Psychometric properties of the Body Image Scale in women with benign gynaecological conditions

Loneliness and Perceived Social Support in Endometriosis: The Roles of Body Image Disturbance and Anticipated Stigma

BACKGROUND

Research has identified that living with the chronic inflammatory disease endometriosis adversely impacts social functioning and interpersonal relationships, specifically, feelings of loneliness and a lack of perceived social support. Commonly experienced body image disturbance (BID), combined with the anticipation of endometriosis-related stigma from others, may result in further social withdrawal. This study aimed to quantitatively investigate the association between BID and social functioning (loneliness and diminished perceived social support), and the potential moderating effect of anticipated stigma on these associations.

METHOD

Participants (N = 212) with a self-reported endometriosis diagnosis completed an online questionnaire measuring social and emotional loneliness, perceived social support, BID, anticipated stigma and demographic and medical characteristics.

RESULTS

Mean scores indicated high levels of BID, emotional loneliness and diminished perceived social support. Bootstrapped multivariable regression analyses indicated that BID was significantly associated with greater emotional loneliness and lower perceived social support. BID was also associated bivariately with greater social loneliness. Anticipated stigma from healthcare workers moderated the association of BID with perceived social support, such that poorer perceived support was reported when anticipated stigma was high, despite the presence of minimal BID.

CONCLUSION

These findings highlight the psychological challenges of living with endometriosis in terms of highly prevalent BID, in the context of feeling lonely and poorly supported. The further negative impact of anticipated stigma suggests that psychosocial interventions may benefit from additionally targeting these perceptions of stigma.

Prevalence of poor body image and its correlation with self-esteem and depression in middle-aged women

OBJECTIVE

This study aimed to determine the prevalence and predictors of poor body image and its influence on low self-esteem and depression in middle-aged women.

METHODS

The study was a cross-sectional survey of 372 women using a predesigned online questionnaire. Main outcome measures were mean scores on the nine-point body image scale (BIS) and prevalence of poor body image (BIS ≥ 10). Significant sociodemographic, physical and mental health predictors of BIS ≥ 10 were established using logistic regression analysis. Correlation of body image with self-esteem, assessed by Rosenberg's self-esteem scale, and depression, assessed by Beck's Depression Inventory, was established using Pearson's correlation coefficient and the odds ratios were determined using logistic regression analysis.

RESULTS

The mean scores obtained for body image were 5.52 (standard deviation 4.82) and the prevalence of BIS ≥ 10 was 17.4%. Significant predictors of poor body image were education status (0.59, 95% confidence interval [CI] = 0.39-0.89), body mass index (2.26, 95% CI = 1.12-4.55), social support structure (0.35, 95% CI = 0.16-0.79), diagnosis of mental illness (3.74, 95% CI = 1.31-10.66) and perception of menopause (positive vs. negative: 0.20, 95% CI = 0.07-0.55). Body image scores correlated with self-esteem (r = -0.46; 95% CI = -0.54 to -0.38) and depression (r = 0.59; 95% CI = 0.52-0.65). BIS ≥ 10 significantly increased the odds of low self-esteem (5.71; 95% CI = 2.66-12.26) and depression (11.25; 95% CI = 4.9-27.7).

CONCLUSIONS

The prevalence of poor body image in middle-aged women was 17.4%. This strongly correlated with low self-esteem and depression. A lower education status, higher body mass index, a negative perception of menopause, poor social support structure and a history of mental health diagnosis increased the odds of poor body image prevalence in middle-aged women.

Body image and depression in endometriosis: Examining self-esteem and rumination as mediators

Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.

Body Image, Medication Use, and Mental Health among Women with Fibromyalgia in Flanders, Belgium

Fibromyalgia (FM) is a chronic illness that does not have clear physical consequences, yet research shows that FM patients often have a low body image. An online cross-sectional study was conducted in Flanders, Belgium, among FM women who are connected to the Flemish League for fibromyalgia patients. An adjusted Body Image Scale (BIS) was used to assess body image, the General Health Questionnaire-12 (GHQ-12) was used for mental health, and the Visual Analogue Scale Fibromyalgia Impact Questionnaire (VASFIQ) was used for FM symptoms. Medication use was assessed by using a 4-point Likert scale. Time since diagnosis and age was assessed. A total of 103 women with FM responded. Linear regression showed that BIS was best predicted in a model by using VASFIQ, GHQ-12, time since diagnosis, and sleep medication, wherein only the GHQ-12 was significant as a variable (B = 0.292; p = 0.009). This model explained 19.3% of the variance. The role of sleep medication use disappeared when controlling for mental health. Mental health was more clearly associated with body image than medication use, or even fibromyalgia symptoms. Thus, having negative mental health is associated with a negative body image. In order to improve the body image of FM patients, symptom control alone is not enough; improving mental health is equally important.

