Screening for abnormal eating attitudes and psychiatric morbidity in an unselected population of 15-year-old schoolgirls

Prevalence and Etiology of Eating Disorders in Polycystic Ovary Syndrome: A Scoping Review

Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disorder affecting females across the lifespan. Eating disorders (EDs) are psychiatric conditions that may impact the development of PCOS and comorbidities including obesity, metabolic syndrome, and type 2 diabetes. The aim of this scoping review was to determine the prevalence of EDs and disordered eating, and to review the etiology of EDs in PCOS. The review was conducted using search terms addressing PCOS, EDs, and disordered eating in databases, including PubMed, Scopus, PsycINFO, and CINAHL. Structured interviews, self-administered questionnaires, chart review, or self-reported diagnosis were used to identify EDs in 38 studies included in the review. The prevalence of any ED in those with PCOS ranged from 0% to 62%. Those with PCOS were 3-6-fold more likely to have an ED and higher odds ratios (ORs) of an elevated ED score compared with controls. In those with PCOS, 30% had a higher OR of bulimia nervosa and binge ED was 3-fold higher compared with controls. Studies were limited on anorexia nervosa and other specified feeding or ED (such as night eating syndrome) and these were not reported to be higher in PCOS. To our knowledge, no studies reported on avoidant/restrictive food intake disorder, rumination disorder, or pica in PCOS. Studies showed strong associations between overweight, body dissatisfaction, and disordered eating in PCOS. The etiologic development of EDs in PCOS remains unclear; however, psychological, metabolic, hypothalamic, and genetic factors are implicated. The prevalence of any ED in PCOS varied because of the use of different diagnostic and screening tools. Screening of all individuals with PCOS for EDs is recommended and high-quality studies on the prevalence, pathogenesis of specific EDs, relationship to comorbidities, and effective interventions to treat ED in those with PCOS are needed.

The Prevalence of “at Risk” Eating Disorders among Athletes in Jordan

Eating disorders (EDs) are addressed as one of the expanding mental health problems worldwide. While an ED is a clinical psychiatric diagnosis that can only be established after a psychiatric assessment, it is important to note that “at-risk” refers to people who will exhibit aberrant eating patterns but do not fully meet the requirements for an ED diagnosis. This study was designed to address the ED symptoms (i.e., “at-risk”) in Jordanian athletes and their association with age, sex, body mass index (BMI), and type of sport. A convenient, cross-sectional study was conducted among 249 athlete participants by answering the Eating Attitude Test (EAT-26). The EAT-26 results indicated an ED prevalence of 34% among Jordanian athletes. Within “at-risk” ED athletes, sex, age, and BMI had no significant differences in the rates of EDs. Outdoor sports had the least effect on EDs, while the highest was amongst gymnastics. EDs prevalence is alarming among Jordanian athletes. Gymnastics is a risk factor for increasing EDs. Our results should be taken into consideration by physicians, mental health professionals, sports nutritionists, coaches, and sport medicine specialists. We recommend establishing strategies pertaining to mental health, especially EDs in sports centers, along with screening programs for those who demand additional assessment and supervision.

State-Based Markers of Disordered Eating Symptom Severity

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic significance of these state-based dynamics for predicting trait-level eating disorder severity, however, remains largely unexplored. The present study uses within-person relationships among state levels of negative mood, body image, and dieting as predictors of baseline, trait-level eating pathology, captured prior to a period of state-based data capture. Two-hundred and sixty women from the general population completed baseline measures of trait eating pathology and demographics, followed by a 7 to 10-day ecological momentary assessment phase comprising items measuring state body dissatisfaction, negative mood, upward appearance comparisons, and dietary restraint administered 6 times daily. Regression-based analyses showed that, in combination, state-based dynamics accounted for 34-43% variance explained in trait eating pathology, contingent on eating disorder symptom severity. Present findings highlight the viability of within-person, state-based dynamics as predictors of baseline trait-level disordered eating severity. Longitudinal testing is needed to determine whether these dynamics account for changes in disordered eating over time.

Inventaires d'auto-évaluation de la psychopathologie chez l'adulte. 1repartie: inventaires multidimensionnels

Les inventaires d'auto-évaluation de la psychopathologie chez l'adulte ont connu un développement remarquable au cours des 2 dernières décennies, à la fois en recherche clinique et en épidémiologie; leurs avantages et leurs limitations sont considérés dans cette revue. Leur construction, leur adaptation éventuelle, l'évaluation de leurs qualités métrologiques et l'établissement de leur stabilité factorielle reposent sur des concepts mélhodologiques dont l'origine et les définitions sont brièvement rappelées. LesHopkins Symptom Check-Lists(HSCL) et leGeneral Health Questionnaire(GHQ) représentent actuellement les 2 grandes familles d'inventaires multidimensionnels. Parmi les différentes HSCL, la HSCL-58 est l'inventaire le plus couramment utilisé, notamment en psychopharmacologie, grâce à sa diffusion, à sa facilité d'emploi, à sa bonne validité externe et à sa structure factorielle si on se limite aux troubles anxiodépressifs non psychotiques. L'existence des 9 dimensions symptomatiques primaires de la SCL-90 est beaucoup moins bien établie, mais ce questionnaire a été utilisé pour des enquêtes épidémiologiques et des essais cliniques, globalement ou à travers certaines de ses dimensions. Plusieurs versions et plusieurs cotations du GHQ ont été produites à partir des 60 items initiaux (GHQ-30, 28, 20, 12). Ils ont fait l'objet de nombreuses études de validation, qui ont, dans l'ensemble, confirmé son intérêt. Le GHQ-28, le plus récent, produit d'analyses factorielles du GHQ-60, englobe 4 dimensions de 7 items chacune: anxiété et insomnie, dépression sévère, gêne sociale, plaintes somatiques. A partir de plusieurs exemples internationaux, le GHQ s'est avéré être un outil intéressant pour le dépistage des cas psychiatriques. En conséquence, la version française du GHQ-28 nous paraît devoir être largement diffusée.

Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis

PURPOSE

We aimed to identify the risk of eating disorders (ED) in women with polycystic ovary syndrome (PCOS) compared to controls.

