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Cusack CE, Ralph-Nearman C, Christian C, Fisher AJ, Levinson CA. Understanding heterogeneity, comorbidity, and variability in depression: Idiographic models and depression outcomes. J Affect Disord 2024; 356:248-256. [PMID: 38608769 DOI: 10.1016/j.jad.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
This study uses time-intensive, item-level assessment to examine individual depressive and co-occurring symptom dynamics. Participants experiencing moderate-severe depression (N = 31) completed ecological momentary assessment (EMA) four times per day for 20 days (total observations = 2480). We estimated idiographic networks using MDD, anxiety, and ED items. ED items were most frequently included in individual networks relative to depression and anxiety items. We built ridge and logistic regression ensembles to explore how idiographic network centrality metrics performed at predicting between-subject depression outcomes (PHQ-9 change score and clinical deterioration, respectively) at 6-months follow-up. For predicting PHQ-9 change score, R2 ranged between 0.13 and 0.28. Models predicting clinical deterioration ranged from no better than chance to 80 % accuracy. This pilot study shows how co-occurring anxiety and ED symptoms may contribute to the maintenance of depressive symptoms. Future work should assess the predictive utility of psychological networks to develop understanding of how idiographic models may inform clinical decisions.
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Affiliation(s)
- Claire E Cusack
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Christina Ralph-Nearman
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Caroline Christian
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Aaron J Fisher
- University of California-Berkeley, Department of Psychology, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America.
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2
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Pictor LE, Laboe AA, Dillon K, Frank M, Gavuji M, Krawczyk A, Schaumberg K. A pilot randomized trial of the body advocacy movement: a novel, dissonance-based intervention designed to target fear of weight gain and anti-fat bias in young adults. Eat Disord 2024:1-20. [PMID: 38557300 DOI: 10.1080/10640266.2024.2332823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The Body Advocacy Movement (BAM) is a novel, cognitive-dissonance-based intervention designed to target fatphobia and anti-fat bias as mechanisms to drive reductions in eating disorder (ED) risk. Previous dissonance-based programs (i.e. the Body Project; BP) have successfully targeted thin-ideal internalization as an intervention mechanism. As burgeoning research indicates that fatphobia and anti-fat bias may play a central role in the maintenance of ED pathology, a focused intervention designed to target these constructs could bolster prevention efforts. The aims of this pilot study include confirming acceptability and feasibility of BAM and developing preliminary estimates of its effects on intervention targets, along with benchmarking these effects against the BP intervention. BAM was found to be accepted by participants and feasible to facilitate in a peer-led model. Preliminary results from 50 participants (BAM: N = 26; BP: N = 24) reveal small-to-moderate pre-to-post intervention effects on fatphobia, anti-fat bias, thin-ideal internalization, and eating pathology, which dissipated at 8-week follow-up. The BAM intervention has the potential to supplement the existing suite of ED prevention programs by specifically targeting anti-fat bias, though additional testing in larger and more diverse samples is necessary to clarify its impact on both hypothesized risk mechanisms and ED outcomes.
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Affiliation(s)
- Lauren E Pictor
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - A A Laboe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - K Dillon
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - M Frank
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - M Gavuji
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - A Krawczyk
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Peng J, Yuan S, Wei Z, Liu C, Li K, Wei X, Yuan S, Guo Z, Wu L, Feng T, Zhou Y, Li J, Yang Q, Liu X, Wu S, Ren L. Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder. BMC Psychiatry 2024; 24:241. [PMID: 38553683 PMCID: PMC10981297 DOI: 10.1186/s12888-024-05698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND A temporal network of generalized anxiety disorder (GAD) symptoms could provide valuable understanding of the occurrence and maintenance of GAD. We aim to obtain an exploratory conceptualization of temporal GAD network and identify the central symptom. METHODS A sample of participants (n = 115) with elevated GAD-7 scores (Generalized Anxiety Disorder 7-Item Questionnaire [GAD-7] ≥ 10) participated in an online daily diary study in which they reported their GAD symptoms based on DSM-5 diagnostic criteria (eight symptoms in total) for 50 consecutive days. We used a multilevel VAR model to obtain the temporal network. RESULTS In temporal network, a lot of lagged relationships exist among GAD symptoms and these lagged relationships are all positive. All symptoms have autocorrelations and there are also some interesting feedback loops in temporal network. Sleep disturbance has the highest Out-strength centrality. CONCLUSIONS This study indicates how GAD symptoms interact with each other and strengthen themselves over time, and particularly highlights the relationships between sleep disturbance and other GAD symptoms. Sleep disturbance may play an important role in the dynamic development and maintenance process of GAD. The present study may develop the knowledge of the theoretical model, diagnosis, prevention and intervention of GAD from a temporal symptoms network perspective.
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Affiliation(s)
- Jiaxi Peng
- Mental Health Education Center, Chengdu University, 610106, Chengdu, China
| | - Shuai Yuan
- University of Amsterdam, 1018WB, Amsterdam, the Netherlands
| | - Zihan Wei
- Xijing Hospital, Air Force Medical University, 710032, Xi'an, China
| | - Chang Liu
- Brain Park, School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, 3800, Clayton, VIC, Australia
| | - Kuiliang Li
- Department of Psychology, Army Medical University, 400038, Chongqing, China
| | - Xinyi Wei
- Department of Psychology, Renmin University of China, 100000, Beijing, China
| | - Shangqing Yuan
- School of Psychology, Capital Normal University, 100089, Beijing, China
| | - Zhihua Guo
- Department of Military Medical Psychology, Air Force Medical University, 710032, Xi'an, China
| | - Lin Wu
- Department of Military Medical Psychology, Air Force Medical University, 710032, Xi'an, China
| | - Tingwei Feng
- Department of Military Medical Psychology, Air Force Medical University, 710032, Xi'an, China
| | - Yu Zhou
- Military Psychology Section, Logistics University of PAP, 300309, Tianjin, China
- Military Mental Health Services & Research Center, 300309, Tianjin, China
| | - Jiayi Li
- Military Psychology Section, Logistics University of PAP, 300309, Tianjin, China
- Military Mental Health Services & Research Center, 300309, Tianjin, China
| | - Qun Yang
- Department of Military Medical Psychology, Air Force Medical University, 710032, Xi'an, China
| | - Xufeng Liu
- Department of Military Medical Psychology, Air Force Medical University, 710032, Xi'an, China
| | - Shengjun Wu
- Department of Military Medical Psychology, Air Force Medical University, 710032, Xi'an, China.