Body image concerns in individuals diagnosed with benign gynaecological conditions: scoping review and meta-synthesis

Background

Benign gynaecological conditions (BCGs) and body image-related concerns are commonly experienced by reproductive-aged female-identified individuals. Qualitative evidence from cancer populations identifies a link between diseases of the sexual organs and body image distress encompassing appearance, sensory and functional aspects. Most BCGs and the impacts on body image have been studied separately. However, commonalities exist between these conditions including chronicity, diagnostic delays, and menstrual-related social stigma. This systematic scoping review and meta-synthesis aimed to compare and contrast the experience of body image in the benign conditions of endometriosis, polycystic ovarian cysts, uterine fibroids, and vulvar intraepithelial neoplasia.

Method

Electronic databases (MEDLINE, PsycINFO, Scopus, CINAHL, Embase, and Allied and Complementary Medicine) were searched in February 2020 and relevant articles were examined to identify papers that qualitatively explored the relationship between body image and BCGs. Meta-synthesis was used to analyse the 17 papers that met the inclusion criteria.

Results

Six main themes evolved from this iterative analysis: loss of control; regained control; silence – menstrual concealment; cultural differences; feeling abnormal, and functional impairment. Body image concerns were widespread although impacts on individual’s lives were dependent on the unique symptom profile of each disease which interacted with socio-cultural factors, daily functioning, and feminine identity. Body image concerns were a common, but hidden, experience rarely screened in routine clinical settings despite causing significant distress.

Conclusions

The chronicity and severity of individuals unique symptom profile often determined the intensity and type of body image concerns individuals described. Across conditions, body image concerns were often left untreated, were concealed, and were associated with reduced quality of life.

A contribution to the validation of the Italian version of the Body Image Scale (BIS)

Background

The Body Image Scale (BIS) is a 10-item mono-factorial scale, designed to capture distress and symptoms related to body image in cancer patients. This paper describes the conversion and psychometric evaluation of an Italian BIS version.

Methods

After the back-translation procedure, the Italian version of the BIS, together with the Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey Questionnaire, have been administered to a sample of Italian adult females, surgically treated for a breast cancer at least one year before.

Results

Data on 109 participants were analyzed. The response rate was 92.5%. Response prevalence was adequate for 9 out of 10 items. Principal component analysis showed a one-factor structure. Internal consistency (Cronbach’s alpha =0.924) was good. The BIS correlated with the theoretically pertinent subscales of the other administered tools and was able to discriminate participants (discriminant validity) according to the undertaken surgical treatment (p = 0.031).

Conclusions

This study supports the valid and reliable use also of the Italian version of the BIS.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5143-6) contains supplementary material, which is available to authorized users.

Changes in Sexuality, Body Image and Health Related Quality of Life in Patients Treated for Hematologic Malignancies: A Longitudinal Study

Longitudinal studies exploring sexuality, body image and health-related quality of life (HRQoL) are lacking in patients treated with chemo- or chemoimmuno-therapy for hematologic malignancies. The aim was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until 6 months after treatment. Twenty patients above 45 years (median age 62) treated for DLBCL, CLL or AML participated. Data were collected at baseline, 1- and 6-months after treatment by means of three instruments: SAQ-S, BIS and EORTC QLQ-C30. The results showed that patients' sexuality was negatively affected 1 month after treatment, but after 6 months the patient reported scores had returned almost entirely to baseline scores. Body image was slight negatively affected after 1 month and after 6 months, 50 % reported that body image was not affected at all. Regarding HRQoL, patients reported gradually improved scores during the study period. Regression analysis showed that changes in sexuality and body image seemed to influence changes in HRQoL. This study has shown changes in sexuality, body image and HRQoL over time in patients above age 45 treated for hematologic malignancies. One month after treatment all three areas becomes negatively affected, and thereafter the patients' scores recovered to a great extent regarding these issues within 6 months. Sexuality and body image seem to be important aspects of HRQoL for these patients and need to be integrated in the cancer rehabilitation during and after treatment.

