis of anorexia nervosa, restricting type (AN-R), anorexia nervosa, binge-purge type (AN-BP), and bulimia nervosa (BN), treated at the child and adolescent inpatient department of the University Hospital in Berlin, Germany, between 1990 and 2015. Across and within ED subgroups, lifetime NSSI prevalence, methods of self-harm, and clinical correlates were evaluated. Independent correlations of demographic and clinical factors with NSSI were identified via multivariable regression models. RESULTS Of 382 inpatients (median = 15.6 (range = 9-18) years, females = 97.1%), 21.5% reported lifetime NSSI, consisting of cutting = 86.6%, scratching = 12.2%, and hitting = 8.5%. NSSI was more frequent in BN (47.6%) and AN-BP (39.3%) than AN-R (8.3%) (Φ = 0.43). Across ED subgroups, NSSI was associated with a higher prevalence of psychiatric comorbidities (AN-R: Φ = 0.55; AN-BP: Φ = 0.69; BN: Φ = 0.78), suicidal ideation (AN-R: Φ = 0.30; AN-BP: Φ = 0.38; BN: Φ = 0.29), and psychiatric medication use (AN-R: Φ = 0.23; AN-BP: Φ = 0.64; BN: Φ = 0.60). In multivariable regression analyses, NSSI was independently associated with a higher prevalence of psychiatric comorbidities (AN-R: OR = 2.93 [1.42, 6.04]; AN-BP: OR = 2.67 [1.13, 6.31]; BN: OR = 3.75 [1.71, 8.23]). Additionally, independent correlates with NSSI in AN-R included a higher prevalence of suicidal ideation (OR = 0.21 [0.72, 0.64]) and less weekly weight gain (OR = 0.03 [0.02, 0.43]), while in BN, NSSI was correlated with longer inpatient treatment duration (OR = 1.01 [1.00, 1.02]). CONCLUSIONS There is a high lifetime prevalence of NSSI among youth with AN and BN requiring inpatient treatment, especially those with binge-purge behaviors. Treatment programs must be tailored to address psychiatric comorbidities and suicidality to improve patient care and suicide prevention. TRIAL REGISTRATION This study was not considered a clinical trial but a retrospective chart review based on routinely assessed clinical parameters. The study includes data from human participants, however: (1) no intervention and no prospective assignment to interventions were performed, and (2) no evaluation of an intervention on participants was accomplished.
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Affiliation(s)
- Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Antonia Wiese
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Zaid
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph U. Correll
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany ,grid.440243.50000 0004 0453 5950Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY USA ,grid.512756.20000 0004 0370 4759Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Charlotte Jaite
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
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23
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Cliffe C, Seyedsalehi A, Vardavoulia K, Bittar A, Velupillai S, Shetty H, Schmidt U, Dutta R. Using natural language processing to extract self-harm and suicidality data from a clinical sample of patients with eating disorders: a retrospective cohort study. BMJ Open 2021; 11:e053808. [PMID: 34972768 PMCID: PMC8720985 DOI: 10.1136/bmjopen-2021-053808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine risk factors for those diagnosed with eating disorders who report self-harm and suicidality. DESIGN AND SETTING This study was a retrospective cohort study within a secondary mental health service, South London and Maudsley National Health Service Trust. PARTICIPANTS All diagnosed with an F50 diagnosis of eating disorder from January 2009 to September 2019 were included. INTERVENTION AND MEASURES Electronic health records (EHRs) for these patients were extracted and two natural language processing tools were used to determine documentation of self-harm and suicidality in their clinical notes. These tools were validated manually for attribute agreement scores within this study. RESULTS The attribute agreements for precision of positive mentions of self-harm were 0.96 and for suicidality were 0.80; this demonstrates a 'near perfect' and 'strong' agreement and highlights the reliability of the tools in identifying the EHRs reporting self-harm or suicidality. There were 7434 patients with EHRs available and diagnosed with eating disorders included in the study from the dates January 2007 to September 2019. Of these, 4591 (61.8%) had a mention of self-harm within their records and 4764 (64.0%) had a mention of suicidality; 3899 (52.4%) had mentions of both. Patients reporting either self-harm or suicidality were more likely to have a diagnosis of anorexia nervosa (AN) (self-harm, AN OR=3.44, 95% CI 1.05 to 11.3, p=0.04; suicidality, AN OR=8.20, 95% CI 2.17 to 30.1; p=0.002). They were also more likely to have a diagnosis of borderline personality disorder (p≤0.001), bipolar disorder (p<0.001) or substance misuse disorder (p<0.001). CONCLUSION A high percentage of patients (>60%) diagnosed with eating disorders report either self-harm or suicidal thoughts. Relative to other eating disorders, those diagnosed with AN were more likely to report either self-harm or suicidal thoughts. Psychiatric comorbidity, in particular borderline personality disorder and substance misuse, was also associated with an increase risk in self-harm and suicidality. Therefore, risk assessment among patients diagnosed with eating disorders is crucial.
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Affiliation(s)
- Charlotte Cliffe
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Aida Seyedsalehi
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Katerina Vardavoulia
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - André Bittar
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Sumithra Velupillai
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Hitesh Shetty
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Ulrike Schmidt
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Rina Dutta
- South London & Maudsley, NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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24
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Krug I, Arroyo MD, Giles S, Dang AB, Kiropoulos L, De Paoli T, Buck K, Treasure J, Fuller-Tyszkiewicz M. A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms. J Eat Disord 2021; 9:153. [PMID: 34809723 PMCID: PMC8607624 DOI: 10.1186/s40337-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.
| | - Mercedes Delgado Arroyo
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.,Department of Psychiatry, University Hospital Vall de' Hebron, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Tara De Paoli
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Kim Buck
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, King's College London, London, UK
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
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25
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A review of sex differences in the mechanisms and drivers of overeating. Front Neuroendocrinol 2021; 63:100941. [PMID: 34454955 DOI: 10.1016/j.yfrne.2021.100941] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/23/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
Disordered eating is often associated with marked psychological and emotional distress, and severe adverse impact on quality of life. Several factors can influence eating behavior and drive food consumption in excess of energy requirements for homeostasis. It is well established that stress and negative affect contribute to the aetiology of eating disorders and weight gain, and there is substantial evidence suggesting sex differences in sub-clinical and clinical types of overeating. This review will examine how negative affect and stress shape eating behaviors, and how the relationship between the physiological, endocrine, and neural responses to stress and eating behaviors differs between men and women. We will examine several drivers of overeating and explore possible mechanisms underlying sex differences in eating behavior.
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26
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Dissociation and Suicidality in Eating Disorders: The Mediating Function of Body Image Disturbances, and the Moderating Role of Depression and Anxiety. J Clin Med 2021; 10:jcm10174027. [PMID: 34501475 PMCID: PMC8432476 DOI: 10.3390/jcm10174027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED on the relationship between elevated dissociation and elevated suicidality. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Participants were assessed using self-rating questionnaires for dissociation, suicidality, bodily related parameters, and severity of ED symptomatology, depression, and anxiety. We found that dissociation and suicidality were directly associated. In addition, depression and anxiety moderated the mediating role of body image parameters in the association between increased dissociation and increased suicidality. Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. ED-related parameters did not moderate these relationships. Our study demonstrates that in inpatients with EDs, increased dissociation may be significantly associated with increased suicidality, both directly and via the intervening influence of body image, depression, and anxiety.
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27
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Mental Pain in Eating Disorders: An Exploratory Controlled Study. J Clin Med 2021; 10:jcm10163584. [PMID: 34441880 PMCID: PMC8397208 DOI: 10.3390/jcm10163584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Mental pain (MP) is a transdiagnostic feature characterized by depression, suicidal ideation, emotion dysregulation, and associated with worse levels of distress. The study explores the presence and the discriminating role of MP in EDs in detecting patients with higher depressive and ED-related symptoms. Seventy-one ED patients and 90 matched controls completed a Clinical Assessment Scale for MP (CASMP) and the Mental Pain Questionnaire (MPQ). ED patients also completed the Beck Depression Inventory-II (BDI-II), Clinical Interview for Depression (CID-20), and Eating Attitudes Test (EAT-40). ED patients exhibited significantly greater severity and higher number of cases of MP than controls. Moreover, MP resulted the most important cluster predictor followed by BDI-II, CID-20, and EAT-40 in discriminating between patients with different ED and depression severity in a two-step cluster analysis encompassing 87.3% (n = 62) of the total ED sample. Significant positive associations have been found between MP and bulimic symptoms, cognitive and somatic-affective depressive symptoms, suicidal tendencies, and anxiety-related symptoms. In particular, those presenting MP reported significantly higher levels of depressive and anxiety-related symptoms than those without. MP represents a clinical aspect that can help to detect more severe cases of EDs and to better understand the complex interplay between ED and mood symptomatology.
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28
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Vieira AI, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Group-based intervention for eating disorders with non-suicidal-self-injury: a case series. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ana Isabel Vieira
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Tânia F. Rodrigues
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sónia Gonçalves
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
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29
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Ruiz-Ramos D, Martínez-Magaña JJ, García AR, Juarez-Rojop IE, Gonzalez-Castro TB, Tovilla-Zarate CA, Sarmiento E, López-Narvaez ML, Nicolini H, Genis-Mendoza AD. Psychiatric Comorbidity in Mexican Adolescents with a Diagnosis of Eating Disorders Its Relationship with the Body Mass Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083900. [PMID: 33917708 PMCID: PMC8068102 DOI: 10.3390/ijerph18083900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of comorbid psychiatric disorders among patients with eating disorders (ED) is higher than the general population. Individuals diagnosed with eating disorders have changes in their body mass index which could promote severe metabolic disruptions. This study aimed (1) to report the prevalence of comorbid psychiatric disorders among a Mexican adolescent sample diagnosed with eating disorders, (2) to compare our results with the prevalence of psychiatric disorders reported from a national survey of mental health of adolescents, (3) to compare the presence of psychiatric comorbidities between ED diagnoses, and (4) to explore the relationship of these comorbidities with the body mass index. In the study, we included 187 Mexican adolescents diagnosed with eating disorders. The psychiatric comorbidities were evaluated using the Mini International Neuropsychiatric Interview for children/adolescents, and a revised questionnaire on eating and weight patterns. We found that 89% of the Mexican adolescents diagnosed with ED had another psychiatric comorbidity. Major depressive disorder (52.40%) and suicide risk (40%) were the most prevalent comorbidities. Attention and deficit hyperactivity disorder (ADHD) prevalence was different between ED diagnosis, and adolescents with binge-eating disorder and ADHD had the higher body mass index. Our results showed that in this sample of Mexican adolescents, the presence of comorbidities could impact body mass index. This emphasizes the importance that clinicians take into consideration the presence of psychiatric comorbidities to achieve an integrative treatment for adolescents diagnosed with ED.
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Affiliation(s)
- David Ruiz-Ramos
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Mexico; (D.R.-R.); (J.J.M.-M.); (I.E.J.-R.); (T.B.G.-C.)
| | - José Jaime Martínez-Magaña
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Mexico; (D.R.-R.); (J.J.M.-M.); (I.E.J.-R.); (T.B.G.-C.)
- Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México 14610, Mexico;
| | - Ana Rosa García
- Hospital Psiquiátrico Infantil Juan N, Navarro, Secretaría de Salud, Ciudad de México 14080, Mexico; (A.R.G.); (E.S.)
| | - Isela Esther Juarez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Mexico; (D.R.-R.); (J.J.M.-M.); (I.E.J.-R.); (T.B.G.-C.)
| | - Thelma Beatriz Gonzalez-Castro
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Mexico; (D.R.-R.); (J.J.M.-M.); (I.E.J.-R.); (T.B.G.-C.)
| | - Carlos Alfonso Tovilla-Zarate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86100, Mexico;
| | - Emmanuel Sarmiento
- Hospital Psiquiátrico Infantil Juan N, Navarro, Secretaría de Salud, Ciudad de México 14080, Mexico; (A.R.G.); (E.S.)
| | | | - Humberto Nicolini
- Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México 14610, Mexico;
| | - Alma Delia Genis-Mendoza
- Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México 14610, Mexico;
- Correspondence: ; Tel.: +52-53501900 (ext. 1197)
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30
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Izquierdo AM, Fischer S. Nonsuicidal self-injury and suicide attempts are uniquely associated with eating disorder pathology and behaviors over and above negative urgency. Eat Behav 2021; 41:101483. [PMID: 33631491 DOI: 10.1016/j.eatbeh.2021.101483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) and suicidal behaviors are prevalent in individuals with eating disorders (EDs). Negative urgency (NU; the tendency to act rashly when distressed) is a common correlate of NSSI, suicide, and ED pathology. The aim of this study was to examine whether lifetime history of NSSI and suicide attempts (SA) contributed unique variance to current ED pathology after controlling for the variance accounted for by NU. Undergraduate students (N = 871; 25.4% male) self-reported lifetime SA and completed a modified Deliberate Self-Harm Inventory to assess lifetime NSSI, the Eating Disorder Examination-Questionnaire (EDE-Q), and the NU scale of the UPPS Impulsive Behavior Scale-Revised. Hierarchical regression analyses indicated that lifetime NSSI but not SA was associated with higher Global EDE-Q scores (NSSI: β = 0.11, p < .001; SA: β = 0.007, p > .05) and restrictive eating (NSSI: β = 0.10, p < .001; SA: β = 0.05, p > .05) after controlling for NU. In addition, lifetime NSSI (OR = 2.98, 95% CI = 1.54-5.76) and SA (OR = 5.68, 95% CI = 1.90-17.02) were significantly associated with past month purging but not binge eating after controlling for NU. Results suggest that NSSI is uniquely associated with increased likelihood of past month ED pathology in a nonclinical sample. Study limitations included low rates of behavioral problems in the sample and no measures of suicidal ideation. Clinicians who treat EDs should regularly assess NSSI and suicidal ideation.
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Affiliation(s)
- Alyssa M Izquierdo
- George Mason University, Department of Psychology, Fairfax, VA, United States.
| | - Sarah Fischer
- George Mason University, Department of Psychology, Fairfax, VA, United States
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Davidson JE, Ye G, Parra MC, Choflet A, Lee K, Barnes A, Harkavy-Friedman J, Zisook S. Job-Related Problems Prior to Nurse Suicide, 2003-2017: A Mixed Methods Analysis Using Natural Language Processing and Thematic Analysis. JOURNAL OF NURSING REGULATION 2021. [DOI: 10.1016/s2155-8256(21)00017-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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John A, Marchant A, Demmler J, Tan J, DelPozo-Banos M. Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank. BJPsych Open 2021; 7:e67. [PMID: 33736714 PMCID: PMC8058850 DOI: 10.1192/bjo.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/16/2020] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with eating disorders who self-harm are a vulnerable group characterised by greater pathology and poorer outcomes. AIMS To explore healthcare utilisation and mortality in those with a record of: self-harm only; eating disorders only; and both co-occurring. METHOD We conducted a retrospective whole population e-cohort study of individuals aged 10-64 years from 2003 to 2016. Individuals were divided into: record of self-harm only; eating disorders only; both self-harm and eating disorders; and no record of self-harm or eating disorders. We used linked routinely collected healthcare data across primary care, emergency departments, hospital admissions and out-patient appointments to examine healthcare contacts and mortality. RESULTS We identified 82 627 individuals: n = 75 165 with self-harm only; n = 5786 with eating disorders only; n = 1676 with both combined. Across all groups and settings significantly more individuals attended with significantly more contacts than the rest of the population. The combined group had the highest number of contacts per person (general practitioner, incident rate ratio IRR = 3.3, 95% CI 3.1-3.5; emergency department, IRR = 5.2, 95% CI 4.7-5.8; hospital admission, IRR = 5.2, 95% CI 4.5-6.0; out-patients, IRR = 3.9, 95% CI 3.5-4.4). Standardised mortality ratios showed the highest excess mortality overall in the self-harm only group (SMR = 3.2, 95% CI 3.1-3.3), particularly for unnatural causes of death (SMR = 17.1, 95% CI 16.3-17.9). SMRs and years of life lost showed an increased risk of mortality in younger age groups in the combined group. Adjusted hazard ratios showed increased mortality across all groups (self-harm only, HR = 5.3, 95% CI 5.2-5.5; eating disorders only, HR = 4.1, 95% CI 3.4-4.9; combined group, HR = 6.8, 95% CI 5.4-8.6). CONCLUSIONS Individuals in all groups had higher healthcare service utilisation than the general population. The increased mortality risk in young people with a record of both eating disorders and self-harm highlights the need for early specialist intervention and enhanced support.