| | - Lei Ren
- Military Psychology Section, Logistics University of PAP, 300309, Tianjin, China.
- Military Mental Health Services & Research Center, 300309, Tianjin, China.
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Brown TA, Klimek-Johnson P, Siegel JA, Convertino AD, Douglas VJ, Pachankis J, Blashill AJ. Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals. Int J Eat Disord 2024; 57:648-660. [PMID: 38279188 DOI: 10.1002/eat.24150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. METHODS N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. RESULTS Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. DISCUSSION Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. PUBLIC SIGNIFICANCE This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Patrycja Klimek-Johnson
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Alexandra D Convertino
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Valerie J Douglas
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - John Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Aaron J Blashill
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
- Department of Psychology, San Diego State University, San Diego, California, USA
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Zhang H, Liu Z, Zheng H, Xu T, Liu L, Xu T, Yuan TF, Han X. Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia - a sample from bariatric surgery candidates and healthy controls. BMC Public Health 2024; 24:653. [PMID: 38429770 PMCID: PMC10905949 DOI: 10.1186/s12889-024-18015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.
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Affiliation(s)
- Hongwei Zhang
- Department of Bariatric & Metabolic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziqi Liu
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychology, Anhui Provincial Children's Hospital, Children's Hospital of Fudan University Anhui Hospital, National Children's Regional Medical Center, Hefei, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Xu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Liu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Xu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
| | - Xiaodong Han
- Department of Bariatric & Metabolic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Gao X, Liu Z. Analyzing the psychometric properties of the PHQ-9 using item response theory in a Chinese adolescent population. Ann Gen Psychiatry 2024; 23:7. [PMID: 38263122 PMCID: PMC10807143 DOI: 10.1186/s12991-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND People are more likely to fall victim to depression during adolescence since it is a period of rapid biopsychosocial transformation. Despite this, most depression research has concentrated on clinical issues, and evaluating depressive symptoms in teenagers is not as widespread. This study used item response theory (IRT) to examine the psychometric properties of the Patient Health Report scale (PHQ-9) in Chinese adolescents. Meanwhile, item function difference tests were used to check whether there were differences in depression symptoms in this group based on education and gender. METHODS In this research, the PHQ-9 was employed as a measurement tool, and 5958 valid data points were obtained from 12 secondary schools in China (Mage = 13.484; SDage = 1.627; range 11-19 years; 52.17% boys). RESULTS IRT shows that all items of the PHQ-9 satisfy monotonicity, unidimensionality and local independence and that they have good psychometric properties. Furthermore, DIF analysis revealed gender and educational disparities in adolescent depressive symptoms. CONCLUSION The study indicates that the PHQ-9 possesses favourable psychometric properties for use in Chinese adolescents. As a result, it serves as a valuable tool for effectively screening depressive symptoms in adolescents. It provides a foundation for prioritizing the development of secondary school students' physical and mental health.
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Affiliation(s)
- Xuliang Gao
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang, 550025, Guizhou, China.
| | - Ziyu Liu
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang, 550025, Guizhou, China
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7
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Meier M, Summers BJ, Buhlmann U. Which Symptoms Bridge Symptoms of Depression and Symptoms of Eating Disorders?: A Network Analysis. J Nerv Ment Dis 2024; 212:61-67. [PMID: 38166183 DOI: 10.1097/nmd.0000000000001715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
ABSTRACT Depression is a common comorbid mental illness in eating disorders (EDs). Network theory focuses on interactions between symptoms, but findings from network analyses of EDs and depression need to be replicated to make reliable claims about the nature of symptomatic interplay. We used cross-sectional data of 366 online-recruited participants with clinically elevated ED symptomatology and constructed a regularized partial correlation network with ED and depression symptoms. To determine each symptom's influence, we calculated expected influence (EI) and bridge EI to identify symptoms that bridged symptoms of depression and ED. Concerns that others see one eat, fear of weight gain, and fear of loss of control over eating were especially important among the ED symptoms. Loss of interest and feeling sad were the key depression symptoms. Eating in secret and low self-esteem emerged as potential bridge symptoms between clusters. These findings regarding bridge symptoms partially overlap with prior network analyses in nonclinical and clinical samples. Future studies that investigate symptom interplay via a longitudinal design to deduce causality are needed.