Association between body image dissatisfaction and weight loss among patients with advanced cancer and their caregivers: a preliminary report

CONTEXT

No prospective studies have dealt with the impact of cachexia-related weight loss on patients' body image as well as the impact of patients' body image changes on the level of patient and family distress.

OBJECTIVES

Our aim was to examine associations between body mass index (BMI), weight loss, symptom distress, and body image for patients with advanced cancer and their caregivers.

METHODS

Outpatients with advanced cancer and different levels of BMI, along with their caregivers, were recruited. Patient assessments included BMI, precancer weight, Body Image Scale (BIS; 0-30), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and sexual interest and enjoyment as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck Cancer Module 35. Caregivers were asked to assess the patient's body image, using the BIS; rate their own quality of life, using the Caregiver Quality of Life Index-Cancer; and rate their overall distress and distress regarding the patient's weight, using the Distress Thermometer (DT).

RESULTS

We included 81 patients and 30 caregivers. Forty-eight patients (59%) experienced weight loss of at least 10%. The mean BIS score was 11.23 (SD = 7.24). Body image dissatisfaction was correlated with weight loss (r = 0.31, P = 0.006), anxiety (HADS-A; r = 0.39, P < 0.001), depression (HADS-D; r = 0.46, P < 0.001), decreased sexual interest (r = 0.37, P = 0.001), decreased sexual enjoyment (r = 0.33, P = 0.004), ESAS score for pain (r = 0.25, P = 0.026), fatigue (r = 0.28, P = 0.014), drowsiness (r = 0.28, P = 0.014), shortness of breath (r = 0.27, P = 0.016), sleep disorders (r = 0.24, P = 0.036), and well-being (r = 0.29, P = 0.011). We found a significant association between the caregivers' evaluation of patients' body image dissatisfaction and patients' BIS score (r = 0.37, P = 0.049) and caregivers' distress regarding the patients' weight (DT; r = 0.58; P = 0.001).

CONCLUSION

Body image dissatisfaction was strongly associated with patients' weight loss and with psychosocial distress among patients and their caregivers. More research is necessary to better understand the association between the severity of body image dissatisfaction and the severity of other problems in patients with cancer.

Body image and psychological outcome after severe skin and soft tissue infection requiring intensive care

BACKGROUND

Patients with severe skin and soft tissue infection (SSTI) requiring intensive care unit (ICU) stay are commonly treated with antibiotics, surgery and in some centers also with hyperbaric oxygen therapy. Long-term follow-up of body image and psychological outcome has not been described despite extensive surgery, potentially altered body image and subsequent psychological problems. The aim was to describe perceived body image and its relation to anxiety, depression and post-traumatic stress disorder (PTSD)-related symptoms in patients with severe SSTI 1 year after ICU stay. Specifically, we aimed to assess potential differences related to gender and anatomic site of infection.

METHODS

Fifty patients treated for severe SSTI in the General ICU, Karolinska University Hospital 2008-2010 received the body image scale (BIS), impact of event scale (IES), and hospital anxiety and depression scale (HADS) 1 year after ICU discharge.

RESULTS

Abdominoperineal SSTI was associated with more body image problems than other anatomic sites of infection in both men and women. Generally, women reported higher BIS scores than men (median 9.5 vs. 3.0 of total 30, P < 0.03) indicating more negative body image. A substantial number of patients reported scar dissatisfaction (63.9%), body dissatisfaction (51.1%) and body feeling less whole (51.0%). BIS scores correlated with HADS anxiety (r = 0.59, P < 0.01), depression (r = 0.60, P < 0.01) and IES (r = 0.61, P < 0.01) scores.

CONCLUSION

One year after severe SSTI requiring intensive care, women and patients with abdominoperineal SSTI reported significantly more body image problems. Negative body image was associated with anxiety, depression and PTSD-related symptoms. Specific follow-up for SSTI patients is warranted.

Sexual function after failed ileal pouch-anal anastomosis

BACKGROUND AND AIMS

Failure of ileal pouch-anal anastomosis (IPAA) occurs in around 10% of the patients. Compared to patients with functioning pouches, health related quality of life is deteriorated after failure. Sexual function in patients with pouch failure is however poorly studied. The aim was to study sexual function in patients with pelvic pouch failure; patients with functioning pouches were used as controls. The hypothesis was that patients with pouch failure have worse sexual function.