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Affiliation(s)
- Ann John
- FFPH, Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Amanda Marchant
- Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Joanne Demmler
- Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Jacinta Tan
- FRCPsych, Swansea University Medical School, Data Science Building, Swansea University, UK; and Specialist Eating Disorder Team, Abertawe Bro Morgannwg University Health Board, UK
| | - Marcos DelPozo-Banos
- Swansea University Medical School, Data Science Building, Swansea University, UK
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Ahn J, Lee JH, Jung YC. Identifying Predictors of Non-Suicidal Self-Injuries in Individuals with Eating Disorders. Yonsei Med J 2021; 62:159-163. [PMID: 33527795 PMCID: PMC7859680 DOI: 10.3349/ymj.2021.62.2.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/30/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Nearly one third of all patients with an eating disorder (ED) present with non-suicidal self-injury (NSSI). Although it is necessary to pay attention clinically to NSSI in ED patients due to an increased suicidal risk, there are limited data on potential predictors of NSSI in ED. We conducted this study to uncover predictors of NSSI in ED. MATERIALS AND METHODS A total of 1355 ED patients who visited an ED clinic was evaluated through structured interviews by psychiatrists. The demographic and clinical characteristics of ED patients with NSSI (NSSI group) and ED patients without NSSI (non-NSSI group) were analyzed to identify potential predictors of NSSI in ED. RESULTS Among all ED individuals, 242 (17.9%) reported a history of NSSI. Compared to the non-NSSI group, the NSSI group reported more severe eating symptomatology, more comorbid psychiatric disease, and more suicidal risk. Comorbid alcohol use disorder, depressive disorder, purging behavior, history of suicide attempt, and rumination symptoms were uncovered as predictors of NSSI in ED. CONCLUSION The findings of the study are meaningful in that they highlight predictors of NSSI in ED in a large clinical sample. Understanding risk factors of NSSI and offering appropriate interventions are important to preventing suicidality in ED.
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Affiliation(s)
- Jaeun Ahn
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Young Chul Jung
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Duffy ME, Siegfried N, Bass G, Joiner TE. Presence and severity of suicidal thoughts and behaviors across the eating disorder diagnostic spectrum: A pilot study. J Clin Psychol 2020; 77:1045-1053. [PMID: 33296527 DOI: 10.1002/jclp.23095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES There is a dearth of research on suicidal thoughts and behaviors among eating disorder patients diagnosed with binge eating disorder (BED) or other specified feeding or eating disorder (OSFED). This pilot study evaluated presence and severity of suicidal thoughts and behaviors by eating disorder diagnosis in a transdiagnostic clinical eating disorder sample. METHODS Participants were individuals (N = 257; 91.1% female; 94.6% Caucasian) currently receiving eating disorder treatment for anorexia nervosa (AN), bulimia nervosa (BN), BED, or OSFED. Participants completed online measures of variables. RESULTS Lifetime and current presence and severity of suicidal ideation and suicide attempts were statistically similar among diagnostic groups. CONCLUSION Though largely overlooked, treatment-utilizing individuals with BED and OSFED may experience elevated rates and severity of suicidal thoughts and behaviors, like those with AN and BN. Attention to suicide-related risk assessment and management is needed when treating individuals with eating disorders, regardless of diagnosis.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | | | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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35
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Wade TD, Hart LM, Mitchison D, Hay P. Driving better intervention outcomes in eating disorders: A systematic synthesis of research priority setting and the involvement of consumer input. EUROPEAN EATING DISORDERS REVIEW 2020; 29:346-354. [PMID: 32706169 DOI: 10.1002/erv.2759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Setting specific research priorities and involving consumers in this process is one pathway to driving better intervention outcomes in eating disorders (EDs). We reviewed research priority setting in the field and the involvement of consumers in this priority setting. METHOD A systematic review following the PRSIMA statement was conducted and eight studies were identified for inclusion; four included substantial input from consumers, and four were researcher led. Similarities and differences across the types of studies were examined. RESULTS Research priorities informed by consumers were primarily concerned with producing better interventions and outcomes. A large degree of overlap with researcher-led priorities was present. The former studies had a greater focus on early intervention, bridging the research-practice gap, and recovery, while the latter were more likely to address diagnosis, genetic factors, brain circuitry, and pharmacotherapy. Priorities endorsed across more than one consumer-informed study included: the role of self-harm, working with health care professionals to increase early detection, supporting transition between services, and six issues about improved treatments. CONCLUSIONS The ED field needs to engage in more meaningful involvement of co-design across consumers, clinicians and researchers along the entire research journey, not just research priority setting. An integrated research strategy incorporating a co-design perspective has the potential to drive better outcomes.
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Affiliation(s)
- Tracey D Wade
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, Australia
| | - Laura M Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Centre for Mental Health, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
| | - Deborah Mitchison
- School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia.,Camden and Campbelltown Hospitals, SWSLHD, Sydney, Australia
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36
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Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). METHODS A literature search was conducted for original articles examining the general and psychiatric populations. RESULTS There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. CONCLUSION The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.
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37
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Cliffe C, Shetty H, Himmerich H, Schmidt U, Stewart R, Dutta R. Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study. Int J Eat Disord 2020; 53:458-465. [PMID: 32043625 DOI: 10.1002/eat.23240] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Suicide attempts requiring hospitalization are known to be common in patients who are diagnosed with eating disorders. Attempting suicide is a major indicator for those at risk of completed suicide. Both the specific eating disorder diagnosis and the influence of psychiatric comorbidities on suicide attempts requiring hospitalization were investigated, with demographic and socioeconomic variables as confounders, over a 10-year observation period from January 2007 to March 2017. METHODS Anonymized health-record data from the South London and Maudsley NHS Foundation Trust (SLaM) were retrieved through the Clinical Record Interactive Search (CRIS) data resource; this is linked to national Hospital Episode Statistics (HES) data. These data include all diagnoses for inpatient admissions. Hazard ratios, with 95% confidence intervals (CIs), were calculated from cox regression analyses and the effects of a number of confounders were estimated by performing multivariable analyses. RESULTS In total, 4,895 patients were diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder otherwise not specified (EDNOS). Of these, 331 (6.7%) had attempted suicide requiring hospitalization and 21 (0.04%) completed suicide. The eating disorder category associated with the highest risk of a suicide attempt was AN (HR: 1.43, 95%CI: 1.08-1.89, p = .01). The risk was significantly increased further if the patient had a comorbid diagnosis of personality disorder, depression, bipolar affective disorder, and substance misuse. DISCUSSION Suicide attempts requiring hospitalization have a high incidence rate among patients with eating disorders, and the risk is significantly increased in AN. Comorbid psychiatric illness and suicidal ideation should be carefully assessed in all eating disorder patients.
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Affiliation(s)
- Charlotte Cliffe
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Hitesh Shetty
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Hubertus Himmerich
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Ulrike Schmidt
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Robert Stewart
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Rina Dutta
- Institute of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Trust, London, UK
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38
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Obeid N, Norris ML, Valois DD, Buchholz A, Goldfield GS, Hadjiyannakis S, Henderson KA, Flament M, Hammond NG, Dunn J, Spettigue W. Bingeing, Purging, and Suicidal Ideation in Clinical and Non-Clinical Samples of Youth. Eat Disord 2020; 28:289-307. [PMID: 31314685 DOI: 10.1080/10640266.2019.1642033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Suicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.
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Affiliation(s)
- Nicole Obeid
- Eating Disorders program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Mark L Norris
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Darcie D Valois
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Annick Buchholz
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Gary S Goldfield
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stasia Hadjiyannakis
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Martine Flament
- Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Nicole G Hammond
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jessica Dunn
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Wendy Spettigue
- Eating Disorders program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Buelens T, Luyckx K, Verschueren M, Schoevaerts K, Dierckx E, Depestele L, Claes L. Temperament and Character Traits of Female Eating Disorder Patients with(out) Non-Suicidal Self-Injury. J Clin Med 2020; 9:jcm9041207. [PMID: 32331415 PMCID: PMC7230745 DOI: 10.3390/jcm9041207] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022] Open
Abstract
Eating disorder (ED) patients show alarmingly high prevalence rates of Non-Suicidal Self-Injury (NSSI). Adolescents seem to be particularly at risk, as EDs and NSSI both have their onset in mid-adolescence. It has been suggested that personality could be a transdiagnostic mechanism underlying both EDs and NSSI. However, little attention has been given to adolescent clinical samples compared to adult and/or community samples. Therefore, the current study investigated the role of personality in a sample of 189 female inpatients with an ED (M = 15.93, SD = 0.98). Our results confirmed the high prevalence of NSSI in EDs, specifically in patients with bingeing/purging behaviours (ED-BP). Temperamental differences were found between ED-BP and the restrictive ED subtype (ED-R). Namely, ED-BP patients showed more harm avoidance and less self-directedness compared to ED-R. Temperamental differences were found in NSSI as well, regardless of ED subtype: ED patients who had engaged in NSSI during their lifetime reported less self-directedness and more harm avoidance. Interestingly, only ED patients who recently engaged in NSSI showed less novelty seeking. These temperamental profiles should be recognised as key mechanisms in the treatment of adolescent ED patients with and without NSSI.
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Affiliation(s)
- Tinne Buelens
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (K.L.); (M.V.); (L.D.); (L.C.)
- Correspondence: ; Tel.: +32-163-77-506
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (K.L.); (M.V.); (L.D.); (L.C.)
- UNIBS, University of the Free State, 9300 Bloemfontein, South Africa
| | - Margaux Verschueren
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (K.L.); (M.V.); (L.D.); (L.C.)
| | - Katrien Schoevaerts
- Psychiatric Hospital Alexianen Zorggroep Tienen, 3300 Tienen, Belgium; (K.S.); (E.D.)
| | - Eva Dierckx
- Psychiatric Hospital Alexianen Zorggroep Tienen, 3300 Tienen, Belgium; (K.S.); (E.D.)
- Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1050 Elsene, Belgium
| | - Lies Depestele
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (K.L.); (M.V.); (L.D.); (L.C.)
- Psychiatric Hospital Alexianen Zorggroep Tienen, 3300 Tienen, Belgium; (K.S.); (E.D.)
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (K.L.); (M.V.); (L.D.); (L.C.)
- Faculty of Medicine and Health Sciences, Universiteit Antwerpen, 2610 Wilrijk, Belgium
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40
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Marino J, Hardin R, Gasbarro A, Dansereau VA, Fischer S. Outpatient treatment for adults with complex eating disorders and co-morbid conditions: a decision making model and case example. Eat Disord 2020; 28:171-183. [PMID: 32129726 DOI: 10.1080/10640266.2020.1723372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although Cognitive Behavioral Therapy (CBT-E) for eating disorders has the most empirical support for the outpatient treatment of adult eating disorders (EDs), this model does not include a focus on intense emotion dysregulation, suicidality, and non-suicidal self-injury (NSSI). Furthermore, a subset of patients do not achieve sustained remission with CBT-E. Given that Dialectical Behavior Therapy (DBT) was designed for treatment refractory, complex patients, clinicians must be able to use assessment information to determine which type of treatment to use. The aims of this manuscript are to 1) describe a DBT-based and research-informed conceptual model for treatment decision making for an outpatient non-academic setting, 2) present a case example of a client with significant ED symptoms and complex medical and psychiatric comorbidities, using this decision making model and 3) present descriptive data from a private practice setting in which patients are referred to DBT vs. CBT-E according to this decision making model.