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Affiliation(s)
- Marieke Meier
- Department of Psychology, University of Münster, Münster, Germany
| | - Berta J Summers
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts
| | - Ulrike Buhlmann
- Department of Psychology, University of Münster, Münster, Germany
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Cusack CE, Vanzhula IA, Sandoval-Araujo LE, Pennesi JL, Kelley SW, Levinson CA. Are central eating disorder network symptoms sensitive to item selection and sample? Implications for conceptualization of eating disorder psychopathology from a network perspective. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2024; 133:48-60. [PMID: 38147054 PMCID: PMC10751960 DOI: 10.1037/abn0000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Item selection is a critical decision in modeling psychological networks. The current preregistered two-study research used random selections of 1,000 symptom networks to examine which eating disorder (ED) and co-occurring symptoms are most central in longitudinal networks among individuals with EDs (N = 71, total observations = 6,060) and tested whether centrality changed based on which items were included in the network. Participants completed 2 weeks of ecological momentary assessment (five surveys/day). In Study 1, we obtained initial strength centrality values by estimating an a priori network using eight items with the highest means. We then estimated 1,000 networks and their centrality from a random selection of unique eight-item symptom combinations. We compared the strength centrality from the a priori network to the distribution of strength centrality estimates from the random-item networks. In Study 2, we repeated this procedure in an independent longitudinal dataset (N = 41, total observations = 4,575) to determine if our results generalized across samples. Shame, guilt, worry, and fear of losing control were consistently central across networks, regardless of items included in the network or sample. Results suggest that these symptoms may be important to the structure of ED psychopathology and have implications for how we understand the structure of ED psychopathology. Existing methods for item inclusion in psychological networks may distort the structure of ED symptom networks by either under- or overestimating strength centrality, or by omitting consistently central symptoms that are nontraditional ED symptoms. Future research should consider including these symptoms in models of ED psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Claire E. Cusack
- University of Louisville, Department of Psychological and Brain Sciences
| | | | | | - Jamie-Lee Pennesi
- University of Louisville, Department of Psychological and Brain Sciences
| | | | - Cheri A. Levinson
- University of Louisville, Department of Psychological and Brain Sciences
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Ralph-Nearman C, Williams BM, Ortiz AML, Levinson CA. Investigating the Theory of Clinical Perfectionism in a Transdiagnostic Eating Disorder Sample Using Network Analysis. Behav Ther 2024; 55:14-25. [PMID: 38216228 DOI: 10.1016/j.beth.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 01/14/2024]
Abstract
Eating disorders are deadly psychiatric illnesses, with treatments working for less than half of individuals who seek treatment. The transdiagnostic theory of eating disorders proposes that eating disorders share similar maintaining symptoms, such as what this theory calls clinical perfectionism (i.e., high levels of concern over mistakes and personal standards). However, it has been difficult to examine the interrelationship of specific aspects of perfectionism, beyond assessing moderation effects, which have generally not found support for the theory of clinical perfectionism in eating disorders. Thus, we used network analysis to test the theory of perfectionism by testing the interrelationships between maladaptive perfectionism facets (concern over mistakes, personal standards, parental criticism, parental expectations, and personal standards) and eating disorder symptoms in 397 individuals diagnosed with an eating disorder. Concern over mistakes was a central symptom and demonstrated the strongest interrelationships with eating disorder symptoms compared to the other aspects of perfectionism, connecting to eating concerns and cognitive restraint. Objective binge eating had a strong negative connection to personal standards. We identified specific central symptoms and illness pathways of perfectionism, which partially supports the theory of clinical perfectionism. Results, if replicated, may suggest that concern over mistakes might be best reconceptualized as part of eating disorder pathology and be targeted to improve treatment outcomes for eating disorders.
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Ford S, Vaughn J, Subramaniam A, Gundala A, Hensley E, Shah N. Supporting data driven translational patient-centered care using network analysis to visualize symptom distress in children with serious illness. J SPEC PEDIATR NURS 2024; 29:e12422. [PMID: 38284219 DOI: 10.1111/jspn.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE There are an increasing number of techniques and tools to improve the capacity for children to relay their perceptions of their symptom experience while undergoing blood and marrow transplant (BMT). Network analysis (NA) is a tool that can illustrate associations between symptoms and the distress they cause. We aimed to develop a biopsychosocial assessment clinical analytic tool to examine symptom relationships for children undergoing BMT to find actionable relationships for intervention to improve clinical outcomes including mood. DESIGN AND METHODS This pilot study used an analytical mobile application tool to support a wide scope of 15 biopsychosocial symptom distress levels and five mood assessments. Children recorded their symptom distress and mood using the app. NA was used to explore relationships between symptom distress and mood. RESULTS Four children, 11-14 years old, undergoing BMT used the app daily during hospitalization. We found a strong presence of emotional distress and its associations symptom distress and mood. Multiple symptom associations were identified including associations between the set of symptoms difficulty breathing and fever (0.557), sad and worried (0.429). Of note, pain distress had a strong capacity to bridge other symptoms and was connected directly to many symptoms. PRACTICE IMPLICATIONS We found the significance of patient struggles with emotional and symptom distress and the importance of this relationship to other clinical outcomes. This provides valuable insights and an improved understanding of the child's symptoms. Our findings support early assessment, intervention, and improved symptom communication to enhance sense of well-being and the child's care experience.
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Affiliation(s)
- Shannon Ford
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Jacqueline Vaughn
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Arvind Subramaniam
- East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Abhinav Gundala
- North Carolina State University, Raleigh, North Carolina, USA
| | - Elizabeth Hensley
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nirmish Shah
- Duke University Medical Center, Durham, North Carolina, USA
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11
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Wu R, Guang Z, Wang Y, Xue B, Zhang A, Dawa Y, Guo C, Tong X, Wang S, Lu C. Eating disorders symptoms and depressive symptoms in Chinese Tibetan University students: a network analysis. BMC Psychiatry 2023; 23:957. [PMID: 38129774 PMCID: PMC10734136 DOI: 10.1186/s12888-023-05452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Depression is being increasingly acknowledged as a global public health concern, and following this trend, attention towards eating disorders (EDs) has surged within China's national consciousness. EDs symptoms frequently coexist with various mental health conditions, including depression. However, research focusing on EDs symptoms and depressive symptoms among Tibetan students in China remains scant. This study employs network analysis to estimate the relational network between EDs and depressive symptoms. METHODS Tibetan (n = 2,582) and Han (n = 1,743) students from two universities in the Xizang Autonomous Region, China, completed the Eating Attitude Test-26 (EAT-26) and the Patient Health Questionnaire-9 (PHQ-9). We estimated the network structure of EDs symptoms and depressive symptoms, identified central and bridge symptoms, and examined whether network characteristics differed by gender and ethnic. RESULTS The core symptoms identified within this study were Calorie_awareness, Desire_to_thin and Fatigue. Conversely, bridge symptoms included Appetite, Suicide, Anhedonia, Guilty, Body_fat_awareness, and Food_preoccupation. The study also revealed no significant gender differences within the network model. However, disparities among ethnic groups were observed within the network structure. CONCLUSIONS Our study examined the correlation between EDs symptoms and depressive symptoms in Tibetan college students. Focusing on the individual's quest for the perfect body shape and some Tibetan students' appetite problems - potentially stemming from transitioning to a new university environment, adapting to the school canteen's diet, or being away from their hometown - could aid in the prevention and management of EDs and depression symptoms. It could reduce the incidence of complications by helping students maintain good physical and mental health. Concurrently, our research provides insights into the relatively higher levels of depression triggered by the unique plateau environment.
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Affiliation(s)
- Ruipeng Wu
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, People's Republic of China
| | - Zixuan Guang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Yingting Wang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Bei Xue
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Ailing Zhang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Yundan Dawa
- Department of Tibetan Medicine, University of Tibetan Medicine(UTC), 850000, Lhasa, People's Republic of China
| | - Chenghui Guo
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Xiaopeng Tong
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China
| | - Shaokang Wang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, 712082, Xianyang, People's Republic of China.
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, People's Republic of China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 510080, Guangzhou, People's Republic of China.
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Lewandowska K, Klinkosz W, Styk W, Kowalczyk M. Diversity of Binge-Eating Disorder Symptoms Is Associated with Anxiety about Getting Fat Rather Than Body Image: A Clinical Study of Women in Poland. Nutrients 2023; 15:4572. [PMID: 37960225 PMCID: PMC10647494 DOI: 10.3390/nu15214572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Anxiety about gaining weight is strongly related to body image. Evidence indicates that body dissatisfaction is a strong predictor of eating disorder development. Although not included in DSM-V diagnostic criteria, body image dissatisfaction, and concern are clearly relevant also for individuals with binge-eating disorder (BED). Weight gain anxiety is associated with psychopathological behaviors, but existing research in this area is primarily focused on bulimia nervosa and anorexia nervosa. The goal of this present study was to investigate body image and body mass anxiety in people with BED. METHODS Women diagnosed with BED (n = 105) aged 18 to 66 were surveyed using the questionnaire developed by the authors evaluating the presence of BED symptoms based on DSM-V criteria, and two other instruments: the Body Esteem Scale (BES), and the Body Mass Anxiety Scale (BMAS-20). Statistical analyses were conducted to examine the correlations of BED with body image and body mass anxiety (Pearson's r), to test differences between groups with greater and lesser BED symptom diversity (Student's t-test or the Mann-Whitney U test), and to assess differences among mild-, moderate- and severe-BED groups (ANOVA with a post-hoc test). RESULTS A medium positive relationship was found between anxiety about getting fat (AGF) and the diversity of BED, measured as the number of BED symptoms. A larger number of BED symptoms was shown to be associated with a higher level of AGF. However, no significant differences in AGF levels were observed among BED-severity groups, specified with the frequency of binge eating episodes. No correlations were found between BED and body image. There were also no significant differences in body image between groups with a larger and a smaller number of BED symptoms. The only significant difference in body image observed among BED-severity groups was the level of weight concern. People with mild BED displayed a higher level of weight concern than those with severe BED. CONCLUSIONS Women who binge eat experience high levels of AGF. In the present study, AGF was primarily associated with the number of BED symptoms and not the rate of recurrence of binge-eating episodes. The frequency of BED episodes, however, was linked with weight concern. On the other hand, the hypothesized relationship between disturbed body image and BED was not confirmed. The findings indicate that anxiety about getting fat should be viewed as one of the psychological costs incurred by women experiencing BED symptoms, and it should be mentioned in the next DSM version.
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Affiliation(s)
- Karolina Lewandowska
- Institute of Psychology, The Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland; (K.L.); (W.K.)
| | - Waldemar Klinkosz
- Institute of Psychology, The Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland; (K.L.); (W.K.)
| | - Wojciech Styk
- Department of Psychology, Medical University in Lublin, 20-059 Lublin, Poland
| | - Magdalena Kowalczyk
- Mental Health Clinic, Complex of Provincial Specialty Clinics in Katowice, 40-038 Katowice, Poland;
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Watkeys OJ, O'Hare K, Dean K, Laurens KR, Harris F, Carr VJ, Green MJ. Cumulative comorbidity between neurodevelopmental, internalising, and externalising disorders in childhood: a network approach. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02312-7. [PMID: 37815628 DOI: 10.1007/s00787-023-02312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
Cumulative comorbidity of mental disorders is common, but the extent and patterns of comorbid psychopathology in childhood are not well established. The current study aimed to elucidate the emergent patterns of cumulative mental disorder comorbidity in children using network analysis of diagnoses recorded between birth and age 12 years. Participants were 90,269 children (mean age 12.7 years; 51.8% male) within the New South Wales Child Development Study (NSW-CDS)-a longitudinal record-linkage cohort study of Australian children born in NSW between 2002 and 2005. Binary indicators for eight types of mental disorder were derived from administrative health records. Patterns of conditional association between mental disorders were assessed utilising network analysis. Of 90,269 children, 2268 (2.5%) had at least one mental disorder by age 12 years; of the 2268 children who had at least one mental disorder by age 12 years, 461 (20.3%) were diagnosed with two or more different disorders out of the eight disorder types included in analyses. All disorders were either directly or indirectly interconnected, with childhood affective and emotional disorders and developmental disorders being most central to the network overall. Mental disorder nodes aggregated weakly (modularity = 0.185) into two communities, representative of internalising and externalising disorders, and neurodevelopmental and sleep disorders. Considerable sex differences in the structure of the mental disorder comorbidity networks were also observed. Developmental and childhood affective and emotional disorders appear to be key to mental disorder comorbidity in childhood, potentially reflecting that these disorders share symptoms in common with many other disorders.