METHODS

36 patients with pouch failure were compared with 72 age and sex-matched controls with ulcerative colitis and functioning pouches. The patients answered a set of questionnaires concerning sexual function (Female Sexual Function Index [FSFI] and International Index of Erectile Function [IIEF]), body image (BIS-scale) and health-related quality of life (SF-36).

RESULTS

Both women and men with pouch failure scored lower than controls in the FSFI and IIEF questionnaires. However, none of the observations were statistically significant. The scores in the failure group (for both sexes) were below the cut-off level for sexual dysfunction. Scores for the BIS instrument were significantly lower for both sexes in the failure group. Women and men in the failure group scored lower than the controls in all domains of the SF-36, however statistically significant only for the social function domain in men.

CONCLUSIONS

The hypothesis, that a failed IPAA is associated with worse sexual function, was not confirmed. Compared to patients with functioning pouches, patients with pouch failure have inferior body image.

Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial

OBJECTIVE

The purpose of this study was to compare clinical outcome and health related quality of life (HRQOL) 5 years after uterine artery embolization (UAE) or hysterectomy in the treatment of menorrhagia caused by uterine fibroids.

STUDY DESIGN

Patients with symptomatic uterine fibroids who were eligible for hysterectomy were assigned randomly 1:1 to hysterectomy or UAE. Endpoints after 5 years were reintervention rates, menorrhagia, and HRQOL measures that were assessed by validated questionnaires.

RESULTS

Patients were assigned randomly to UAE (n = 88) or hysterectomy (n = 89). Five years after treatment 23 of 81 UAE patients (28.4%) had undergone a hysterectomy because of insufficient improvement of complaints (24.7% after successful UAE). HRQOL measures improved significantly and remained stable until the 5-year follow-up evaluation, with no differences between the groups. UAE had a positive effect both on urinary and defecation function.

CONCLUSION

UAE is a well-established alternative to hysterectomy about which patients should be counseled.

Depression, anxiety and body image after treatment for invasive stage one epithelial ovarian cancer

BACKGROUND

Diagnosis of epithelial ovarian cancer (EOC) in young women has major implications including those to their reproductive potential. We evaluated depression, anxiety and body image in patients with stage I EOC treated with fertility sparing surgery (FSS) or radical surgery (RS). We also investigated fertility outcomes after FSS.

METHODS

A retrospective study was undertaken in which 62 patients completed questionnaires related to anxiety, depression, body image and fertility outcomes. Additional information on adjuvant therapy after FSS and RS and demographic details were abstracted from medical records. Both bi- and multivariate regression models were used to assess the relationship between demographic, clinical and pathological results and scores for anxiety, depression and body image.

RESULTS

Thirty-nine patients underwent RS and the rest, FSS. The percentage of patients reporting elevated anxiety and depression (subscores > or = 11) were 27% and 5% respectively. The median (interquartile range) score for Body Image Scale (BIS) was 6 (3-15). None of the demographic or clinical factors examined showed significant association with anxiety and BIS with the exception of 'time since diagnosis'. For depression, post-menopausal status was the only independent predictor. Among those 23 patients treated by FSS, 14 patients tried to conceive (seven successful), resulting in seven live births, one termination of pregnancy and one miscarriage.

CONCLUSION

This study shows that psychological issues are common in women treated for stage I EOC. Reproduction after FSS is feasible and led to the birth of healthy babies in about half of patients who wished to have another child. Further prospective studies with standardised instruments are required.

Impact of pessary use on prolapse symptoms, quality of life, and body image

OBJECTIVE

We sought to evaluate whether use of a vaginal pessary would change body image, bother symptoms, and quality of life in women with pelvic organ prolapse.

STUDY DESIGN

Women presenting for pessary insertion completed the short forms of Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire, and Body Image Scale. After successful pessary insertion and use for at least 3 months, subjects completed the surveys again. Scores were compared with a paired t test.

RESULTS

A total of 75 subjects were enrolled and follow-up responses were available for 54 subjects for analysis. Body Image Scale scores showed a significant decrease (6.1-3.4; P<.001), indicating an improvement in these women's perception of themselves, as did Pelvic Floor Distress Inventory-20 scores (81.34-45.83; P<.001) and Pelvic Floor Impact Questionnaire scores (50.32-17.98; P=.003).

CONCLUSION

The use of a pessary for 3 months reduces bother symptoms and improves both quality of life and perception of body image in women.

Sexuality and body image after uterine artery embolization and hysterectomy in the treatment of uterine fibroids: a randomized comparison

In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n = 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE.