Body image and suicidal ideation in adolescents

Gender differences in the network of suicidal ideation, interpersonal needs and depressive symptoms among Chinese college students

Interpersonal needs and depression are two recognized significant risk factors for suicidal ideation. Previous studies have preliminarily revealed the gender-dependent effects of interpersonal needs and depression on suicidal ideation. However, there are very few studies that place these variables within a single framework and apply symptom-level analysis to investigate the gender-dependent relationships among them. This study applied symptom-level network analysis to construct female and male networks using data from 781 female and 628 male young adults. The networks included interpersonal needs, depressive symptoms, and suicidal ideation. Key characteristics of networks, including edge connections, bridge expected influence (BEI), and global expected influence (GEI), were compared. The results suggested that gender significantly impacts edge connections, node BEI, and GEI of the final networks. Several significantly gender-dependent connections were disclosed, such as perceived burdensomeness (PB)-suicidal ideation, hopelessness-suicidal ideation, PB-sense of failure, and PB-sadness. PB (marginally) and thwarted belongingness show significant gender differences in their impact on depressive symptoms. The GEI of the female network is significantly greater than that of the male network. These findings offer valuable insights for modern theoretical frameworks examining gender differences in the connections between suicidal ideation, interpersonal needs, and depressive symptoms. Additionally, results provide empirical support for selecting screening, prevention, and intervention strategies for suicidal ideation and depression across genders.

Are Instagram Gym Advertisements Working Out? An Experimental Study of Model Body-Size and Slogan-Type

Previous health communication research has demonstrated the negative psychological and health effects of depicting thin-sized models in mass media advertisements including on social media sites such as Instagram. However, gym advertisements are one common source for the presentation of lean and thin-sized models on Instagram. Therefore, the current study guided by social comparison theory and signaling theory aimed to experimentally examine the effect of thin-sized models relative to plus-sized models as well as slogan-type (health and wellness versus physique-based) on women's appearance comparison, body satisfaction, perceived gym fit, and intentions to join the gym. A sample of 217 undergraduate students who identified as women were randomly assigned to one of four Instagram gym advertisement conditions varying in model body-size and slogan-type. Appearance comparisons, perceived gym fit, and intentions to join the gym were measured post advertisement exposure and body satisfaction was measured pre-and-post advertisement exposure. As expected, exposure to Instagram gym advertisements featuring thin-sized models resulted in greater appearance comparisons and lower body satisfaction than exposure to Instagram gym advertisements featuring plus-sized models. Moreover, the combination of plus-sized models with health and wellness slogans in Instagram gym advertisements resulted in greater gym fit perceptions although there was no effect of model body-size and slogan-type on intentions to join the gym. This study supports social comparison theory, signaling theory, and practically the findings indicate that Instagram gym advertisements that depict plus-sized models (versus thin) with health-and-wellness slogans (versus physique) generate fewer body image concerns and lead to greater gym fit perceptions.

Mediating effects of psychological resilience on the relationship between social support and body image dissatisfaction among patients with primary brain tumors in China

Several studies have documented that patients with different types of tumors experience serious body image dissatisfaction (BID). However, few studies have explored BID in patients with brain tumors. This study examined the level of BID and verified the mediating effects of psychological resilience on the relationship between social support and BID among Chinese patients with primary brain tumors. Participants included 226 Chinese patients with primary brain tumor (64.2% women) between 18 and 80 years of age (mean age = 48.36 ± 12.44), who completed the measures of a demographic questionnaire, the Multidimensional Perceived Social Support Scale (MPSSS), Resilience Scale-14 (RS-14), and Body Image Scale (BIS). The average BIS score among Chinese patients with primary brain tumors was 6.20 (SD = 4.85; range, 0-24), and 200 (88.5%) participants experienced body image dissatisfaction (BIS score ≥ 1), and 50 (22.1%) were significant body image dissatisfaction (BIS score ≥ 10). Spearman's rank-order correlation indicated that BID, psychological resilience, and social support were significantly correlated. Mediation analysis indicated that the direct paths from social support to psychological resilience and psychological resilience to BID were both significant, but the path from social support to BID was not, psychological resilience played a complete mediating role between social support and BID. The current results support that Chinese patients with brain tumors experience BID, and more awareness and interventions should be given from healthcare professionals. These findings have implications for developing and implementing intervention programs to enhance social support and psychological resilience among this population and cope with BID.

The pride framework: a sociocultural-developmental approach for understanding LGBTQ+ adolescents' body image and disordered eating

This theoretical review paper offers a sociocultural-developmental framework for understanding LGBTQ+ adolescents' body image concerns and disordered eating risk. The Pride Framework integrates well-established sociocultural theories and extant empirical research, drawing from objectification theory, the tripartite influence model, minority stress theory, and intersectionality theory. The Pride Framework situates sociocultural appearance pressures within the adolescent developmental context, wherein biological, cognitive, and social transitions exacerbate the likelihood of body image disturbances and eating pathology. Various processes are then posited to link these sociocultural-developmental pressures to body image concerns and disordered eating. Crucially, this framework underscores that LGBTQ+ status itself does not pose a risk for body dissatisfaction and eating disorders. Instead, it is the experience of residing in a society that stigmatizes LGBTQ+ identities that increases youth's vulnerabilities. LGBTQ+ health researchers and practitioners are encouraged to engage in collaborative efforts with the aim of fostering acceptance for LGBTQ+ youth. This, in turn, could support normative adolescent identity exploration processes within sociocultural settings that are both affirming and inclusive, potentially mitigating adverse health consequences associated with body image disturbances.

#LoveYourBody: An Experimental Test of the Effects of Objectification and Body Appreciation Content on Instagram Fitness and Health Posts Among Young Women

Fitspiration content on Instagram often includes images in which women are objectified but may also include captions that aim to positively motivate viewers, such as through messaging about body appreciation. Viewing objectifying content in fitspiration posts may be problematic for young women's mental health, but it's unclear if positive messaging may help to alleviate some of these effects. In this study, we conducted a 2 × 2 online experiment assessing the effects of body appreciation and objectification content present in Instagram fitness posts by influencers on young women (N = 200). The outcome variables were state body appreciation, trait body appreciation, self-esteem, and self-compassion. We found an interaction between the presence and absence of objectification and presence and absence of body appreciation that significantly influenced self-compassion and body appreciation. The interaction suggests that self-compassion and state body appreciation are higher in the presence of body appreciation messaging, although there were not main effects for just viewing objectifying images or body appreciation captions. This means that just body appreciation or just objectification may not affect state body appreciation and self-compassion, but the two together have an effect. Our findings suggest that body appreciation captions may serve as a protective factor for self-compassion and state body appreciation when young women view Instagram fitspiration posts that include sexual objectification. Health communicators could encourage influencers to include body appreciation content in their fitspiration posts to help improve self-compassion among viewers, and interventions could work to promote body appreciation among young women to encourage self-compassion.