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Affiliation(s)
- Oliver J Watkeys
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Kirstie O'Hare
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia
| | - Kimberlie Dean
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia
- Justice Health and Forensic Mental Network, Matraville, Australia
| | - Kristin R Laurens
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
| | - Felicity Harris
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia
| | - Vaughan J Carr
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - Melissa J Green
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Level 1, AGSM Building, Kensington Campus, Sydney, Australia.
- Neuroscience Research Australia, Sydney, Australia.
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14
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Liang G, Cheng Y, Barnhart WR, Song J, Lu T, He J. A network analysis of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults. Int J Eat Disord 2023; 56:1842-1853. [PMID: 37337937 DOI: 10.1002/eat.24012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/07/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Previous studies have revealed associations between disordered eating symptoms, big-five personality traits, and psychological distress. However, limited research has explored these relationships as a network, including their interconnections, and even less has done so in non-Western populations. We employed network analysis to investigate the co-occurrence of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults. METHOD A sample of 500 Chinese adults (256 men) completed measures assessing big-five personality traits, psychological distress, and disordered eating symptoms. The network of personality traits, psychological distress, and disordered eating symptoms was estimated, including its central and bridge nodes. RESULTS The central nodes in the network were the facets of openness (like adventure), extraversion (like going to social and recreational parties), and disordered eating symptoms (dissatisfaction with body weight or shape). Moreover, certain facets of neuroticism (always worrying something bad will happen), psychological distress (feeling worthless), and an inverse facet of extraversion (bored by parties with lots of people) were identified as essential bridge nodes in maintaining the structure of the network. CONCLUSION Our findings suggest that personality traits (e.g., openness and extraversion) and body dissatisfaction are important in maintaining the network in a community sample of Chinese adults. While future replication is needed, findings from this study suggest that individuals with negative self-thinking, predisposed neuroticism, and extraversion may be at risk of developing disordered eating symptoms. PUBLIC SIGNIFICANCE The present study contributes to existing knowledge by employing a network perspective to examine the associations between disordered eating symptoms, big-five personality traits, and psychological distress in a Chinese adult community sample. The identified facets of neuroticism and extraversion and symptoms of psychological distress may be worthy of targeting in the prevention and treatment of disordered eating in the Chinese context.
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Affiliation(s)
- Guangsheng Liang
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Yawei Cheng
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, Texas, USA
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Jianwen Song
- Department of Educational Psychology, Baylor University, Waco, Texas, USA
| | - Tom Lu
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, Texas, USA
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, People's Republic of China
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15
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Hamatani S, Matsumoto K, Andersson G, Tomioka Y, Numata S, Kamashita R, Sekiguchi A, Sato Y, Fukudo S, Sasaki N, Nakamura M, Otani R, Sakuta R, Hirano Y, Kosaka H, Mizuno Y. Guided Internet-Based Cognitive Behavioral Therapy for Women With Bulimia Nervosa: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49828. [PMID: 37725414 PMCID: PMC10548332 DOI: 10.2196/49828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Individual face-to-face cognitive behavioral therapy is known to be effective for bulimia nervosa (BN). Since foods vary considerably between regions and cultures in which patients live, cultural adaptation of the treatment program is particularly important in cognitive behavioral therapy for BN. Recently, an internet-based cognitive behavioral therapy (ICBT) program was developed for Japanese women with BN, adapted to the Japanese food culture. However, no previous randomized controlled trial has examined the effectiveness of ICBT. OBJECTIVE This paper presents a research protocol for strategies to examine the effects of guided ICBT. METHODS This study is designed as a multicenter, prospective, assessor-blinded randomized controlled trial. The treatment groups will be divided into treatment as usual (TAU) alone as the control group and ICBT combined with TAU as the intervention group. The primary outcome is the total of binge eating and purging behaviors assessed before and after treatment by an independent assessor. Secondary outcomes will include measures of eating disorder severity, depression, anxiety, quality of life, treatment satisfaction, and working alliances. Treatment satisfaction and working alliances will be measured post assessment only. Other measures will be assessed at baseline, post intervention, and follow-up, and the outcomes will be analyzed on an intention-to-treat basis. RESULTS This study will be conducted at 7 different medical institutions in Japan from August 2022 to October 2026. Recruitment of participants began on August 19, 2022, and recruitment is scheduled to continue until July 2024. The first participants were registered on September 8, 2022. CONCLUSIONS This is the first multicenter randomized controlled trial in Japan comparing the effectiveness of ICBT and TAU in patients with BN. TRIAL REGISTRATION University Hospital Medical Information Network UMIN000048732; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055522. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49828.
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Affiliation(s)
- Sayo Hamatani
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Hospital, Kagishima, Japan
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Yukiko Tomioka
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Rio Kamashita
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Atsushi Sekiguchi
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yasuhiro Sato
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin Fukudo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Natsuki Sasaki
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryoko Otani
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryoichi Sakuta
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Hirotaka Kosaka
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Yoshifumi Mizuno
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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16
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de Vos JA, Radstaak M, Ten Klooster PM, Bohlmeijer ET, Westerhof GJ. Exploring mental health dynamics during eating disorder treatment: A psychometric network study with panel data. Psychother Res 2023:1-14. [PMID: 37683123 DOI: 10.1080/10503307.2023.2254918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
To explore mental health associations during eating disorder (ED) treatment. Based on the dual-continua model of mental health, general and ED-specific psychopathology, as well as emotional, psychological, and social well-being were considered as mental health domains. Network analyses with panel data were applied to explore within- (temporal and contemporaneous networks) and between-person effects in a sample of 1250 female ED patients during 12 months of outpatient treatment. The associations between the domains and their centrality were examined. Autoregressive and cross-lagged effects were also estimated. ED psychopathology was the most central domain in the temporal network. ED psychopathology changes predicted further ED psychopathology changes and small changes in the other domains. Weak bi-directional associations were found between changes in the well-being domains and general psychopathology. In contrast to the temporal network, ED psychopathology was the least central and psychological well-being the most central domain in the contemporaneous and between-subjects networks. This suggests a central role of psychological well-being for experiencing mental health within time points. ED psychopathology may change relatively independent from other mental health domains. Well-being domains may be considered as more stable aspects of mental health.
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Affiliation(s)
- Jan Alexander de Vos
- Stichting Human Concern, Centrum voor eetstoornissen, Amsterdam, The Netherlands
- Research Department, GGZ Friesland, Leeuwarden, The Netherlands
| | - Mirjam Radstaak
- Psychology, Health and Technology, and the Centre for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Psychology, Health and Technology, and the Centre for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
| | - Ernst T Bohlmeijer
- Psychology, Health and Technology, and the Centre for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
| | - Gerben J Westerhof
- Psychology, Health and Technology, and the Centre for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
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17
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Ortiz SN, Grunewald W, Forrest LN, Smith A. Testing the longitudinal relationship between muscle dysmorphia symptoms and suicidality: A network analysis investigation. Body Image 2023; 46:372-382. [PMID: 37481936 DOI: 10.1016/j.bodyim.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
Research on suicidality in muscle dysmorphia is limited despite the high rates of suicidal thoughts and behaviors in related disorders. This study employed network analysis to examine the longitudinal relationships between muscle dysmorphia symptoms, as well as the relations between MD symptoms and suicide risk factors. Fifty individuals (Mage = 30.6 years, 63 % male) meeting criteria for muscle dysmorphia received four daily surveys for three weeks. Multi-level vector autoregression analysis was used to estimate associations between muscle dysmorphia- and suicide-related thoughts, emotions, and behaviors. The most central nodes in the muscle dysmorphia networks related to assessing muscle size, dieting, using muscle-building supplements, experiencing body dissatisfaction, seeking reassurance, and avoiding others due to concerns about appearance. In the comorbidity networks, the most central suicide-related factors were feelings of burdensomeness, feeling disgusted, and dwelling on the past. Our findings indicated that various intrusive thoughts (body dissatisfaction, dieting), compulsions (seeking reassurance, body checking, supplement use), and beliefs (burden to others, disgust with oneself) predicted future engagement in muscle dysmorphia and suicide-related symptomology. Targeting intrusive thoughts and compulsions, as well as feelings of disgust and burdensomeness, may reduce the severity of these conditions.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, OH, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | - April Smith
- Department of Psychology, Auburn University, Auburn, AL, USA
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18
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Klapsas M, Hindle A. Patients' Pre and Post-Bariatric Surgery Experience of Dieting Behaviours: Implications for Early Intervention. Obes Surg 2023; 33:2702-2710. [PMID: 37468701 DOI: 10.1007/s11695-023-06689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Bariatric surgery works, in part, by surgically changing signals of hunger and satiety to achieve weight loss. Not all patients experience optimal outcomes. One potential explanation is that post-surgery dieting may subvert the ability to identify physiological cues of hunger and fullness. Dieting behaviours (e.g. restriction/cognitive restraint) are correlated with disordered eating, and disordered eating implicated in poor outcomes. This study examines the experience of dieting after bariatric surgery. METHOD Seventeen adult participants who had undertaken bariatric surgery and residing in Australia participated in semi-structured interviews. Surgeries occurred in 2021 (n = 8), 2020 (n = 4), 2019 (n = 2), and one participant each had surgery in 2014, 2009, and 2004. Thematic analysis elicited themes related to post-operative dieting. RESULTS All participants reported chronic pre-surgery dieting. Lifestyle change was the overarching post-surgical theme comprising (i) flexibility (e.g. allowing food, intuitive eating), and (ii) control, comprising surgery control (e.g. set portions, surgery instilled control) and dieting control (e.g. discipline, restriction/restraint). Descriptions of lifestyle change often mirrored pre-surgery descriptions of dieting. CONCLUSION Post-surgery lifestyle change appears to encompass a tension between flexible/adaptive approaches to eating and the need to maintain control. Control may emerge as practices that mirror pre-surgery dieting with the potential to interfere with adaptive eating behaviours or promote disordered eating. Dieting behaviours may be a precursor to the development of disordered eating. Health care practitioners should regularly assess dieting behaviour post-surgery to enable early intervention where warranted. Future research should consider how post-surgery re-emerging dieting may be identified and measured to aid in intervention.
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Affiliation(s)
- Margaret Klapsas
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Annemarie Hindle
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia.
- Department of Psychology, Counselling and Therapy, La Trobe University, 133 McKoy Street, Wodonga, VIC, 3689, Australia.
- Centre for Eating, Weight, and Body Image, Suite 215, 100 Victoria Parade, East Melbourne, VIC, 3002, Australia.
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19
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Yuan D, Wu J, Li S, Zhang R, Zhou X, Zhang Y. Network analysis of cold cognition and depression in middle-aged and elder population: the moderation of grandparenting. Front Public Health 2023; 11:1204977. [PMID: 37674685 PMCID: PMC10479032 DOI: 10.3389/fpubh.2023.1204977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Background Cognitive decline and negative emotions are common in aging, especially decline in cold cognition which often co-occurred with depression in middle-aged and older adults. This study analyzed the interactions between cold cognition and depression in the middle-aged and elder populations using network analysis and explored the effects of grandparenting on the cold cognition-depression network. Methods The data of 6,900 individuals (≥ 45 years) from the China Health and Retirement Longitudinal Study (CHARLS) were used. The Minimum Mental State Examination (MMSE) and the Epidemiology Research Center Depression Scale-10 (CESD-10) were used to assess cold cognition and depressive symptoms, respectively. Centrality indices and bridge centrality indices were used to identify central nodes and bridge nodes, respectively. Results Network analysis showed that nodes "language ability" and "depressed mood" were more central nodes in the network of cold cognition and depression in all participants. Meantime, nodes "attention," "language ability" and "hopeless" were three key bridge nodes connecting cold cognition and depressive symptoms. Additionally, the global connectivity of the cold cognition and depression network was stronger in the non-grandparenting than the grandparenting. Conclusion The findings shed a light on the complex interactions between cold cognition and depression in the middle-aged and elder populations. Decline in language ability and depressed mood can serve as predictors for the emergence of cold cognitive dysfunction and depression in individuals during aging. Attention, language ability and hopelessness are potential targets for psychosocial interventions. Furthermore, grandparenting is effective in alleviating cold cognitive dysfunction and depression that occur during individual aging.
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Affiliation(s)
- Dongling Yuan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jialing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shansi Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ruoyi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Zhou
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute of Central South University, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
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20
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Duncan-Plummer T, Hasking P, Tonta K, Boyes M. Cognitive-emotional networks in students with and without a history of non-suicidal self-injury. J Affect Disord 2023; 329:394-403. [PMID: 36828146 DOI: 10.1016/j.jad.2023.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Contemporary models of non-suicidal self-injury (NSSI) suggest that emotional vulnerabilities, negative self-schemas, and beliefs about NSSI work together to differentiate students who self-injure from those who do not. However, it is unclear how these mechanisms are differentially related among students with and without a history of NSSI. Considering this, we used a network analysis approach to explore how students with and without a history of NSSI vary in processing their emotional experiences in relation to their self-concepts and beliefs about NSSI. METHOD A sample of 480 university students (Mage = 21.18, SD = 2.43; 73.5 % female) completed self-report measures about their perceived emotional experiences (e.g., emotional reactivity, emotion regulation difficulties), self-concepts (e.g., self-esteem, self-efficacy), and NSSI. RESULTS A network comparison test revealed that students with a history of NSSI perceived themselves to have difficulties regulating particularly intense, unwanted negative emotions. In light of this, students with a history of NSSI expected some benefits of NSSI (e.g., emotion regulation) regardless of potential barriers (e.g., pain). Conversely, for students without a history of NSSI, expecting NSSI to have aversive outcomes was tied to expecting NSSI to have few benefits. LIMITATIONS The cross-sectional design limits inferences to be made about the network structures. CONCLUSIONS Students with and without a history of NSSI appear to differ in their cognitive processing of negative emotions and strategies used to deal with these emotions.
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Affiliation(s)
- Thomas Duncan-Plummer
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Penelope Hasking
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Kate Tonta
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Mark Boyes
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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Sfeir M, Rahme C, Obeid S, Hallit S. The mediating role of anxiety and depression between problematic social media use and bulimia nervosa among Lebanese university students. J Eat Disord 2023; 11:52. [PMID: 36991483 PMCID: PMC10052263 DOI: 10.1186/s40337-023-00776-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Background Bulimia nervosa (BN) is a disorder that is characterized by binge eating and inappropriate compensatory behavior to control weight. The aim of this study was to evaluate the mediating role of anxiety and depression between problematic social media use (PSMU) and BN among a sample of Lebanese university students. Methods This cross-sectional study was carried out between July and September 2021; a total of 363 university students was recruited through convenience sampling. The PROCESS SPSS Macro version 3.4, model four was used to test the indirect effect and calculate three pathways. Pathway A determined the regression coefficient for the effect of PSMU on mental health issues (depression/anxiety); Pathway B examined the association between mental health issues on BN, and Pathway C’ estimated the direct effect of PSMU on BN. Pathway AB was used to calculate the indirect effect of PSMU on BN via depression/anxiety. Results Results showed that depression and anxiety partially mediated the association between PSMU and BN. Higher levels of PSMU were associated with more depression and anxiety; higher depression and anxiety were associated with more BN. PSMU was directly and significantly associated with more BN. When entering anxiety (M1) then depression (M2) as consecutive mediators in a first model, the results showed that only depression mediated the association between PSMU and bulimia. When taking depression (M1) then anxiety (M2) as consecutive mediators in a second model, the results showed that the mediation PSMU → Depression → Anxiety → Bulimia was significant. Higher PSMU was significantly associated with more depression, which was significantly associated with more anxiety, which was significantly associated with more bulimia. Finally, higher PSMU was directly and significantly associated with more bulimia Conclusion The current paper highlights the relationship that social media use has on BN and other aspects of mental health such as anxiety and depression in Lebanon. Future studies should replicate the mediation analysis conducted in the current study while taking into account other eating disorders. Additional investigations of BN and its correlates must strive to improve the comprehension of these associations’ pathways through designs that allow to draw temporal frameworks, in order to efficiently treat this eating disorder and prevent its negative outcomes. Bulimia nervosa, an eating disorder, is characterized by an impulsive consumption of food in a short period of time, followed by behaviors that compensate the eating such as vomiting or excessive exercise in order to avoid weight gain. Individuals with problematic social media use were found to have higher levels of bulimia symptoms. Symptoms of bulimia can also be associated with both depression and anxiety. The aim of the current study was to examine the mediating role of anxiety and depression between problematic social media use and bulimia nervosa. The results of our study found that problematic social media use was directly associated with more bulimia nervosa and also associated with higher depression and anxiety, both of which were associated with bulimia nervosa. Tackling associated disorders may help reduce symptoms of bulimia nervosa. Clinicians should carefully examine these associations while assessing and implementing treatment plans.