METHODS

We performed a systematic review and meta-analysis of studies that included women with well-defined PCOS and controls and used validated ED screening/diagnostic tools to measure mean ED score, prevalence of abnormal ED scores, and/or prevalence of specific ED diagnoses such as bulimia nervosa and binge eating disorder.

RESULTS

Eight studies, including 470 women with PCOS and 390 controls, met inclusion criteria for the systematic review. Meta-analysis of seven of those studies found that the odds of an abnormal ED score (OR 3.05; 95% CI 1.33, 6.99; four studies) and the odds of any ED diagnosis (OR 3.87; 95% CI 1.43, 10.49; four studies) were higher in women with PCOS compared to controls.

CONCLUSIONS

Our study suggests that women with PCOS are at increased odds of having abnormal ED scores and specific ED diagnoses. Given the potential implications of an ED on weight management strategies, our findings support routine screening for ED in this population.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

The relationship between risk of eating disorders, age, gender and body mass index in medical students: a meta-regression

PURPOSE

Age, gender and body mass index (BMI) are commonly described risk factors for the development of eating disorders. However, the magnitude of these factors (individually and together) is still not well-defined in some populations.

METHODS

A systematic search was performed for studies that reported the prevalence of eating disorder risk among medical students using the Eating Attitudes Test-26 (EAT-26) and age, gender and BMI as risk factors. We included studies published in English peer-reviewed journals between 1982 and 2017. A total of 14 studies were included in the analyses, and the meta-regression analyses were performed using mean age (years), gender (proportion of female subjects), and mean BMI (kg/m²) as moderators with the risk of eating disorders measured using EAT-26 as an outcome variable. Four interaction terms were created (1) age × gender (2) age × BMI (3) gender × BMI and (4) age × gender × BMI to assess if two or more independent variables simultaneously influence the outcome variable.

RESULTS

Utilizing the EAT-26, the pooled prevalence of at risk for eating disorders among medical students (k = 14, N = 3520) was 10.5% (95% CI 7.3-13.7%). Meta-regression model of age, gender and BMI alone revealed poor predictive capabilities. Meta-regression model of age × gender × BMI interaction revealed statistically significant results with a covariate coefficient of 0.001 and p value of 0.044.

CONCLUSION

Results from this sample of medical students provided evidence for the role of interactions between risk factors (e.g., age × gender × BMI) in predicting individuals at risk for eating disorders, whereas these variables individually failed to predict eating disorders.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Are Body Image Issues Affecting Our Adolescents? A Cross-sectional Study among College Going Adolescent Girls

BACKGROUND

Body image relates to how people think and feel about their own body. In today's society, with the growing sense of ideal body image, adolescents try to lose or gain body weight to attain that perfect body. Body image perception is still naive, and this research will try to understand these unexplored areas, where there is paucity of body image-related studies.

OBJECTIVES

The objective of the study is to find out the proportion of girls dissatisfied about body image, and the association of various factors with body image dissatisfaction and to ascertain the weight control behaviors adopted by adolescent college girls.

METHODOLOGY

A cross-sectional study was done among 1200 college girls in Coimbatore. A semi-structured questionnaire was used to collect data on various factors associated with body image dissatisfaction. Body mass index (BMI) of the participants was calculated.

RESULTS

Body image dissatisfaction was there among 77.6% of the girls. It was found that factors such as higher BMI, sociocultural pressure to be thin and depression were all significantly associated with body image dissatisfaction. The most commonly followed weight control behaviors were eating small meals and skipping meals. Improving the appearance and body shape were the main reasons for weight control behaviors.

CONCLUSION

This study establishes the fact that body image dissatisfaction is no longer a western concept and affects Indian adolescent girls to a great extent. Hence, effective interventions have to be planned to increase awareness on ideal body weight and protect our young generation from pressures of negative body image.

A study on the relationship between exercise addiction, abnormal eating attitudes, anxiety and depression among athletes in Israel

BACKGROUND AND AIMS

The aim of this study was to investigate the relationship between exercise addiction, abnormal eating attitudes, anxiety, and depression among competitive and amateur athletes.

METHODS

Participants were 100 athletes of mean age 28.3 years (18-62), of which there were 67 males and 35 females. The sample consisted of competitive and amateur athletes who participated in individual and group sports. They filled in the Exercise Addiction Inventory, Body Shape Questionnaire, a questionnaire assessing Eating Attitudes Test, Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory (BDI).

RESULTS

Ratings of exercise addiction were positively correlated with BDI scores across the study sample. Exercise addiction ratings were associated with abnormal eating attitudes, but not with trait or state anxiety. Athletes engaging in individual sports scored marginally higher on depression scores than group athletes but there was no difference in depression scores between competitive and amateur athletes. Multiple regression analysis revealed that abnormal eating attitudes contributed significantly to ratings of exercise addiction and explained 7.7% of the variance. According to the Sobel test, the difference in the association between exercise addiction and eating disorder was significant. Therefore, body shape was a mediating factor between eating disorder and exercise addiction.

DISCUSSION AND CONCLUSIONS

This study extends our preliminary findings of an association between exercise addiction and depression. Second, abnormal eating attitudes may explain most of the variance of exercise addiction. This is a further support for previous evidence of comorbidity between exercise addiction and eating disorders.

Effects of single genetic variants and polygenic obesity risk scores on disordered eating in adolescents - The HUNT study

PURPOSE

Improving the understanding of the role of genetic risk on disordered eating (DE).

METHODS

A case-control study including 1757 (F: 979, M: 778) adolescents (aged 13-19 years) from the Nord-Trøndelag Health Study (HUNT), an ethnically homogenous Norwegian population based study. Cases and controls were defined using a shortened version of the Eating Attitude Test. Logistic regression was employed to test for associations between DE phenotypes and 24 obesity and eating disorder susceptibility SNPs, and the joint effect of a subset of these in a genetic risk score (GRS).

RESULTS

COMT was shown to be associated with poor appetite/undereating (OR: 0.6, CI 95%: 0.43-0.83, p = 0.002). Independent of obesity associations, the weighted GRS was associated to overeating in 13-15 year old females (OR: 2.07, CI 95%: 1.14-3.76, p = 0.017). Additionally, a significant association was observed between the GRS and loss of control over eating in the total sample (OR: 1.62, CI 95%: 1.01-2.61, p = 0.046).