The individualized treatment for minimally invasive repair of pectus carinatum in adolescent: a single center' s retrospective study

BACKGROUND

Pectus carinatum (PC) mainly present at the growth spurt time of the early teenage years or the puberty. Poor outer appearance is a major reason for seeking help for surgeons to increase self-confidence and self-esteem. At present, minimally invasive repair (MIR) is one of effective ways to correct the chest wall deformity. Therefore, there is great practical significance to conduct clinical research on MIR about the adolescent PC.

METHODS

We applied Abramson procedure in PC group or we applied Abramson procedure and Nuss procedure in PC/PE group. We retrospectively reviewed the results of 41 cases who underwent the surgical correction at our department from January 2020 to April 2023.

RESULTS

All the procedures were successfully done without severe complications. The median operation Time was 80 min in PC group while was 130 min in PC/PE group. The median LOS were 4 days in PC group while 5 days in PC/PE group. The median compression depth was 32 mm in PC group while 12 mm in PC/PE group. Postoperatively, there are some complications. All Pneumothorax patients being treated conservatively were found in 9 patients in two groups. One patient suffered overcorrection after operation. There were 3 patients suffered steel wires breakage in two groups. One patient reoperation postoperatively for the dislocation of the bar secondary to steel wires breakage.

CONCLUSIONS

The Abramson procedure or Abramson procedure and Nuss procedure have good short-term results in repair PC and PC/PE. Select one or two procedures should be done individually based on whether the lower plane over depressed after Abramson procedure.

Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors

OBJECTIVE

Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs.

METHODS

Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors.

RESULTS

The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies.

DISCUSSION

Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.

Predictors of non-suicidal self-injury in adolescents with depressive disorder: the role of alexithymia, childhood trauma, and body investment

Purpose

This study analyzes the relationship of alexithymia, childhood trauma, and body investment to non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder and whether they have predictive and diagnostic value for non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder.

Patients and methods

A total of 225 patients with a diagnosis of adolescent depressive disorder were included in the study and were divided into two groups according to the DSM-5 criteria: 98 cases without NSSI and 127 cases with NSSI. Compare the demographic data, 24-item Hamilton Depression Scale (HAMD-24), 20-item Toronto Alexithymia Scale (TAS-20), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Body Investment Scale (BIS) scores between two groups. Binary logistic regression was used to analyze the independent risk factors contributing to NSSI behaviors in adolescents with depression, and establish four predictive models. Based on the models' predictive probability, the ROC curves were plotted to calculate the value of the predictive diagnostic effect.

Results

The group without NSSI had lower scores than the group with NSSI on HAMD-24 total score, TAS-20 total score, difficulty identifying feelings, difficulty describing feelings, and externally focused thinking, as well as lower scores on CTQ-SF total score, physical neglect, emotional neglect, physical abuse, and emotional abuse. In contrast, the BIS total score, body image feelings and attitudes, body care, and body protection factor scores were higher for the group without NSSI. The BIS body care factor score and the CTQ-SF emotional abuse factor score were significantly linked with adolescents diagnosed with depressive disorder who exhibited NSSI behaviors. These results provide a good diagnostic model for adolescents with depressive disorder.

Conclusion

Low levels of body care and childhood emotional abuse may independently contribute to the implementation of NSSI in adolescents with depressive disorder. Body investment and childhood trauma are valuable in diagnosing and predicting NSSI behaviors and should be considered as potentially important factors in clinical treatment.

The Longitudinal Associations of Body Dissatisfaction with Health and Wellness Behaviors in Midlife and Older Women

Emerging research suggests that body dissatisfaction (BD) is prevalent among midlife and older women (i.e., upwards of 70%). Cross-sectionally, BD is associated with myriad poor health and wellness outcomes (e.g., depression, disordered eating, bad nutrition) in midlife/older women. However, relatively few studies have examined the longitudinal relations between BD and health outcomes in this population. This preliminary study investigated the longitudinal associations of BD with wellbeing and health-related quality of life (QOL) among midlife/older adult women over one year. Participants (n = 86, women aged 40-72 years, M = 51.49, SD = 7.34, 86% white) completed self-report measures of BD, psychosocial impairment, health behaviors, and QOL at baseline (T1) and 12-month follow-up (T2). A series of multiple linear regression models included T1 BD as the predictor variable of health outcomes at T2, covarying for T1 BMI and age in all models. BD was associated with greater negative emotions and psychosocial impairment, less physical activity enjoyment, and poorer physical, psychological, and social QOL one year later. Findings suggest that BD is associated with negative consequences for women across the lifespan (ƒ2 ranges = 0.06-0.60). Future research investigating BD as a unique, modifiable risk factor for health outcomes among diverse samples of midlife/older women is warranted. Targeting BD in interventions may improve health indices beyond eating disorders for this population.

Muscle dysmorphia symptomatology is prospectively associated with suicidal thoughts, suicidal behaviors, and non-suicidal self-injury among a sample of Canadian adolescents and young adults

INTRODUCTION

Limited, primarily cross-sectional research has identified associations between muscle dysmorphia and suicidal thoughts suicidal behaviors, and non-suicidal self-injury (NSSI). This study aimed to investigate the associations between muscle dysmorphia and suicidal thoughts, suicidal behaviors, and NSSI prospectively over a 1-year period among a large, diverse sample of Canadian adolescents and young adults.

METHODS

Data from wave one (2021) and wave two (2022) of the Canadian Study of Adolescent Health Behaviors were analyzed (N = 912). Multiple modified Poisson regression analyses were used to determine the associations between muscle dysmorphia symptomatology at wave one and three items of suicidal thoughts and behaviors and one item of NSSI at wave two. Unadjusted models and adjusted models were estimated.

RESULTS

Total muscle dysmorphia symptomatology and symptoms of Appearance Intolerance were prospectively associated with suicidal ideation and suicide planning at 12-month follow-up. These findings were significant across unadjusted and adjusted models.

CONCLUSIONS

Findings from this study expand prior research and underscore the clinical complexity of muscle dysmorphia. Future research should investigate mechanisms explaining the association between muscle dysmorphia and suicide and develop interventions to prevent suicide among people with muscle dysmorphia.

Independent and joint associations of aerobic and muscle-strengthening exercise with mental health in adolescents: A cross-sectional analysis before and during COVID-19 using the 2015-2021 National Youth Risk Behavior Survey

PURPOSE

COVID-19 led to social isolation that may have compromised adolescent mental health. This study examined the independent and joint associations of aerobic physical activity (PA) and muscle-strengthening exercise (MSE) with mental health problems in adolescents.