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Affiliation(s)
- Joanna Marino
- Private practice, Potomac Behavioral Solutions, Arlington, VA, USA
| | - Rebecca Hardin
- Private practice, Potomac Behavioral Solutions, Arlington, VA, USA
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
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41
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Bagaric M, Touyz S, Heriseanu A, Conti J, Hay P. Are bulimia nervosa and binge eating disorder increasing? Results of a population-based study of lifetime prevalence and lifetime prevalence by age in South Australia. EUROPEAN EATING DISORDERS REVIEW 2020; 28:260-268. [PMID: 32061193 DOI: 10.1002/erv.2726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/04/2019] [Accepted: 01/17/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to provide updated lifetime prevalence estimates of eating disorders, specifically bulimia nervosa (BN) and binge eating disorder (BED) and investigate changes over time in lifetime prevalence by age. METHOD Two thousand nine hundred seventy-seven participants from South Australia were interviewed in the Health Omnibus Survey. DSM-5 criteria were used for current and broad (in accord with the International Statistical Classification of Diseases and Related Health Problems-11 [ICD-11]) criteria for lifetime prevalence of BED. RESULTS This study found that the lifetime prevalence of BN was 1.21% (95% CI [0.87, 1.67]) and 2.59% (95% CI [2.07, 3.22]) for males and females, respectively, and that lifetime prevalence for BED-broad was 0.74% (95% CI [0.49, 1.11]) and 1.85% (95% CI [1.42, 2.40]) for males and females, respectively, which is higher than reported in previous research. Current prevalence (past 3 months) of BN was 0.40% (95% CI [0.23, 0.70]) and 0.81% (95% CI [0.54, 1.20]) for males and females, respectively, and current prevalence for BED was found to be 0.03 (95% CI [0.01, 0.04]) and 0.20% (95% CI [0.09, 0.44]) for males and females, respectively. CONCLUSIONS The current study confirmed the moderate community prevalence of BN and BED. BED was found to be less prevalent than BN in the present study, and a significant lifetime prevalence by age effect was found for both. Lifetime prevalence by age indicated that past increases in prevalence may be waning in this century and that overall BN and BED are not increasing in Australia.
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Affiliation(s)
- Marija Bagaric
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Stephen Touyz
- School of Psychology, Inside Out Institute, University of Sydney, Camperdown, NSW, Australia
| | - Andreea Heriseanu
- School of Psychology, University of Sydney, Camperdown, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Janet Conti
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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42
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Sagiv E, Gvion Y. A multi factorial model of self-harm behaviors in Anorexia-nervosa and Bulimia-nervosa. Compr Psychiatry 2020; 96:152142. [PMID: 31726288 DOI: 10.1016/j.comppsych.2019.152142] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/02/2019] [Accepted: 10/21/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Co-existence of eating disorders and NSSI, suicide attempts and ideations is well established yet much is not known about the personality traits and behavioral tendencies that maintain this relationship. To this date no empirical work has been produced that offers a multifactorial view on the contributing variables to the occurrence of self-harm behaviors in EDs. METHOD Binge eating, depression, impulsivity, ruminations and loss aversion were assessed in a sample of 93 patients diagnosed with Anorexia-Nervosa and Bulimia-Nervosa and other EDs with a history of NSSI and suicide attempts. RESULTS Binge eating was found to be a predictor of depression, which in turn was found to be related to NSSI frequency, suicide attempts and suicide ideations. Ruminations were found to mediate a relationship between depression and suicide ideations. Trait impulsivity predicted suicide attempts, while the attentional construct of impulsivity was associated to suicide ideations as well as attempts. Higher loss aversion was positively associated with NSSI frequency and suicide ideations. CONCLUSION Our findings suggest that trait and state aspects of impulsivity are related to different self-harm behaviors in EDs. Exploring these differences is potentially of great value in understanding the process of transition from suicidal ideation to suicide attempt and the process of NSSI and may assist clinicians formulate better interventions for patients with EDs at risk. Ways in which individual findings in our model correspond with previous research and future implications are discussed.
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Affiliation(s)
- Eran Sagiv
- Bar Ilan University, Sheba tel hashomer medical center, Israel.
| | - Yari Gvion
- Bar Ilan University, Sheba tel hashomer medical center, Israel
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43
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Maston G, Gibson AA, Kahlaee HR, Franklin J, Manson E, Sainsbury A, Markovic TP. Effectiveness and Characterization of Severely Energy-Restricted Diets in People with Class III Obesity: Systematic Review and Meta-Analysis. Behav Sci (Basel) 2019; 9:E144. [PMID: 31817943 PMCID: PMC6960910 DOI: 10.3390/bs9120144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 12/17/2022] Open
Abstract
Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m2) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (<6 months) and long-term (>1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks' duration and those of ≥6 weeks' duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks' duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.
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Affiliation(s)
- Gabrielle Maston
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (A.A.G.); (A.S.); (T.P.M.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney 2006, Australia; (J.F.); (E.M.)
| | - Alice A. Gibson
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (A.A.G.); (A.S.); (T.P.M.)
| | - H. Reza Kahlaee
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney 2006, Australia;
- School of Life, and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney 2006, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney 2006, Australia; (J.F.); (E.M.)
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney 2006, Australia; (J.F.); (E.M.)
| | - Amanda Sainsbury
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (A.A.G.); (A.S.); (T.P.M.)
| | - Tania P. Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (A.A.G.); (A.S.); (T.P.M.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney 2006, Australia; (J.F.); (E.M.)
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Sagiv E, Hadlaczky G, Sheetrit N, Gur E, Horesh N, Gvion Y. The Fear of Losing-Nonsuicidal Self-Injury as a Protective Mechanism in Eating Disorders. Front Psychiatry 2019; 10:825. [PMID: 31803081 PMCID: PMC6873791 DOI: 10.3389/fpsyt.2019.00825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against "high damage" decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.
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Affiliation(s)
- Eran Sagiv
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Gergö Hadlaczky
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Noga Sheetrit
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Eitan Gur
- The Eating Disorders Department, Sheba Medical Center, Ramat Gan, Israel
| | - Netta Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Yari Gvion
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychology, Academic College Tel Aviv–Yaffo, Yaffo, Israel
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Geulayov G, Ferrey A, Hawton K, Hermon C, Reeves GK, Green J, Beral V, Floud S. Body mass index in midlife and risk of attempted suicide and suicide: prospective study of 1 million UK women. Psychol Med 2019; 49:2279-2286. [PMID: 30488817 PMCID: PMC6754262 DOI: 10.1017/s0033291718003239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND High body mass index (BMI) has been associated with lower risks of suicidal behaviour and being underweight with increased risks. However, evidence is inconsistent and sparse, particularly for women. We aim to study this relationship in a large cohort of UK women. METHODS In total 1.2 million women, mean age 56 (s.d. 5) years, without prior suicide attempts or other major illness, recruited in 1996-2001 were followed by record linkage to national hospital admission and death databases. Cox regression yielded relative risks (RRs) and 95% confidence intervals (CIs) for attempted suicide and suicide by BMI, adjusted for baseline lifestyle factors and self-reported treatment for depression or anxiety. RESULTS After 16 (s.d. 3) years of follow-up, 4930 women attempted suicide and 642 died by suicide. The small proportion (4%) with BMI <20 kg/m2 were at clearly greater risk of attempted suicide (RR = 1.38, 95% CI 1.23-1.56) and suicide (RR = 2.10, 1.59-2.78) than women of BMI 20-24.9 kg/m2; p < 0.0001 for both comparisons. Small body size at 10 and 20 years old was also associated with increased risks. Half the cohort had BMIs >25 kg/m2 and, while risks were somewhat lower than for BMI 20-24.9 kg/m2 (attempted suicide RR = 0.91, 0.86-0.96; p = 0.001; suicide RR = 0.79, 0.67-0.93; p = 0.006), the reductions in risk were not strongly related to level of BMI. CONCLUSIONS Being underweight is associated with a definite increase in the risk of suicidal behaviour, particularly death by suicide. Residual confounding cannot be excluded for the small and inconsistent decreased risk of suicidal behaviour associated with being overweight or obese.
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Affiliation(s)
| | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, UK
| | - Carol Hermon
- Nuffield Department of Population Health, University of Oxford, UK
| | | | - Jane Green
- Nuffield Department of Population Health, University of Oxford, UK
| | - Valerie Beral
- Nuffield Department of Population Health, University of Oxford, UK
| | - Sarah Floud
- Nuffield Department of Population Health, University of Oxford, UK
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Prasetyo YB, Kurnia AD, Masruroh NL, Nursalam N, Hargono R, Ahsan A, Kumboyono K. Factors influencing promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder. J Taibah Univ Med Sci 2019; 14:454-459. [PMID: 31728144 PMCID: PMC6838962 DOI: 10.1016/j.jtumed.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aimed to identify predictors of promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder (ARFID). METHODS A cross-sectional descriptive survey was administered to 245 mothers who were caring for children with ARFID. Data were collected with a self-administered questionnaire. For descriptive data analysis, independent t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis, and multiple linear regression were employed. RESULTS The factors related to promotive behaviours in these mothers were embodied in mutual parenting, especially in terms of childcare (p = 0.001 < 0.05) and interaction with children (p = 0.001 < 0.05. Additionally, multiple linear regression showed that mutual parenting remained at the communication domain, with children as the primary predictor (β 0.401, p 0.001), where the number of children (β -0.201, p = 0.008) influenced the promotive behaviours. CONCLUSIONS This study found that the number of children and mutual parenting in interacting with children were key factors that influenced promotive behaviours in mothers of children with ARFID. We suggest that nursing interventions can potentially improve promotive behaviours in this population.