CONCLUSIONS

The COMT variant (rs4680) was associated with poor appetite/undereating. Our study further confirms prior findings that obesity risk also confers risk for loss of control over eating; and overeating amongst girls.

Prevention of Eating Disorders among Adolescents

Since eating disorders frequently begin during adolescence, high school students represent a high risk population for the development of these disorders. For this reason, a pilot project for the prevention of eating disorders was instituted at the high school level. The primary goal of this pilot project was to educate students, faculty, and staff at the school about the incidence, symptoms, and consequences of eating disorders. Consultation and referral services were also provided. An evaluation component of the project assessed the informational impact of the prevention program on the students. On a questionnaire designed for the project, a significantly greater number of questions about eating disorders were answered correctly by students who were recipients of the prevention program than by those who were not. The results of this project demonstrate the feasibility of using the high school setting to promote increased awareness of eating disorders and their consequences among high school students.

Evaluation of Body Shape, Eating Disorders and Weight Management Related Parameters in Black Female Students of Rural and Urban Origins

This study examined body shape dissatisfaction, eating disorder and weight management-related parameters as well as assimilation of Western cultural norms regarding body shape in black female students of urban and rural origins. Subjects (n=180; 20 ± 4,4 years old) were weighed, their height was measured and they completed the Body Shape Questionnaire, EAT-26, Eating Inventory (restraint scale), Adolescent Self-Concept Scale and a questionnaire concerning weight management behaviours. Main findings include lower prevalences of overestimation of body weight and body shape dissatisfaction, similar prevalences for dieting and the use of Hazardous weight reduction methods, and higher prevalences for overweight, obesity, disordered eating attitudes and behaviours, and dietary restraint among subjects than among similar white groups. Furthermore, those with urban origins were more likely to be restrained eaters, to have attempted weight reduction, to aim for weight loss and to fear weight gain. These data indicate that there are signs of more realism concerning weight status among black female students. However, there are also signs of assimilation of Western cultural norms concerning body shape, eating attitudes and behaviours and weight management. This diversity in the black student population in South Africa needs to be recognized when planning interventions to address eating related problems.

Spanish version of the eating attitudes test 40: dimensionality, reliability, convergent and criterion validity

The Eating Attitudes Test-40 (EAT-40; Garner & Garfinkel, 1979) is one of the most widely used measures in the field of eating disorders (ED). The factor structure of the EAT-40, as well as the optimal cut-off score to identify subjects with ED, are subjects of debate. Both controversial issues are addressed in the present study. Participants were 95 clinical females meeting DSM-IV-R criteria for ED and 89 females without ED. The results supported a unidimensional structure of the EAT-40 items scores. The general factor accounted for a high percentage (50.63%) of the variance in EAT-40 total scores. The questionnaire proved to have good internal consistency and test-retest reliability. Clinical participants displayed higher mean scores than normal subjects in the EAT-40. Further, participants meeting DSM-IV-R criteria for ED differed significantly from "symptomatic" and "asymptomatic" participants. Correlations with the BULIT-R and the EDI-II scores supported the convergent validity of the questionnaire. The EAT-40 also demonstrated good specificity (94.38%) and sensitivity (93.68%) to detect ED when a cut-off score of 27 was used to discriminate between subjects with and without ED. The implications of these findings for the conceptualization and the assessment of ED are discussed.

Do girls with anorexia nervosa have elevated autistic traits?

BACKGROUND

Patients with anorexia may have elevated autistic traits. In this study, we tested test whether patients with anorexia nervosa (anorexia) have an elevated score on a dimensional measure of autistic traits, the Autism Spectrum Quotient (AQ), as well as on trait measures relevant to the autism spectrum: the Empathy Quotient (EQ), and the Systemizing Quotient (SQ).

METHODS

Two groups were tested: (1) female adolescents with anorexia: n = 66, aged 12 to 18 years; and (2) female adolescents without anorexia: n =1,609, aged 12 to 18 years. Both groups were tested using the AQ, EQ, and SQ, via the parent-report adolescent versions for patients aged 12 to 15 years old, and the self-report adult versions for patients aged over 16 years.

RESULTS

As predicted, the patients with anorexia had a higher AQ and SQ. Their EQ score was reduced, but only for the parent-report version in the younger age group. Using EQ-SQ scores to calculate 'cognitive types', patients with anorexia were more likely to show the Type S profile (systemizing (S) better than empathy (E)), compared with typical females.

CONCLUSIONS

Females with anorexia have elevated autistic traits. Clinicians should consider if a focus on autistic traits might be helpful in the assessment and treatment of anorexia. Future research needs to establish if these results reflect traits or states associated with anorexia.

Validity of the 12-item General Health Questionnaire (GHQ-12) in detecting depressive and anxiety disorders among high school students

Despite the common use of the 12-item General Health Questionnaire (GHQ-12) with adolescents, there is limited data supporting its validity with this population. The aims of the study were to investigate the psychometric properties of the GHQ-12 among high school students, to validate the GHQ-12 against the gold standard of a diagnostic interview, and to suggest a threshold score for detecting depressive and anxiety disorders. Six hundred and fifty-four high school students from years 10 to 12 (ages 15-18) completed the GHQ-12 (Likert scored) and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Test Revision (DSM-IV-TR). Receiver operating characteristic (ROC) curves were plotted. The mean GHQ-12 score for the total sample was 9.9 (S.D.=5.4). Results from the ROC curve indicated that the GHQ-12 performed better than chance at identifying depressive and anxiety disorders (area under the curve (AUC)=0.781). A GHQ-12 threshold score of 9/10 for males and 10/11 for females was found to be optimal. Given the significant proportion of mental illness among high school students, there may be a need to introduce screening for mental illnesses as part of the school curriculum. This can assist with the early identification and enable low stigma preventive intervention within the school environment.

Eating attitudes and dieting behavior among religious subgroups of Israeli-Arab adolescent females

OBJECTIVES

The aim of the study was to compare the eating attitudes and behaviors, including weight concerns and dieting behavior, among three religious subgroups (Moslems, Druze, and Christians) and three age subgroups (12-13, 14-15, and 16-18 years old) of Israeli-Arab adolescent females.

METHODS

The sample consisted of 1141 Israeli-Arab adolescent females, including 926 (81.2%) Moslem, 128 (11.2%) Christian, and 87 (7.6%) Druze schoolgirls in the seventh to twelfth grades. Participants were assessed using the EAT-26 questionnaire.

RESULTS

The results showed that 75% of the students had a negative EAT-26 score (>20) and that 25% of the students had a positive EAT-26 score (<20). No significant differences were found in total scores, subscale scores, or scores above 20 between the age subgroups or the religious subgroups. The results demonstrated a high prevalence of disturbed eating attitudes and behaviors among Israeli-Arab adolescent schoolgirls.

DISCUSSION

Higher prevalence of disturbed eating attitudes found among Israeli-Arab schoolgirls as compared to their Jewish counterparts. Although our sample is a communal based, there still remains an open question as to why the desired "slenderness culture" evident in the results is not reflected in the number of ED clinic referrals, among clinical population. These discrepancies were discussed in light of ethnicity-specific factors that may influence the perceived severity of eating disorders and the receptiveness of primary practitioners to address them.

Eating behavior and body image among psychology students

OBJECTIVE: To characterize eating habits and possible risk factors associated with eating disorders among psychology students, a segment at risk for eating disorders. METHOD: This is a cross-sectional study. The questionnaires Bulimic Investigatory Test Edinburgh (BITE), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ) and a variety that considers related issues were applied. Statistical Package for the Social Sciences (SPSS) 11.0 was utilized in analysis. The study population was composed of 175 female students, with a mean age of 21.2 (DP ± 3.6 years). RESULTS: A positive result was detected on the EAT-26 for 6.9% of the cases (CI95%: 3.6-11.7%). The prevalence of increased symptoms and intense gravity, according to the BITE questionnaire was 5% (CI95%: 2.4-9.5%) and 2.5% (CI95%: 0.7-6.3%), respectively. According to the findings, 26.29% of the students presented abnormal eating behavior. The population with moderate/severe BSQ scores presented dissatisfaction with corporal weight. CONCLUSION: The results indicate that attention must be given to eating behavior risks within this group. A differentiated gaze is justified with respect to these future professionals, whose practice is jeopardized in cases in which they are themselves the bearers of installed symptoms or precursory behavior.

[Validation of the Eating Attitudes Test (EAT) as a screening tool in the general population]

BACKGROUND AND OBJECTIVE

To validate the best alternative cut-off point of a Spanish version of the Eating Attitudes Test (EAT-40) for the screening of eating disorders cases in the general population.

SUBJECTS AND METHOD

The translated questionnaire was administered to a representative sample of 2,734 female students who ranged in age from 13 to 22 years. Participants who scored above 21 points were interviewed, as were a random sample of participants who scored 21 or below. Internal and external validity parameters were estimated for different alternative cut-off scores below the usual EAT score of 30.

RESULTS

The best diagnostic prediction was obtained with a cut-off score of 21 points (sensitivity: 73.3%; specificity: 85.1%). A positive predictive value of 20% and a negative predictive value of 98.4% were obtained.

CONCLUSIONS

The best diagnostic prediction in a non-clinical setting is obtained with a cut-off score of 21, below that recommended by the authors of the questionnaire.

Adolescent cannabis users at 24 years: trajectories to regular weekly use and dependence in young adulthood

AIMS

To examine the association between cannabis use by 18 years and problematic cannabis use at 24 years, considering possible mediating and confounding factors.

DESIGN

Ten-year representative prospective study with data from six time-points in adolescence (mean age 14.9-17.4 years) and two in young adulthood (mean age 20.7 and 24.1 years)

SETTING

Victoria, Australia.

PARTICIPANTS

Inception cohort of 1943 secondary school students (95.6% response rate), with 1520 (78% of adolescent participants) interviewed in the final wave.

MEASUREMENTS

Participants reported frequency of cannabis use for the past 6 months at each time-point in adolescence (age 14-17 years). Cannabis exposure was defined as: maximum frequency of use (occasional, weekly, daily), number of waves of use (1 or 2; 3-6) and first wave of use (early use: first waves 1-3). Young adult (24 years) outcomes were: weekly+ cannabis use and DSM-IV cannabis dependence, referred to collectively as problematic use.

FINDINGS

Of those interviewed at age 24 (wave 8), 34% had reported cannabis use in adolescence (waves 1-6), 12% at a level of weekly or more frequent use; 37% of these adolescent cannabis users were using at least weekly at wave 8, with 20% exhibiting dependence. Persistent adolescent cannabis and tobacco use as well as persistent mental health problems were associated strongly with problematic cannabis use at 24 years, after adjustment for potential confounding factors.

CONCLUSIONS

Heavy, persistent and early-onset cannabis use were all strongly predictive of later cannabis problems. Even so, occasional use was not free of later problems. Where there was co-occurring tobacco use or persistent mental health problems, risks for later problem cannabis use was higher.

Prognosis of adolescent partial syndromes of eating disorder

BACKGROUND

Partial syndromes of eating disorder are common in adolescents but the health significance of these syndromes remains uncertain.

AIMS

To document the health and social adjustment in young adulthood of females assessed as having a partial syndrome of eating disorder in adolescence.

METHOD

A community sample of 1943 participants was tracked over 10 years in an eight-wave cohort study. A partial syndrome was defined as the fulfilment of at least two DSM-IV criteria for either anorexia or bulimia nervosa at one assessment or more between the ages of 15 years and 17 years.

RESULTS

Partial syndromes were found in 9.4% of 15- to 17-year-old female participants and 1.4% of males. There were few instances of progression of partial syndromes to fully fledged anorexia and bulimia nervosa. However, among those with partial syndromes depressive and anxiety symptoms were two to three times higher in young adulthood, substance misuse was common, and a majority of those with a partial syndrome of anorexia nervosa were still underweight in their mid-20s.

CONCLUSIONS

Given the level of subsequent psychopathology and social role impairment, there may be justification for initiating trials of preventive and early clinical intervention strategies for adolescent partial syndromes.

Comportamento alimentar e imagem corporal entre estudantes de educação física

OBJETIVO: Caracterizar práticas alimentares e possíveis fatores de risco associados a transtornos do comportamento alimentar entre estudantes de Educação Física em uma universidade pública do município do Rio de Janeiro. MÉTODO: Estudo seccional, elegendo-se como população-alvo um segmento de risco para o surgimento de transtornos alimentares. Foram aplicados os questionários Bulimic Investigatory Test Edinburgh (BITE), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ) e uma variável que considera os dois instrumentos associados. RESULTADOS: Detectou-se resultado positivo em 6,9% (IC95%: 3,6-11,7%) no EAT-26. No BITE, para sintomas elevados e gravidade intensa, foram encontradas prevalências de 5% (IC95%: 2,4-9,5%) e 2,5% (IC95%: 0,7-6,3%), respectivamente. Constatou-se que 26,29% das estudantes apresentavam comportamento alimentar anormal. CONCLUSÃO: Os resultados deste estudo indicam que se deve atentar para comportamentos alimentares de risco nesse grupo, justificando-se um olhar diferenciado em relação a esses futuros educadores.

Mental health of adolescents in Tehran, Iran

PURPOSE

To investigate mental health in Iranian adolescents, particularly in high school students from urban areas.

METHOD

A sample of 4599 girls and boys was selected from third year classes from high schools in Tehran by a stratified cluster random sampling method. They were investigated by means of the 12-item General Health Questionnaire (GHQ-12) in a cross-sectional study. Following the recommendations of Goldberg et al, the chosen cut-off point for the differentiation between individuals with and without psychiatric morbidity was a score of 7 because of the high mean score within the population.

RESULTS

Of the students, 1270 (19.5%) achieved a GHQ-12 score above the threshold. Significantly more girls (34.1%) than boys (23.7%) had GHQ-12 scores indicating some psychiatric morbidity. On average, the 18-year-old adolescents reported a higher level of mental health problems compared with 17-year-old adolescents in the same school year.

CONCLUSION

A considerable proportion of adolescent high school students experience mental disorders, with girls experiencing such disorders more frequently than boys. Periodic mental health surveys in high schools are proposed to identify students in need of counselling or treatment to improve their coping skills and problem-solving abilities.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

The association between the body mass index of first-year female university students and their weight-related perceptions and practices, psychological health, physical activity and other physical health indicators

Objective

To investigate the association between the weight status of first–year female students (FYFS) and various weight management–related characteristics to identify possible components of a weight management programme for students.

Design

Cross‐sectional study.

Setting

Female residences at a South African university.

Subjects

A total of 360 FYFS.

Results

Mean (± standard deviation (SD)) body mass index (BMI) of the FYFS was 21.8 ± 2.6 kg m−2, with 7.2% being underweight, 81.9% normal‐weight, 10.0% overweight and 0.8% obese. Underweight, normal–eight and overweight students differed with regard to their perception of their weight (P < 0.001), weight goals (P < 0.001) and previous weight–loss practices (P < 0.001). Mean ± SD score on the 26-item Eating Attitudes Test (EAT–26) was 8.5 ± 9.0 with 8.4% classified as high scorers. Mean ± SD score on the 34-item Body Shape Questionnaire (BSQ) was 87.7 ± 32.2, with 76.1% classified as low, 11.9% as medium and 11.9% as high scorers. The self-concept questionnaire indicated that 36.7% had a high, 43.9% a medium and 19.4% a low self-concept. Higher BMI correlated with a higher BSQ score (P < 0.001), a lower self-concept (P = 0.029) and a higher EAT-26 score (P < 0.001). Smoking was prevalent amongst 13.1% of students, and 51.2% used vitamin and/or mineral supplements. Students who quitted smoking had higher (P = 0.006) BMI (22.7 ± 2.9 kg m-2) than those who never smoked before (21.6 ± 2.5 kg m−2). Normal-weight students were more physically active than underweight or overweight students (P = 0.038).

Conclusions

The specific weight management-related needs of FYFS include information about supplement use, smoking, realistic weight goals, safe and sound weight-loss methods, weight cycling, body-shape perceptions, eating attitudes and behaviours, self-concept and physical activity. Interventions aimed at correcting these problems should target all students, regardless of their BMI.

Recurrent binge eating (RBE) and its characteristics in a sample of young women in Germany

OBJECTIVE

To examine the characteristics of recurrent binge eating (RBE) in a non-treatment-seeking sample from the general population. RBE individuals are described in terms of socio-economic status, general psychopathology, and comorbidity rates of mental disorders.

METHOD

Participants were 1877 German females aged 18-24 years from a population-based epidemiological study.

RESULTS/DISCUSSION

The point prevalence of RBE in our sample was 0.9% (N = 17). Compared to healthy women, subjects with RBE suffered more often from comorbid mental disorders and also exhibited more general psychopathology: They were similar to women with other mental disorders and other eating disorders (EDs). RBE seems to be a syndrome of clinical significance itself and might be an important risk factor for the development of further EDs, especially binge eating disorder (BED) and other mental disorders.

Teen smokers reach their mid twenties

PURPOSE

Most outcome studies of adolescent smokers have focused on tobacco use in the short term. Few have reported on the health of adolescent smokers as they reach young adulthood.

METHODS

The design was a 10-year, eight-wave cohort study of a state-wide community sample of 1943 participants in Victoria, Australia. Participants were initially aged 14 to 15 years. Tobacco use was assessed with self-reported frequency of use and a seven-day retrospective diary. The Fagerstrom Test for Nicotine Dependence was used to define nicotine dependence in young adulthood. A computerized interview assessment was used during the teens and in young adulthood.

RESULTS

Former daily smokers in adolescence accounted for most cases of nicotine dependence and high-dose (10+ cigarettes per day) smoking in young adulthood. Other substance abuse and psychiatric morbidity in young adulthood were also markedly elevated in this group. This was most clearly evident for cannabis dependence, where close to two-thirds of all cases were formerly daily tobacco smokers. Male smokers were more likely to continue as young adults. Persistent symptoms of depression and anxiety during the teens predicted progression to nicotine dependence, as did having a parent smoking daily.

CONCLUSIONS

The poor health outcomes of daily adolescent smokers as they reach young adulthood provide a rationale for greater tobacco control initiatives directed at early users. Clinical interventions might usefully consider factors such as psychiatric morbidity and parental smoking.

Can collaboration between education and health professionals improve the identification and referral of young people with eating disorders in schools? A pilot study

In this pilot study, a number of different methods of identifying young people with eating disorders in schools were compared. Pupils aged 16-18 years from 3 schools in the South West of the UK participated (389 boys and 374 girls in total). A self-report questionnaire (EDE-Q) was found to be the most effective method of case identification. However, very few of these cases accepted the offer of help and it was strongly suspected that other cases went undetected despite teacher, parent and school nurse guidance. Implications for future early intervention studies are discussed.

Partial eating disorders among adolescents: a review

PURPOSE

Many adolescents do not fulfill all the DSM-IV criteria's for anorexia nervosa and bulimia, but do nevertheless suffer from partial eating disorders (EDs). This review focuses on the definition, epidemiology and clinical aspects of these disorders.

METHODS

Search on Medline & PsycINFO, review of websites, screening of bibliographies of articles and book chapters.

RESULTS

There is still no consensus on the definition of these disorders, which cover a wide range of severity. Affected adolescents often suffer from physical and psychological problems owing to co-morbidity or as a consequence of their eating patterns: chronic constipation, dyspeptic symptoms, nausea, abdominal pain, fatigue, headaches, hypotension, menstrual dysfunction as well as dysthymia, depressive and anxiety disorders, or substance misuse and abuse. In comparison with those who are unaffected, adolescents with partial ED are at higher risk of evolving into full ED. However, most of them evolve into spontaneous remission. Adolescents with partial ED engaged, over a period of several months, in potentially unhealthy weight-control practices, suffering from intense fear of gaining weight and a disturbed body weight/image should be offered therapeutic support.

CONCLUSION

Future research should focus on the exact delineation of various subtypes of clinical presentations in partial ED and on evidence-based treatment and follow-up of these various situations.

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2%, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6% exhibited anorexia nervosa and 5.6%, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40% sensitivity, 84% specificity, and 14% positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence

AIMS

To examine the risk posed by cannabis use in young people for tobacco use disorders. Specifically we examined whether cannabis use in non-smokers predicted later initiation of tobacco use and whether cannabis use predicted later nicotine dependence in tobacco users.

DESIGN

A 10-year eight-wave cohort study.

SETTING

State of Victoria, Australia.

PARTICIPANTS

A community sample of 1943 participants initially aged 14-15 years.

MEASUREMENTS

Self-report of tobacco and cannabis use was assessed in the teens using a computerized interview assessment and in young adulthood with a CATI assessment. The Fagerström Test for Nicotine Dependence was used to define nicotine dependence.

FINDINGS

For teen non-smokers, at least one report of weekly cannabis use in the teens predicted a more than eightfold increase in the odds of later initiation of tobacco use (OR 8.3; 95% CI 1.9-36). For 21-year-old smokers, not yet nicotine-dependent, daily cannabis use raised the odds of nicotine dependence at the age of 24 years more than threefold (OR 3.6, 1.2, 10) after controlling for possible confounders, including level of tobacco use and subsyndromal signs of nicotine dependence.

CONCLUSIONS

Weekly or more cannabis use during the teens and young adulthood is associated with an increased risk of late initiation of tobacco use and progression to nicotine dependence. If this effect is causal, it may be that a heightened risk of nicotine dependence is the most important health consequence of early frequent cannabis use.

Eating attitudes in a diverse sample of Israeli adolescent females: a comparison study

OBJECTIVES

To estimate the eating attitudes in Israeli Jewish female adolescents.

METHODS

A representative sample of 1270 females in grades 7-12 from five different Israeli schools from five different residential areas were assessed by EAT-26.

RESULTS

Of the total sample, 19.5% were identified as having abnormal eating attitudes. In terms of age, the 16 year olds were found to have the significantly highest rate of total and positive EAT-26 scores. As for school subgroups, the secular boarding schools had the significantly highest rate and the kibbutz had the lowest rate of positive EAT-26 scores for the total and for all subscales.

DISCUSSION

EAT-26 was found to be a useful tool for screening and identifying at-risk groups in a large adolescent Israeli population.

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

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

Gender, eating behavior, and personality characteristics in physically active students

The aim of this paper was to examine associations between personality traits, eating disorder (ED) behavior, exercise, and gender. The participants (n=1482: 905 women and 577 men) were students from four universities in Norway. The subjects filled out a compound questionnaire including demographics, weekly hours of exercise, type of sport, Karolinska Scales of Personality (KSP), and the Eating Disorder Inventory (EDI). Because of the data collection procedure, it is difficult to provide a clear-cut response rate in this study. The results showed that the risk ratio for women who scored 40 or higher on the EDI was three times higher compared with men. ED behavior did not seem to be associated with high weekly hours of physical activity in general. There were significant gender differences in personality traits. However, women and men with high scores on the EDI showed no differences on the KSP scales, except on "detachment" and "indirect aggression". The most important predictors for weekly hours of physical activity were the EDI scales "drive for thinness" and "body dissatisfaction", and the personality variables "extraversion" and "neuroticism". The factors that contributed most to the differences between students who scored 40 or higher on the EDI and those who scored below 40 on the EDI were neuroticism, BMI, gender, and age.

Teenage drinking and the onset of alcohol dependence: a cohort study over seven years

AIM

To determine whether adolescent alcohol use and/or other adolescent health risk behaviour predisposes to alcohol dependence in young adulthood.

DESIGN

Seven-wave cohort study over 6 years.

PARTICIPANT

A community sample of almost two thousand individuals followed from ages 14-15 to 20-21 years.

OUTCOME MEASURE

Diagnostic and Statistical Manual volume IV (DSM-IV) alcohol dependence in participants aged 20-21 years and drinking three or more times a week.

FINDINGS

Approximately 90% of participants consumed alcohol by age 20 years, 4.7% fulfilling DSM-IV alcohol dependence criteria. Alcohol dependence in young adults was preceded by higher persisting teenage rates of frequent drinking [odds ratio (OR) 8.1, 95% confidence interval (CI) 4.2, 16], binge drinking (OR 6.7, 95% CI 3.6, 12), alcohol-related injuries (OR 4.5 95% CI 1.9, 11), intense drinking (OR 4.8, 95% CI 2.6, 8.7), high dose tobacco use (OR 5.5, 95% CI 2.3, 13) and antisocial behaviour (OR 5.9, 95% CI 3.3, 11). After adjustment for other teenage predictors frequent drinking (OR 3.1, 95% CI 1.2, 7.7) and antisocial behaviour (OR 2.4, 95% CI 1.2, 5.1) held persisting independent associations with later alcohol dependence. There were no prospective associations found with emotional disturbance in adolescence.

CONCLUSION

Teenage drinking patterns and other health risk behaviours in adolescence predicted alcohol dependence in adulthood. Prevention and early intervention initiatives to reduce longer-term alcohol-related harm therefore need to address the factors, including alcohol supply, that influence teenage consumption and in particular high-risk drinking patterns.

Screening for eating disorders and high-risk behavior: caution

OBJECTIVE

The current study reviews the state of eating disorder screens.

METHODS

Screens were classified by their purported screening function: identification of cases with (a) anorexia nervosa only; (b) bulimia nervosa only; (c) eating disorders in general; (d) partial syndrome, eating disorder not otherwise specified (EDNOS), or subclinical; (e) not a-d but at high risk. Information is presented on development, psychometric properties, and external validation (e.g., sensitivity, specificity, positive predictive values, and negative predictive values).

RESULTS

Screens differ widely with regard to objective, psychometric properties and the validation methodology used. Most screens that identify cases are not appropriate for the identification of at-risk behaviors. Little data on the external validity of screens are available.

DISCUSSION

Screens should be used with caution. A sequential procedure, in which subjects identified as being at risk during the first stage is followed by more specific diagnostic tests during the second stage, might overcome some of the limitations of the one-stage screening approach.

Population at risk for eating disorders in a Spanish region

OBJECTIVE

To estimate the prevalence of adolescent population at risk for eating disorders (EDs), to examine gender differences and their association with non-psychotic mental disorders.

METHODS

Cross-sectional study using an anonymous, self-reported questionnaire in the classroom and measurement of weight and height in a representative sample of 4334 teenagers of both sexes. A definition of population at risk for EDs has been established, that differentiates those with dieting criteria and those with binge-purge eating behaviour criteria. This definition includes a combination of weight, behaviour, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, and Eating Disorder Inventory (EDI) results. The General Health Questionnaire-28 (GHQ-28) was used to assess non-psychotic mental disorders.

RESULTS

The prevalence of population at risk for EDs was 2.2% (95% CI: 1.6-2.8) for men and 15.3% (95% CI: 13.8-16.9) for women. The prevalence rate of combining both ED risk and mental disorder was 0.8% (95% CI: 0.4-1.2) for men and 9.9% (95% CI: 8.6-11.2) for women. Non-psychotic mental disorders were more prevalent in the population at risk for EDs than in the rest of the population.

CONCLUSIONS

A considerable proportion of adolescent females have eating problems and non-psychotic mental disorders. Their male counterparts also suffer from these disorders, however, a different pattern is followed.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Antecedents and consequences of binge eating episodes in women with an eating disorder

The aim of this study was to explore antecedents and sequelae of binge eating episodes. A sample of eating disorders (n = 154 women) was selected from a total of 1849 female respondents (out of 2500) recruited as part of a general population-based survey. Included participants met DSM-III-R criteria for anorexia nervosa (AN), bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) based on the Survey for Eating Disorders (SEDs). Preliminary criteria for binge eating disorder (BED) were added. Results indicated that the most frequently reported antecedents and consequences of binge eating were emotional and physiological factors. There were significant differences between the different ED subgroups in their frequency of binge eating episodes. Regarding antecedents of a binge eating episode, the SEDs-defined ED subgroups had overall differences in frequency on "stomach feeling". In particular, the BN-group reported "euphoria" more frequently than the BED and EDNOS-groups. Concerning consequences of a binge eating episode, there were overall differences between the ED subgroups on "fall asleep", and in addition a borderline significance was found for "disturbed by others" (p = 0.059). None of the eight women in the AN group reported "euphoria" as a factor that terminated a binge eating episode. The findings may have important implications with regard to prevention and treatment of ED.

Comportamento alimentar e imagem corporal em atletas

O ambiente esportivo pode ser um meio ampliador de pressões socioculturais motivadas pelo ideal de corpo magro. A presente investigação teve o objetivo de verificar a presença de comportamentos sugestivos de transtornos do comportamento alimentar (TCAs), de alterações na imagem corporal e de disfunções menstruais em atletas da EEFD-UFRJ. Foram avaliadas 12 atletas do sexo feminino (20 ± 2,0 anos) com 4,6 ± 2,3 anos de treinamento (13,8 ± 2,9h/semana) e seus resultados foram comparados com os de 32 jovens não-atletas (15,0 ± 1,4 ano). A avaliação de atitudes e comportamentos relacionados com a alimentação e o controle de peso foi realizada pelo Eating Attitudes Test (EAT-26), a existência de comportamentos sugestivos de bulimia nervosa pelo Bulimic Investigatory Test Edimburgh (BITE) e o grau de insatisfação com a imagem corporal pelo Body Shape Questionnaire (BSQ). Esses são instrumentos de auto-aplicação e foram usados na versão em português. As atletas apresentavam massa corporal total de 59 ± 7,3kg, estatura de 1,65 ± 0,03m, percentual de gordura corporal (%G) 23,1 ± 4,1% e índice de massa corporal (IMC) de 21,6 ± 2,3kg/m². O BSQ apontou que 33% das atletas apresentam leve distorção da imagem corporal mesmo estando com valores para gordura corporal dentro de padrões esperados para a idade e sexo. O BITE apontou 16,6% das atletas com padrão alimentar não-usual na escala de sintomas, sem que estas apresentassem expressão na escala de gravidade. As atletas com padrão alimentar não-usual estão incluídas no total sugestivo de distorção de imagem corporal. O EAT-26 exibiu resultado negativo para todas as atletas. Os resultados encontrados na análise sugerem a presença de sintomas que não caracterizam, precisamente, a bulimia nervosa ou a anorexia nervosa, mas ressaltam a necessidade de avaliação e vigilância mais criteriosas da existência de TCA e seus precursores no ambiente esportivo, como forma de prevenção.

Bulimia Nervosa: A Primary Care Review

Bulimia nervosa is a psychiatric condition that affects many adolescent and young adult women. The disorder is characterized by bingeing and purging behavior and can lead to medical complications. Thus, patients with bulimia nervosa commonly present in the primary care setting. Physical and laboratory examinations reveal markers of bulimia nervosa that are useful in making the diagnosis. Treatment is beneficial, and outcomes of early intervention are good. This article discusses the history, presentation, and tools needed for recognizing and treating bulimia nervosa in primary care.

Eating disorder symptoms among adults with severe and persistent mental illness

This article presents pilot data examining the: (1) prevalence of eating disorder symptoms among adults with severe and persistent mental illness (SPMI) and (2) clinical and demographic predictors of eating disorder symptoms. Participants were 149 adults with SPMI who were receiving community mental health services. The Eating Attitudes Test, Body Image Avoidance Questionnaire, purging questions, and Body Mass Index were used to assess eating disorder symptoms. Forty percent of participants indicated eating disorder symptoms. Predictors of eating disorder symptoms included female gender and greater clinical severity. The findings suggest the need for clinical attention to eating disorders for this population.

Menstrual functioning and psychopathology in a county-wide population of high school girls

OBJECTIVE

To examine the association between menstrual functioning and depressive disorder symptoms (DDS), obsessive-compulsive disorder symptoms (OCDS), and eating disorder symptoms (EDS) in high school girls.

METHOD

Survey data from a county-wide high school population (completion rate 91%) were used. Associations between menstrual indices and scores above clinical cutoff on the Beck Depression Inventory, Leyton Obsessive-Compulsive Inventory-Child Version, and Eating Attitudes Test were examined by using logistic regression ( = 2,547 girls).

RESULTS

Controlling for chronological age and other risk factors, late menarche was associated with DDS (odds ratio [OR] = 2.26, 95% confidence interval [CI] = 1.16-4.18). Gynecological year 1 (GY1) was associated with DDS (OR = 3.13, CI = 1.23-7.33), EDS (OR = 3.11, CI = 1.00-8.09), and OCDS, both number (OR = 5.75, CI = 1.79-15.74) and interference (OR = 12.55, CI = 3.20-41.4). Secondary amenorrhea was associated with DDS (OR = 1.94, CI = 11.30-2.84) and EDS (OR = 2.32, CI = 1.51-3.49); polymenorrhea with EDS (OR = 1.92, CI = 1.27-2.86); and irregular cycles with EDS (OR = 1.70, CI = 1.11-2.54) and DDS (OR = 1.76, CI = 11.21-2.53).

CONCLUSIONS

In high school girls, late menarche, GY1, and menstrual cycle abnormalities are associated differentially with DDS, OCDS, and EDS.

A review of the validity of the General Health Questionnaire in adolescent populations

OBJECTIVE

To comprehensively review the validity of the General Health Questionnaire (GHQ) [1] with adolescents (aged 12-19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic.

METHOD

Systematic review of the English language peer-reviewed literature.

RESULTS

Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version.

CONCLUSION

The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated.

IMPLICATIONS

Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.

Dietary restraint in relation to nutrient intake, physical activity and iron status in adolescent females

AIM

To investigate the prevalence of dietary restraint in a female adolescent population, and to examine the nutritional consequences of dietary restraint and its implications for iron status.

METHODS

A total of 64 adolescent females, aged 14-15 years, were recruited from two all-girl schools in central London. Nutrient intake, body weight, physical activity and iron status were measured. Findings were compared between three groups of subjects classified by dietary restraint.

RESULTS

Adolescents with a higher BMI percentile were more likely to be highly restrained. Scores on the dietary restraint psychometric measures were comparable with other UK studies in this age group. Energy intake was inversely related to dietary restraint (mean energy intake (SE) for each restraint group were: low 8.99 MJ (0.48), medium 7.98 MJ (0.22) and high 7.35 MJ (0.39) P < 0.05); however, a corresponding relationship between dietary restraint and reduced micronutrient intakes was not found. Highly restrained eaters obtained more of their energy intake from bread, fruit and cheese and less from meat, meat products and confectionery. Levels of physical activity were not significantly different between the dietary restraint groups. There was a poor relationship between reported energy intake and estimated energy expenditure. Haematological parameters of iron status were similar across the restraint groups.

CONCLUSIONS

Dietary restraint was exercised by the consumption of a "healthy eating diet". Dieting was not related to a lower iron status; however, the low dietary iron intake and poor iron status of the whole sample is of concern.

An ethnic comparison of eating attitudes and associated body image concerns in adolescent South African schoolgirls

OBJECTIVE

The purpose of this study was to investigate whether differences exist in eating attitudes and body shape concerns amongst adolescent schoolgirls representing South Africa's ethnically and culturally diverse population currently undergoing epidemiological transition.

METHOD

A questionnaire survey, including the Eating Attitudes Test, Body Shape Questionnaire and a Body Silhouette Chart, was administered to 228 South African schoolgirls (60 black, 83 mixed race and 85 white) aged 15-18 years from five secondary schools in the greater Cape Town area.

RESULTS

Black girls had significantly higher mean BMI values (24.1 (3.3)) than either white (21.9 (3.0)) or mixed race girls (22.1 (3.7)) (P < 0.05). Controlling for differences in BMI, white subjects scored significantly higher on the Body Shape Questionnaire than did mixed race or black subjects, whereas no ethnic differences were found for Eating Attitude Test scores. A comparable percentage (mean = 18.8%) of black, mixed race and white girls had scores indicative of eating disorder pathology on the Eating Attitudes Test, while a higher percentage of white, compared to mixed race and black, girls had abnormal scores on the Body Shape Questionnaire (33%, 26% and 20%, respectively; P < 0.05). The ideal body size desired by white girls was significantly smaller than that of the mixed race or black samples. Dissatisfaction with present body size was significantly higher in white, compared to black or mixed race girls (P < 0.001).

CONCLUSION

These findings suggest that the prevalence of abnormal eating attitudes is equally common in South African schoolgirls from different ethnic backgrounds. White girls exhibit greater body image concerns and body image dissatisfaction than mixed race or black individuals. These findings reinforce the notion that eating disorders are culture-reactive rather than culture-bound phenomena and provide insight into the extent of eating-related problems and body image issues in developing societies.