METHODS

Participants were US adolescents who completed the 2015-2021 National Youth Risk Behavior Survey (N = 61,298; 45.7% female). Data were collected between 2015 and 2021 and analyzed in 2023. Outcomes were binary response items asking about feeling sad/hopeless, having difficulty concentrating, remembering, or making decisions, and having a suicidal ideation. Preventive exposure variables were items asking about frequencies of aerobic PA and MSE with responses dichotomized to align with recommendations. Independent and joint associations were examined using robust Poisson regression with covariates selected using double selection lasso. Structural equation models examined the associations treating PA and MSE as continuous predictors and poor mental health as a latent dependent variable.

RESULTS

Meeting either recommendation alone associated with a 4-10% lower prevalence of mental health problems (APR = 0.90-0.96, p < 0.05), and meeting both recommendations associated with a 15%-20% lower prevalence of mental health problems (APR = 0.80-0.85, p < 0.001). Although categorical joint associations were stronger in males (p < 0.05), multiplicative interactions were observed in females using continuous variables for PA and MSE (β = -0.09, p < 0.001).

CONCLUSION

Meeting aerobic PA and MSE recommendations associated with lower prevalence of mental health problems. Participation in MSE below recommended levels may be beneficial for females when combined with aerobic PA. Future research should examine these associations by acquiring contextual information and device-based assessments.

Influence of psychosocial characteristics of patients and opinions of their relatives on indication for surgical treatment of pectus excavatum

BACKGROUND

To assess the subjective experience of patients and their parents or relatives about the existing pectus excavatum deformity and to contribute to the definition of indications for surgical treatment of this deformity.

METHODS

The initial sample of psychosocial characteristics consisted of self-assessments and observations of patients (and parents) regarding their health, self-image, health care, possible environmental response to their physical appearance, expectations regarding treatment. A modified version of the original Nuss questionnaire on quality of life was used in the psychological part of the examination.

RESULTS

The study included a sample of 58 patients aged 10 to 30 years, and a sample of 58 family members of the patient (parents, relatives). The experience of poor emotional status, withdrawals, and bad self-image in patients older than 15 years than younger were significant. The tendency for female patients to have a worse experience is pronounced and significant. The largest percentage of parents have an 'indecisive' or 'weakly expressed' attitude towards surgery. Parents at a significantly higher rate show greater concern for female children.

CONCLUSION

A systematic evaluation of the psychosocial perception of patients and their relatives (who will consent for the operation) may be a useful diagnostic assessment before correcting an anterior chest wall malformation.

Understanding suicidality in Pacific adolescents in New Zealand using network analysis

INTRODUCTION

Pacific adolescents in New Zealand (NZ) are three to four times more likely than NZ European adolescents to report suicide attempts and have higher rates of suicidal plans. Suicidal thoughts, plans, and attempts, termed suicidality in this study, result from a complex dynamic interplay of factors, which emerging methodologies like network analysis aim to capture.

METHODS

This study used cross-sectional network analysis to model the relationships between suicidality, self-harm, and individual depression symptoms, whilst conditioning on a multi-dimensional set of variables relevant to suicidality. A series of network models were fitted to data from a community sample of New Zealand-born Pacific adolescents (n = 550; 51% male; Mean age (SD) = 17 (0.35)).

RESULTS

Self-harm and the depression symptom measuring pessimism had the strongest associations with suicidality, followed by symptoms related to having a negative self-image about looks and sadness. Nonsymptom risk factors for self-harm and suicidality differed markedly.

CONCLUSIONS

Depression symptoms varied widely in terms of their contribution to suicidality, highlighting the valuable information gained from analysing depression at the symptom-item level. Reducing the sources of pessimism and building self-esteem presented as potential targets for alleviating suicidality amongst Pacific adolescents in New Zealand. Suicide prevention strategies need to include risk factors for self-harm.

Prevalence of non-suicidal self-injury, suicidal ideation, suicide attempts, suicide mortality in eating disorders: a systematic review and meta-analysis

Eating disorders have a wide and profound impact on psychological and general health. The study aims to provide a comprehensive and up-to-date review of non-suicidal self-injury, suicidal ideation, suicide attempts, and suicide mortality in a variety of eating disorders. A systematic search was conducted using four databases from inception until April 2022, limiting the search to English-language. For each of the eligible studies, the prevalence of suicide-related issues in eating disorders was calculated. The prevalence of non-suicidal self-injury, suicide ideation, and suicide attempts was then calculated for each anorexia nervosa and bulimia nervosa. The random-effects method was used for the pool of studies. Fifty-two articles were used for this study and included in the meta-analysis. The prevalence of non-suicidal self-injury is 40% with a confidence interval between 33-46% (I2 97.36%). The prevalence of suicide ideation is 51% with a confidence interval between 41-62% (I2 97.69%). The prevalence of suicide attempts is 22% with a confidence interval between 18-25% (I2 98.48%). The heterogeneity in the studies included in this meta-analysis was high. There is a high prevalence of non-suicidal self-injury, suicidal ideation, and suicide attempts in eating disorders. Thus, comorbidity between eating disorders and suicide issues is an important topic that can provide insights into etiology. Future studies must consider eating disorders along with other types of mental health issues, such as depression, anxiety, sleep problems, and aggression.

Global Prevalence of Eating Disorders in Nutrition and Dietetic University Students: A Systematic Scoping Review

BACKGROUND

Nutrition and dietetics (ND) training encourages behaviors that can be considered risk factors for eating disorders or disordered eating. This paper aims to explore the prevalence of eating disorders (EDs) and predictors of eating disorders (/P-EDs) in ND students.

METHODS

A systematic scoping review of the literature was performed on PubMed, ERIC, PsychINFO, OVID Medline, and Scopus in October 2022.

RESULTS

A total of 2097 papers were retrieved from the search, of which 19 studies met the inclusion criteria. The resultant literature reported that 4-32% of ND students were at high risk of EDs (n = 6 studies), and 23-89% could be classified as having orthorexia nervosa (n = 7 studies). Further, 37-86% reported body image/fat dissatisfaction (n = 10 studies), and 100% of students reported weight dissatisfaction (n = 1 study).

CONCLUSIONS

This paper highlights the prevalence of EDs and P-EDs across ND students. Further research is warranted to explore the cause, context, and impact on ND students' wellbeing and professional identity and supporting diversity within the profession. Future studies should also consider curriculum approaches to address this occupational hazard.