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Affiliation(s)
- Yoyok B. Prasetyo
- Department of Health Sciences, Faculty of Public Health, Airlangga University, Indonesia
| | - Anggraini D. Kurnia
- Community Department, Department of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang, Indonesia
| | - Nur L. Masruroh
- Community Department, Department of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang, Indonesia
| | | | - Rahmat Hargono
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Airlangga University, Indonesia
| | - Ahsan Ahsan
- Department of Nursing, Faculty of Medicine, Brawijaya University, Indonesia
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Pérez S, Ros MC, Folgado JEL, Marco JH. Non-suicidal Self-injury Differentiates Suicide Ideators and Attempters and Predicts Future Suicide Attempts in Patients with Eating Disorders. Suicide Life Threat Behav 2019; 49:1220-1231. [PMID: 30357895 DOI: 10.1111/sltb.12521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed first to identificate psychopathological variables differentiating between suicide ideators, suicide attempters and patients without suicide ideation or attempts, and second to identificate better predictors of suicide attempts longitudinally. METHOD We compared suicide ideation, hopelessness, borderline symptoms, frequency, types, number of different non-suicidal self-injury (NSSI) methods, intrapersonal and interpersonal functionality of NSSI in a sample of 238 patients with Eating Disorders (1) with no history of suicide ideation or suicide attempts (n = 150); (2) with recent suicide ideation (n = 65); and (3) with suicide attempts in the previous year (n = 23). In addition, we analyzed the predictive power of the mentioned variables over the number of suicide attempts 7 months after the first assessment. RESULTS The group of suicide attempters showed a major number of different methods of NSSI, higher frequency of NSSI, cutting, and more NSSI intra and interpersonal functions than the group of ideators. Unlike in previous studies, hopelessness did not differentiate between patients with ideation and suicide attempts. In addition, the best predictor of suicide attempts 7 months later was frequency of NSSI at T1 (N = 123). CONCLUSIONS Cutting, frequency and different methods of NSSI, intra and interpersonal functions were risk factors that differentiated ideators from attempters, being frequency of NSSI the best predictor of suicide attempts longitudinally. Thus, patients with ED with NSSI should be the focus of preventive interventions for suicidal behavior.
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Affiliation(s)
- Sandra Pérez
- Department of Personality, Assessment and Therapeutic Interventions, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
| | | | - Jose E Layron Folgado
- School of Doctorate. Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
| | - Jose H Marco
- Department of Personality, Assessment and Psychotherapeutic Interventions, Universidad Católica de Valencia "San Vicente Mártir", Valencia, Spain
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48
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Prasetyo YB, Nursalam N, Hargono R, Ahsan A. Socio-demographic Determinants and the Family Ability to Care for Children with Avoidant Restrictive Food Intake Disorder (ARFID). JURNAL NERS 2019. [DOI: 10.20473/jn.v14i1.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The ability of families to care for avoidant restrictive food intake disorder children is still low. There is only few studies that examined relationship between family factor to ability to care children with avoidant restrictive food intake disorder. The purpose of this study was to identify the influence of socio-demographic factors on the ability of families to represent children with avoidant restrictive food intake disorder.Method: The study design was cross-sectional, and the majority of samples were gathered using the rule of the thumb, totaling 245 participants. The sampling technique used a type of multistage sampling. Data were collected by questionnaire. We then conducted an analysis of the univariate data using frequency distribution, while for the bivariate data, we used the chi-square technique. All of the data was processed using IBM SPSS 23.0 statistics.Results: The results showed that the ability of care from the families (health promotion behavior) of children with avoidant restrictive food intake disorder was influenced by the socio-demographic factors, namely maternal age (p= 0.010), the number of children (p= 0.047) and education (p= 0.036).Conclusion: Young mothers need appropriate guidance and direction through good health education. Good health education in young mothers can reduce the pressure faced by the mothers when caring for their children with avoidant restrictive food intake disorder. Health promotion behavior is influenced by maternal education and maternal age. Through good mother's education, the mother will be able to provide a good pattern of care to children who experience avoidant restrictive food intake disorder.
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49
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Mandelli L, Arminio A, Atti AR, De Ronchi D. Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria. Psychol Med 2019; 49:1237-1249. [PMID: 30488811 DOI: 10.1017/s0033291718003549] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Quantification of suicidal risk in specific populations is important for the adoption of targeted prevention and harm reduction measures. Though there remains little systematic evidence, risk of suicide attempts for bulimia nervosa (BN) and binge-purging anorexia nervosa (AN-bp) appears higher than restrictive AN (AN-r); risk in binge eating disorder (BED) is still unclear. The aim of this meta-analysis was to compare proportions of suicide attempts in eating disorder (ED) subgroups. METHODS A literature search using combinations of key-words for ED and suicide attempts was performed. Studies reporting proportions of suicide attempters in at least two ED groups, diagnosed according to DSM-IV or -5 and ICD-10 diagnostic criteria were considered. ED subgroups were analyzed in pairs using a binary random effect model for proportions. Publication bias, meta-regression, and sensitivity analyses were performed. RESULTS In BN, attempted suicide was more frequent (21%) than in AN (12.5%), but the difference was statistically significant only when BN was compared with AN-r (9-10%). In BED, the proportion of suicide attempts was as high as in AN (10-12%). CONCLUSIONS Though limited by heterogeneity across the studies in terms of methodology and aims, inability to control for relevant confounding variables, exclusion of ED not otherwise specified, this study supports suicide attempts as a major issue in EDs, especially in binge-purging subtypes, i.e. BN and AN-bp. Similar suicidal proportions were observed in AN and BED. The reasons for a greater proportion of attempted suicide in binge/purging subtypes need to be explored in future studies.
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Affiliation(s)
- Laura Mandelli
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
| | - Angelo Arminio
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
| | - Anna-Rita Atti
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
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50
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Duffy ME, Henkel KE, Joiner TE. Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals With Eating Disorders: A National Study. J Adolesc Health 2019; 64:461-466. [PMID: 30314865 DOI: 10.1016/j.jadohealth.2018.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. METHODS Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. RESULTS Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. CONCLUSIONS Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, Florida; Department of Psychology, University of Saint Joseph, West Hartford, Connecticut.
| | - Kristin E Henkel
- Department of Psychology, University of Saint Joseph, West Hartford, Connecticut
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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