Analysis of Attempted Suicide in a Pediatric Setting: Extracted Notes for Clinical Practice and Complexity of Help

Background and Objectives: Suicidality among adolescents is a global mental health issue. However, the post-suicidal care of minors is insufficient and lacks complexity, as repeated attempts occur. Further, little is known about the social (i.e., family setting) and psychological (for example, exposure to bullying, suicidality, or addiction within a close environment) backgrounds of minors who engage in suicidal behavior in Lithuania. Thus, the aim of our study was to evaluate and compare psychosocial factors that may influence minors’ decisions to attempt suicide for the first time and then repeatedly and to extract notes for future clinical practice. Materials and Methods: Data from 187 cases of suicide attempts by minors treated at the Children’s Hospital of Vilnius University Santara Clinics from January 2011 to January 2018 was obtained and analyzed. Results: The data showed that 48.7% of minors hospitalized because of a suicide attempt had a history of previous suicide attempts. Minors who attempted suicide repeatedly were more often engaged in non-suicidal self-injurious behavior (p = 0.033). Further, a small number had experienced suicide within their close surroundings (p = 0.045). The comparative analysis did not reveal any significant differences in psychosocial backgrounds between first-time attempters and those who attempted suicide for at least a second time. Conclusions: Social and psychological support after a suicide attempt in a pediatric setting is lacking efficiency, as minors who repeatedly attempt suicide suffer from similar psychosocial burdens. Complex and targeted follow-up care is needed.

Suicide burden in Latin America, 1990-2019: findings from the Global Burden of Disease Study 2019

OBJECTIVES

Suicide is a critical public health issue worldwide. The objective was to report the findings from the Global Burden of Disease study on the burden of suicide in Latin America from 1990 to 2019 and to assess its association with the sociodemographic index (SDI).

STUDY DESIGN

This was a cross-sectional descriptive study.

METHODS

Following the 2019 Global Burden of Disease study, suicide mortality, premature mortality, years lived with disability, and disability-adjusted life-years in Latin America are reported.

RESULTS

The number of deaths from suicides increased significantly in most countries, but the age-standardized suicide mortality rate had a heterogeneous behavior. Suicide burden was higher for males in all age groups, and in most countries, the male-to-female ratio increased between 1990 and 2019. Almost all suicide burden is attributable to premature mortality. The highest suicide burden was present in young males and females. All countries had an increase in the SDI, and in most countries, there was a statistically significant correlation between this indicator and the suicide disability-adjusted life-years rates.

CONCLUSIONS

To best promote suicide prevention, it is important to understand sex and age-specific suicide burden patterns. According to these results, prevention programs intended to prevent suicide should be implemented with a special focus on high-risk groups such as young adults and the elderly.

Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study

Objective

Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse.

Methods

Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.

Results

Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.

Conclusion

This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.

Agreement of adolescents’ self-perception of their body image with the analysis on the three-dimensional body image

Abstract Objectives: to verify the agreement among adolescents’ perception of their own body image and the health professionals’ analysis based on three-dimensional body image and the inter-rater agreement. Methods: a cross-sectional study was carried out with 1,662 adolescents, aged 18 to 19 years old, from the 1997/98 birth cohort in São Luís, Maranhão. Self-perception of body image was assessed using the Stunkard’s body image scale. Three nutritionists evaluated the three-dimensional body image obtained by the Photonic Scanner (3D Body Scanner) and classified according to the Stunkard’s scale. The agreement between raters was verified by using weighted Kappa. Results: the analysis of agreement between raters in the general group and when stratified by sexwas considered moderate to good by Kappa. Regarding the intraclass correlation (ICC), good and excellent correlation values were observed both in the general group, males and females. There was a greater perception of overweight by all raters, when compared with the adolescents’ self-assessments. When stratified by sex, examiner 1 had the same perception as male self-assessments, as for females the perception of overweight was more frequent, as well as raters 2 and 3, for both sexes. Conclusion: agreement between raters and self-assessments was considered weak/moderate in Kappa and good/excellent in ICC.

Self-Compassion Moderates the Association Between Body Dissatisfaction and Suicidal Ideation in Adolescents: A Cross-Sectional Study

Identifying risk and protective factors for suicidal ideation during adolescence is essential for suicide prevention. One potential risk factor is body dissatisfaction which appears to peak during adolescence. The present study investigated the self-compassion buffering effects in the relationship between body dissatisfaction and suicidal ideation. A convenience sample comprising 580 adolescents (mean age 16.35 years; SD = .87; range 14-18 years) was recruited from public schools. The results indicated a strong positive association between body dissatisfaction and suicidal ideation (Cohen's f 2 = .25). The association was significantly moderated by the self-compassion (β =  - .16, SE = .04, p = .01, t  = 2.4.34, .95% CI [- .16, - .01]). Structural equation modeling analysis showed that the lack of self-kindness was associated with a moderate suicidal ideation level (Cohen's f 2 = .14). Also, higher levels of self-judgment predicted suicidal ideation with a moderate to large effect size (Cohen's f 2 = .28). The findings suggest that therapeutic programs designed to develop self-compassion should be implemented to reduce the risk of suicidal ideation among adolescents with body dissatisfaction. The findings empirically show that a higher degree of self-judgment is strongly associated with suicidal thoughts among adolescents, which must be systematically addressed in clinical studies on suicidal risk.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00727-4.

Gender Differences in Body Appreciation and Its Associations With Psychiatric Symptoms Among Chinese College Students: A Nationwide Survey

BACKGROUND

Body appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China.

METHOD

This cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively.

RESULTS

In total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F _(1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = -0.129, P < 0.001; anxiety symptoms, β = -0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = -0.172, P < 0.001; anxiety symptoms, β = -0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men.

CONCLUSION

Chinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Trauma and self-harming behaviors in high school students: The mediating role of identity formation

INTRODUCTION

This study investigated the link between trauma and self-harming behaviors in South African high school students, and examined the mediating role of identity formation. Traumatic experiences have been commonly associated with self-harming behaviors in adolescents. However, research addressing this association in non-Western countries is limited.

METHODS

A total of 552 South African high school students aged 13-21 (60.4% female; M_age = 16 years) were included in the study. Students completed self-report questionnaires on traumatic experiences, identity formation, and self-harming behaviors (disturbed eating behaviors and suicidal thoughts and behaviors).

RESULTS

Structural equation modelling indicated that the association between traumatic experiences and self-harming behaviors was partially mediated by identity formation. Traumatic experiences were associated with more identity diffusion, bulimia, and suicidal thoughts and behaviors. Identity diffusion, in turn, was associated with more drive for thinness, bulimia, body dissatisfaction, and suicidal thoughts and behaviors. Identity consolidation was positively associated with drive for thinness and negatively with body dissatisfaction and suicidal thoughts and behaviors. No moderation effects by gender or age were found.

CONCLUSIONS

Traumatic experiences were associated with higher levels of identity diffusion, which, in turn, were associated with more self-harming behaviors in South African high school students. These findings suggest the importance of focusing on identity diffusion in prevention and intervention programs targeting self-harming behaviors.

Body mass index, subjective body shape, and suicidal ideation among community-dwelling Korean adults

Background

Previous studies have not investigated in depth the combination of objective body weight and subjective body shape and its association with suicidal ideation among different age groups. Therefore, this study aimed to examine the abovementioned association among Korean adults, stratified by developmental stages.

Methods

We used nationally representative data from the 2017 Korean Community Health Survey, and included 222,037 participants aged 19 years or older in our study. Suicidal ideation was considered as the dependent variable (1 = yes, 0 = no). Along with body mass index (BMI) and subjective body shape measures, seven categories were created (1 = underweight-skinny, 2 = underweight-normal/fat, 3 = healthy weight-skinny, 4 = healthy weight-normal, 5 = healthy weight-fat, 6 = overweight-skinny/normal, 7 = overweight-fat). Multivariate logistic regression was conducted for each age group.

Results

Adjusted for covariates, young adults who were overweight-fat (OR = 1.18, p < .01), middle-aged adults who were underweight-skinny (OR = 1.32, p < .05), and older adults who were healthy weight-fat (OR = 1.19, p < .05) were more likely to have suicidal ideation than their healthy weight-normal counterparts.

Conclusions

The results suggest that the association between the combination of objective body weight and subjective body shape and suicidal ideation differs according to the developmental stage. Therefore, this difference should be considered when developing suicide prevention interventions based on the developmental stages.

Body Dissatisfaction as a Mediator between Identity Formation and Eating Disorder Symptomatology in Adolescents and Emerging Adults

Objective:

Eating disorder symptomatology generally develops during adolescence and emerging adulthood. Previous research has focused on the role of identity formation or body image in the development of eating disorder symptomatology, but integrative work is lacking. For this reason, the present cross-sectional study examined the mediating role of body dissatisfaction in the relation between identity formation and eating disorder symptomatology.

Method:

The sample comprised 659 participants between 15 and 30 years old (68.9% females; M_age = 19.44; SD_age = 3.99). All participants completed self-report measures on identity (Self-concept and Identity Measure), body dissatisfaction (the Body Image Feelings and Attitudes subscale of the Body Investment Scale and the Body Dissatisfaction subscale of the Eating Disorder Inventory-3), and eating disorder symptomatology (Eating Disorder Inventory-3). Latent variable modeling from a structural equation modeling approach was used.

Results:

First, identity formation significantly predicted eating disorder symptomatology. Additionally, indirect effects were found linking identity formation to eating disorder symptomatology through the mechanism of body dissatisfaction. No significant differences between males and females or between adolescents and emerging adults on direct or indirect effects were found.

Conclusion:

The present study indicated that body dissatisfaction mediated the relationship between identity formation and eating disorder symptomatology during mid-to-late adolescence and emerging adulthood. Provided that the present findings can be replicated in a future longitudinal study, they demonstrate that both identity formation and body dissatisfaction should be taken into account in prevention and intervention programs targeting eating disorder symptomatology.

Study of suicide burden of mortality in México 1990-2017

OBJECTIVE

The primary goal was to analyze the level and trend of the burden of suicide mortality in Mexico between 1990 and 2017 at a national and state scale.

METHODS

A secondary analysis based on the 2017 global burden of disease study. Mortality rates and years of life lost due to premature death (YLL) were reported here. A joinpoint regression analysis based on a log-linear model was used to analyze the trend of YLL.

RESULTS

The burden of disease due to suicides increased in Mexico, mainly in young males and females; though the raise that happened in the elderly is an additional challenge for the health system. The burden of disease varied substantially between states. The male mortality rates were higher than those of females during the whole period under study, nonetheless with a trend to reduce the difference between the sexes. A bimodal pattern of the burden of disease due to suicide in Mexico was also observed, with the higher rates located in those aged between 15 and 19 years, and an important increase in people older than 85 years of age.

CONCLUSION

These results show a worrisome picture, not only from a social, economic and health point of view but also from the needs of public policies. This situation represents a wake-up call about the need to implement timely identification actions, a comprehensive multisectoral prevention strategy and the detailed study of suicide associated risk factors.

Sex difference in the association between physical activity and suicide attempts among adolescents from 48 countries: A global perspective

BACKGROUND

Adolescent suicide is a global public health concern. Given that physical activity has a positive effect in the prevention and treatment of common psychiatric disorders, it may also protect against suicides. However, global data examining associations between physical activity and suicide attempts among adolescents are lacking, and sex-specific associations remain poorly understood. Thus, we assessed the association between physical activity and suicide attempts among adolescents aged 12-15 year from 48 countries.

METHODS

Cross-sectional data from the Global School-based Student Health Survey, which included 136,857 adolescents [mean age (SD) 13.8 (1.0) years; 48.9% girls] were analyzed. Suicide attempt was defined as at least one suicide attempt in the past 12 months. Physical activity was assessed by the PACE+ Adolescent Physical Activity Measure and participants were dichotomized into those who do and do not comply with the World Health Organization physical activity recommendations (60 min of moderate-to-vigorous intensity physical activity daily). Multivariable logistic regression analysis and meta-analysis were conducted to assess the associations.

RESULTS

Meeting physical activity guidelines was associated with lower odds for suicide attempts in boys (OR=0.78; 95%CI=0.70-0.86), but higher odds for suicide attempts in girls (OR=1.22; 95%CI=1.10-1.35). The associations for boys and girls were relatively consistent across countries.

LIMITATIONS

Causality or temporal associations cannot be established due to the cross-sectional nature of the study.

CONCLUSIONS

Engagement in physical activity may be an effective strategy for prevention of suicide attempts for boys but not for girls. Future studies should investigate the factors that lead to this sex difference.

The Relative Associations of Body Image Dissatisfaction among Psychiatric Out-Patients in Singapore

Background: Adults with body image dissatisfaction (BID) are more likely to be depressed, anxious, and suicidal when compared to those without intense dissatisfaction over their appearance. The current study aimed to estimate the prevalence and factors associated with BID among out-patients with mental illness in Singapore. Methods: Data was collected from 310 psychiatric out-patients using a self-administered questionnaire. Measurements used were socio-demographic characteristics, Body Mass Index scores, Body Shape Questionnaire, Binge Eating Scale, Eating Attitudes Test, Beck’s Depression Inventory, Beck’s Anxiety Inventory and Alcohol Use Disorders Identification Test. Results: A prevalence of 30.9% of BID was established among psychiatric out-patients in Singapore. Being female, having higher BMI scores, binge eating behavior, eating disorders, and those diagnosed with depression were positively associated with BID. Conclusion: BID is prevalent among those with psychiatric illnesses which could lead to a higher degree of psychological distress and the emergence of eating disorders.

Effect of physical activity on suicidal ideation differs by gender and activity level

BACKGROUND

Suicide is a critical complication of psychiatric disorders. Physical activity has a positive effect on mental health; however, its effects on suicidal ideation have received little attention compared to other psychiatric symptoms.

METHODS

Data were obtained from the Korea National Health and Nutrition Examination Survey 2014. Suicidal ideation was measured by the ninth item of the Patient Health Questionnaire-9. Physical activity was measured by the International Physical Activity Questionnaire (IPAQ) and categorized into three groups by activity level. Multiple logistic regression analysis was performed for the entire sample, men, and women. The following three models were used: Model 1 (adjusted for sociodemographic and health-related variables), Model 2 (additionally adjusted for subjective body image), and Model 3 (additionally adjusted for diagnosed depression).

RESULTS

Compared to the low IPAQ group, the moderate IPAQ group was significantly associated with decreased suicidal ideation in Model 3 for the entire sample (OR, 0.733; 95% CI, 0.538-0.999) and in all models for women. However, the high IPAQ group showed no significant association. None of the IPAQ groups showed significant associations in men.

LIMITATIONS

This is a cross-sectional study. Therefore, the direction of causality cannot be determined. This study also investigated suicidal ideation over the past two weeks, which may be inconsistent with studies conducted over the past year.

CONCLUSIONS

The beneficial relationship between physical activity and suicidal ideation is weaker in men and individuals with high activity levels. Detailed guidelines on physical activity according to gender and activity level are recommended.

Young men's body dissatisfaction: A qualitative analysis of anonymous online accounts

Associated with numerous adverse health outcomes, body dissatisfaction in young men requires close examination. This study explores online accounts relating to male body image, including young men's personal disclosures within one online newspaper article, and posts responding to this topic. Discursively informed thematic analysis indicated that non-disclosure was considered a problematic social expectation by the young men featured in the article. Also, reader posts variously constructed body dissatisfaction as a symptom of adolescence, a lack of self-care and an incapacity to capitalise on compensatory qualities. Our analysis suggests young men may welcome safe opportunities to critically discuss prevailing body image ideals.

Construction and Validation of the Touch Experiences and Attitudes Questionnaire (TEAQ): A Self-report Measure to Determine Attitudes Toward and Experiences of Positive Touch

Despite growing interest in the beneficial effects of positive touch experiences throughout our lives, and individual differences in how these experiences are perceived, there is not yet available a contemporary self-report measure of touch experiences and attitudes, for which the factor structure has been validated. This article describes four studies carried out during the construction and validation of the Touch Experiences and Attitudes Questionnaire (TEAQ). The original TEAQ, containing 117 items relating to positive touch experiences was systematically constructed. Principal component analysis reduced this measure to 57 items and identified six components relating to touch experiences during childhood and adult experiences relating to current intimate touch and touch with friends and family. Three attitudinal components were identified relating to attitude to intimate touch, touch with unfamiliar people, and self-care. The structure of this questionnaire was confirmed through confirmatory factor analysis carried out on data obtained from a second sample. Good concurrent and predictive validity of the TEAQ compared to other physical touch measures currently available was identified. Known-group validity in terms of gender, marital status and age was determined, with expected group differences identified. This study demonstrates the TEAQ to have good face validity, internal consistency, construct validity in terms of discriminant validity, known-group validity and convergent validity, and criterion-related validity in terms of predictive validity and concurrent validity. We anticipate this questionnaire will be a valuable tool for the field of physical touch research.

Non-suicidal self-injury in patients with eating disorders: prevalence, forms, functions, and body image correlates

INTRODUCTION

More than one third of patients with eating disorders report NSSI. Moreover, negative attitudes and feelings toward the body, body dissatisfaction, and body image disturbances have been linked to NSSI in community and clinical samples. However, there is a lack of studies exploring NSSI frequency and functions and the specific relationship between multidimensional body image dimensions and NSSI in eating disorder patients.

OBJECTIVES

First, we explored the frequency, types, and functions of NSSI in a sample of 226 Spanish female participants with eating disorders (ED). Second, we explored differences in NSSI and body image depending on the ED restrictive-purgative subtype; and third, we explored differences in body dissatisfaction, body image orientation, and body investment in eating disorder patients without NSSI (n = 144), with NSSI in their lifetime (n = 19), and (b) with NSSI in the previous year (n = 63).

RESULTS

Of the overall sample, 37.1% (n = 89) had a history of self-injury during their lifetime, and 27.1% (n = 65) had self-injured in the previous year. Among the types of ongoing NSSI, the most frequent were banging (64.6%) and cutting (56.9%). Restrictive vs purgative patients differed on NSSI lifetime, Appearance Evaluation, Body Areas Satisfaction, Body Protection and Feelings and Attitudes toward the Body. Moreover, significant differences were found on Appearance Evaluation, Body Areas Satisfaction, Positive Feelings and Attitudes towards the Body, Body Protection, and Comfort with physical contact, between participants without a history of self-injury and both NSSI groups.

DISCUSSION

Body dissatisfaction and body investment have been found to be variables related to NSSI. Thus, the present study highlights the importance of working on body image in ED patients to reduce the frequency of NSSI.

Gender differences in exposure and vulnerability to psychosocial and behavioral factors of suicide attempt among Korean adolescents

INTRODUCTION

This study examined gender differences in suicide attempts and their association with exposure and vulnerability to psychosocial, behavioral, and structural factors among Korean adolescents.

METHODS

Data of 74 854 adolescents, taken from the 2010 Korea Youth Risk Behavior Survey, were used. Logistic regression analysis was used to assess the contribution of differential exposure to psychosocial, behavioral, and structural factors for gender differences of suicidal attempt.

RESULTS

Gender differences were observed in the degree of exposure to the various factors. Females were more likely to report psychosocial problems, whereas males were more likely to report experience of smoking and drinking alcohol and to engage in vigorous physical activity. Stress and unhappiness were significantly associated with suicide attempts in both males and females, and gender differences in these variables were nonsignificant. Depressive symptoms were associated with a higher risk of suicide attempts, and this relationship was significantly stronger for males. The effects of cigarette smoking and risky drinking were significantly stronger in females.

DISCUSSION

Greater exposure to perceived stress, feelings of unhappiness, depression, and higher vulnerability of smoking and heavy drinking accounted for higher suicide attempts of female adolescents. Higher exposure to health-related behaviors and greater vulnerability to depressive symptoms in male were also noted. In conclusion, differences in exposure and vulnerability to psychosocial and behavioral factors may partly explain gender differences in suicide attempts among Korean adolescents.

Body image and nonsuicidal self-injury: Validation of the Body Investment Scale in participants with eating disorders

The Body Investment Scale (BIS) assesses body image feelings, body care, protection of the body, and comfort in touch, in order to identify and distinguish participants with self-harming and self-destructive tendencies. However, the psychometric properties of the BIS were not analysed in participants diagnosed with eating disorders. The main objective of the present study is to confirm the factor structure of the Spanish version of the BIS and analyse its psychometric properties in a sample composed of women diagnosed with eating disorders. Participants were 250 Spanish women between 12 and 60 years old (M = 26.05, SD = 11.97) diagnosed with eating disorders. A confirmatory factor analysis showed a poor fit of the original BIS. The final model showed an acceptable 4-factor structure (Body Feelings, α = .88; Body Touch, α = .82; Body Protection, α = .77; Body Care, α = .68), with a good fit to the data (SBχ²₍₂₄₆₎  = 393.21, CFI = .906, IFI = .908, RMSEA = .049). The relationships between the BIS and both the Purpose-In-Life Test-10 Items and Beck Hopelessness Scale were analysed, as well as differences in the BIS score according to nonsuicidal self-injuries and suicidal ideation in the past year. The BIS is an appropriate instrument to assess the body investment dimension of body image in women with eating disorders.

Associations Among Meaning in Life, Body Image, Psychopathology, and Suicide Ideation in Spanish Participants With Eating Disorders

OBJECTIVE

The aims of this study were to (a) analyze whether participants with eating disorders have lower meaning in life than the nonclinical population; (b) discover whether participants with eating disorders with low meaning in life have more body image disturbances, more psychopathology, and higher suicide ideation than participants with high meaning in life; (c) analyze whether meaning in life is associated with eating disorder psychopathology; and (d) analyze whether meaning in life is able to predict eating disorder psychopathology and suicide ideation, when body image is controlled.

METHOD

The clinical sample comprised 247 Spanish participants diagnosed with eating disorders, and the nonclinical sample comprised Spanish 227 participants.

RESULTS

Participants with eating disorders had lower meaning in life than the nonclinical population. Patients with low meaning in life had higher psychopathology and suicide ideation than participants with high meaning in life. Meaning in life was a significant predictor of the eating disorder psychopathology and suicide ideation.

CONCLUSION

Low meaning in life is associated with eating disorder psychopathology in a Spanish sample with eating disorders.

The relationship between cyberbullying and friendship dynamics on adolescent body dissatisfaction: A cross-sectional study

The relationship between cyberbullying and friendship dynamics on adolescent body dissatisfaction was examined. Data from the Irish contribution to the international cross-sectional 2013/2014 Health Behaviour in School-aged Children study were used. Results showed that girls were three times more likely than boys to report that their body is too fat, and adolescents who were cyberbullied were almost twice as likely as adolescents who were not cyberbullied to consider themselves too fat. Stronger friendship dynamics were associated with decreased levels of body dissatisfaction, and friendship dynamics were found to partially mediate the relationship between cyberbullying and body dissatisfaction.

Psychopathological Differences Between Suicide Ideators and Suicide Attempters in Patients with Mental Disorders

BACKGROUND

Although suicide is one of the leading causes of death worldwide, there is a need for studies to identify variables that can differentiate patients with suicide ideation at risk of transitioning to an attempt.

METHOD

In this study, we assessed suicide ideation and attempts, non-suicidal self-injury (NSSI), hopelessness, borderline symptoms and meaning in life in a sample of 348 patients with different diagnoses of mental disorders. We divided the sample into four subgroups: patients without suicide ideation or suicide attempts; patients with current suicide ideation; patients with lifetime suicide attempts and patients with a suicide attempt in the previous year.

RESULTS

The group with suicide attempts in the previous year showed higher levels of hopelessness, borderline symptoms and NSSI, and lower levels of meaning in life than the other groups.

LIMITATIONS

Groups were composed of unequal numbers of patients, and in some of them, the sample size was small. The sample was composed mainly of women with eating disorders. The study design was retrospective, and so the results must be considered in terms of correlates.

CONCLUSIONS

Our results suggest that hopelessness, borderline symptoms-including NSSI-and meaning in life play a key role in suicide attempts. Thus, psychotherapeutic interventions should focus on managing NSSI, searching for meaning and managing emptiness, loss of control and feelings such as self-contempt in patients with suicide ideation. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Recent suicide attempters show higher levels of hopelessness, borderline symptoms and NSSI than lifetime attempters and suicide ideators. Clinicians should focus attention on assessing hopelessness, borderline symptoms and NSSI in those with suicide ideation. Lower levels of meaning in life are related to recent suicide attempts. Levels of hopelessness differentiate between recent and lifetime suicide attempters.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Identifying a physical indicator of suicide risk: Non-suicidal self-injury scars predict suicidal ideation and suicide attempts

BACKGROUND

Suicide risk is challenging to quantify due to reliance on self-report, which is limited by individuals' lack of insight and the desire to conceal such intentions. Non-suicidal self-injury (NSSI) is one of the most robust predictors of suicidal ideation (SI) and suicide attempts (SA). Although NSSI often leads to permanent scarring, which can be assessed by objective physical examination, no research has examined whether scarring denotes tangible risk for SI and SA. The present study examined whether NSSI scar presence and number predict current SI and SA history. Further, we examined whether brooding would exacerbate the effects of NSSI scarring on SI or SA.

METHODS

Young adults (N=231; M=21.24 years; 78% female) completed self-report questionnaires assessing SA history, frequency of NSSI, presence/number of NSSI scars, brooding, current depressive symptoms, and SI.

RESULTS

NSSI scar presence and number predicted current SI and SA history after controlling for current depressive symptoms. Moreover, scar presence and number predicted current SI over and above the effects of SA history and NSSI frequency, method, and medical severity. Further, NSSI scar presence and number predicted SI more strongly among individuals with greater levels of brooding than among individuals with lower levels of brooding.

CONCLUSIONS

The presence and number of NSSI scars are objective physical indicators of risk for SI and SAs. Brooding may further heighten the risk of SI for individuals bearing NSSI scars.

The Association between Body Weight Misperception and Psychosocial Factors in Korean Adult Women Less than 65 Years Old with Normal Weight

With society's increasing interest in weight control and body weight, we investigated the association between psychological factors and body image misperception in different age groups of adult Korean women with a normal weight. On a total of 4,600 women from the Korea National Health and Nutrition Examination Survey 2007-2009, a self-report questionnaire was used to assess body weight perception and 3 psychological factors: self-rated health status, stress recognition, and depressed mood. Through logistic regression analysis, a poor self-rated health status (P = 0.001) and a higher recognition of stress (P = 0.001) were significantly associated with body image misperception and this significance remained after controlling for several sociodemographic (Model 1: adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.31-2.00), health behavior and psychological factors (Model 2: aOR, 1.59; 95% CI, 1.29-1.96; Model 3: aOR, 1.36; 95% CI, 1.01-1.84). Especially, highly stressed middle-aged (50-64 yr) women were more likely to have body image misperception (Model 2: aOR, 2.85; 95% CI, 1.30-6.26). However, the correlation between depressed mood and self-reported body weight was inconsistent between different age groups. In conclusion, self-rated health status and a high recognition rate of severe stress were related to body weight misperception which could suggest tailored intervention to adult women especially women in younger age or low self-rated health status or a high recognition rate of severe stress.

Hopelessness in adolescents

BACKGROUND

The hopelessness scales devised by Beck and by Kazdin have been used in hundreds of studies of both non-clinical and clinical samples. The present study identified non-clinical adolescent samples to see if the mean scores differed by age, sex, year of publication of the study, and nation.

METHODS

Studies of school students administered the Beck Hopelessness Scale or the Kazdin Hopelessness Scale for Children were identified from a literature search using PsycINFO and the search term "hopelessness" anywhere in the text. Seventy-eight studies were found reporting mean scores, 44 for American students and 34 for students in other countries.

RESULTS

The scores of American students were significantly lower than those of students in other countries, and there was a tendency for boys to have higher scores than girls (in 18 of the 27 studies which reported differences by sex). There was no tendency for the hopelessness scores of American students to have increased in recent years.

CONCLUSIONS

American adolescents appear to be less hopeless than adolescent in other nations, and the scores of American adolescents do not seem to have changed significantly over the last 30 years.

Self-relevant disgust and self-harm urges in patients with borderline personality disorder and depression: a pilot study with a newly designed psychological challenge

Background

Borderline personality disorder (BPD) is a common psychiatric condition associated with self-harm. Self-harm is poorly understood and there is currently no treatment for acute presentations with self-harm urges.

Objectives

By using a new task (Self-relevant Task; SRT), to explore emotions related to one's own person (PERSON task) and body (BODY task), to study the correlations of these emotions, specifically disgust, with self-harm urge level changes, and to test the task's potential to be developed into an experimental model of self-harming for treatment trials.

Methods

17 BPD patients, 27 major depressive disorder (MDD) patients, and 25 healthy volunteers performed the SRT. Emotion labels were extracted from task narratives and disgust and self-harm urge level changes measured by visual analogue scales. We used validated rating scales to measure symptom severity.

Results

The SRT was effective at inducing negative emotions and self-harm urge changes. Self-harm urge changes correlated with borderline symptom severity. Post-task disgust levels on the visual analogue scales were higher in BPD patients than in healthy controls in the PERSON task, and higher than in both control groups in the BODY task. Changes in disgust levels during the task were significantly greater in the patient groups. Post-task disgust levels or changes in disgust were not associated with self-harm urge changes (except the latter in MDD in the PERSON task), but self-harm urge changes and disgust (but no other emotion) narrative labels were on a whole sample level.

Conclusion

Although associations with the analogue scale measures were not significant, self-disgust reported in the narrative of patients may be associated with a higher probability of self-harm urges. Further research with larger sample sizes is needed to confirm this relationship and to examine whether reducing self-disgust could reduce self-harm urges. The SRT was effective and safe, and could be standardized for experimental studies.

Trajectory of suicidal ideation in relation to perceived overweight from adolescence to young adulthood in a representative United States sample

PURPOSE

To examine the trajectory of suicidal ideation in relation to perceived overweight from adolescence to young adulthood.

METHODS

Four waves (1995-2008) of the National Longitudinal Study of Adolescent Health that prospectively followed up a nationally representative sample of United States middle and high school students (N = 6,504) were analyzed using hierarchical generalized linear models with a logit link function.

RESULTS

Overall, suicidal ideation tended to decrease with age (logit coefficient [coef.] = -.07, p < .001). Participants who perceived themselves as overweight were more likely to think about committing suicide, especially in females, even after controlling for rigorously measured depressive symptoms (coef. = .14, p < .01). Girls were more likely than boys to have suicidal ideation at age 10 (coef. = -.31, p < .001). However, the association between suicidal ideation and perceived overweight became weaker and the prevalence of suicidal ideation became lower as participants grew older. The downward trend in suicidal ideation was steeper in females than in males (coef. = .03, p < .001), with males actually showing a higher prevalence of suicidal ideation than females around 20-30 years of age. Random effects of age, depression, and perceived overweight were insignificant, which indicated that participants did not vary significantly in terms of effects of these variables on suicidal ideation.

CONCLUSIONS

The results of this study underline the need for development of family, school, and community interventions to address body weight perception to reduce suicidal ideation and attempts, especially among female teenagers.

[Body image dissatisfaction as a mediator of the association between BMI, self-esteem and mental health in early adolescents: a multiple-group path analysis across gender]

PURPOSE

This study was done to examine not only the relationships between body mass index (BMI), self-esteem, body image dissatisfaction (BID) and mental health, according to gender, but the mediating role of BID on mental health in relation to BMI and self-esteem among early adolescents.

METHODS

Data from 576 (296 boys and 280 girls) elementary school students in grades 5 to 6 were collected. A multiple-group path analysis was utilized to examine the relationships between BMI, self-esteem, BID and mental health by gender.

RESULTS

In the path analysis for all students, poor mental health was related directly to BID, while it was indirectly related to BMI and self-esteem. In the multiple-group path analysis of both genders, BID was found to have a significant direct and indirect effect on mental health for girls alone.

CONCLUSION

The findings suggested that BID should be examined early to prevent poor mental health in early adolescent girls. This study helps to elucidate the role of early adolescent BID on mental health and provides insight for further prevention and intervention programs in school and community mental health settings.

Cutaneous body image dissatisfaction and suicidal ideation: mediation by interpersonal sensitivity

OBJECTIVE

Cutaneous body image (CBI) dissatisfaction, feelings of social exclusion and stigmatization have been associated with increased suicidality in dermatology patients. We examined the relation between CBI dissatisfaction and suicidal ideation in a non-clinical sample, and examined the possible mediating effect of interpersonal sensitivity (IS), a symptom dimension related to self-consciousness, feelings of inferiority and social exclusion.

METHODS

As part of a larger study, 312 community-based participants from London, Ontario, Canada (241 women, 71 men; mean±SD age: 38.4±14.9years) rated their CBI satisfaction, measured with the Cutaneous Body Image Scale (Gupta MA et al., 2004). The Brief Symptom Inventory (BSI) (Derogatis L et al.,1982) was used to measure the constructs of suicidal ideation (4 suicide-related items from the BSI) and IS (Interpersonal Sensitivity subscale of BSI).

RESULTS

Assessing mediation using the Baron & Kenny (1986) model, CBI satisfaction had a significant negative effect on suicidal ideation [c=-0.316, t(296)=-5.73, p<0.001] and IS [a=-0.365, t(297)=-6.76, p<0.001]; when CBI satisfaction and IS were considered together, IS had a significant positive effect on suicidal ideation (b=.690, t(295)=15.80, p<.001) while the effect of CBI satisfaction on suicidal ideation was no longer significant [c*=-.063, t(295)=-1.44, ns].

CONCLUSION

Our findings suggest an inverse relationship between CBI satisfaction and suicidal ideation, which is mediated by IS. This relationship likely falls in a continuum between non-clinical and clinical situations, with suicide risk being greater when individuals experience greater CBI dissatisfaction and social alienation.