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Affiliation(s)
- Michel Sfeir
- grid.8364.90000 0001 2184 581XDepartment of Clinical Psychology, University of Mons, Mons, Belgium
- grid.9851.50000 0001 2165 4204Institute of Psychology (IP), Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Clara Rahme
- grid.512933.f0000 0004 0451 7867Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- grid.411323.60000 0001 2324 5973Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- grid.512933.f0000 0004 0451 7867Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- grid.411423.10000 0004 0622 534XApplied Science Research Center, Applied Science Private University, Amman, Jordan
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Christian C, Cusack CE, Ralph-Nearman C, Spoor SP, Hunt RA, Levinson CA. A Pilot, Time-Series Investigation of Depression, Anxiety, and Eating Disorder Symptoms in Adults Experiencing Major Depressive Symptoms: The Need for Eating Disorder Assessment and Research in Depression. Behav Ther 2023; 54:214-229. [PMID: 36858755 DOI: 10.1016/j.beth.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/27/2022]
Abstract
Major Depressive Disorder (MDD) is a prevalent psychiatric disorder impacting 10-16% of Americans in their lifetime. Approximately 60% of individuals with MDD have comorbid anxiety disorders. Additionally, although scarce research has examined eating disorders (EDs) in depression, a bidirectional association exists between ED and MDD symptoms. The current pilot study (N = 31 individuals with moderate to severe depression) modeled networks of depressive, anxiety, and ED symptoms using intensive time-series data. This study also tested if temporal central symptoms predicted six-month clinical outcomes. The most central symptoms were guilt, self-dislike, lack of energy, and difficulty concentrating. Several anxiety and ED symptoms were also central, including physical anxiety, social anxiety, body dissatisfaction, and desire for thinness. The central symptom crying predicted six-month depression with a medium effect size. These findings suggest anxiety and ED symptoms may influence the day-to-day course of depression in some individuals with comorbid diagnoses, but predictors of symptoms across hours may differ from predictors across longer time scales (i.e., months). Time scale should be considered when conducting and interpreting research on MDD. Research, assessment, and treatment for MDD should continue to explore transdiagnostic approaches including anxiety and ED symptoms to optimize care for individuals with complex presentations.
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Nicholas JK, Cusack CE, Levinson CA. Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis. Behav Ther 2023; 54:346-360. [PMID: 36858764 DOI: 10.1016/j.beth.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022]
Abstract
Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one's weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.
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Lai L, Tong J, Xiang YT, Zhang L, Ren Z. Mental health concerns and network structures of psychological helpline help-seekers during the COVID-19 pandemic in China: Pandemic stage differences. J Affect Disord 2023; 323:444-451. [PMID: 36435401 PMCID: PMC9683523 DOI: 10.1016/j.jad.2022.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The present study aimed to investigate the pandemic stage differences of mental health helpline help-seekers emotional responses, psychiatric symptoms, and related network structures during the COVID-19 pandemic in China. METHODS The data was collected by a large-scale psychological helpline in response to the COVID-19 pandemic in mainland China. Counselor-reported information about the help-seekers pandemic-related emotional responses and psychiatric symptoms were recorded. A total of 26,870 callers' data from February 28, 2020, to April 23, 2021, were collected in the present study. A linear probability model and network analysis were conducted to determine the differences in help-seekers mental health concerns and network structures between the pandemic (stage I, from February 28, 2020, to April 28, 2020, N = 9821) and the regular prevention and control period (stage II, from April 29, 2020, to April 23, 2021, N = 17,049). RESULTS Results revealed that anger, sadness, and obsession symptoms increased in stage II while symptoms of anxiety, somatization, and feelings of fear and stress were relieved. The network analysis results demonstrated both stage I and II networks centered on anxiety firmly. In stage II, the connection between anxiety and hypochondria and fear's strength centrality descended significantly. LIMITATIONS The mental health outcomes of callers only included the counselor-reported data. CONCLUSIONS The mental health concerns of helpline callers showed pandemic-related stage differences.
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Affiliation(s)
- Lizu Lai
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent CyberPsychology and Behavior(CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, China
| | - Jingqiang Tong
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent CyberPsychology and Behavior(CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao; Center for Cognition and Brain Sciences, University of Macau, Macao
| | - Lin Zhang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent CyberPsychology and Behavior(CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, China
| | - Zhihong Ren
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent CyberPsychology and Behavior(CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, China.
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25
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Melles H, Jansen A. Transdiagnostic fears and avoidance behaviors in self-reported eating disorders. J Eat Disord 2023; 11:19. [PMID: 36782316 PMCID: PMC9926724 DOI: 10.1186/s40337-023-00745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Fears and avoidance behaviors are common symptoms of eating disorders. It was investigated whether different eating disorder diagnoses are equally characterized by similar fears and avoidance behaviors. METHODS Individuals with self-reported eating disorders (n = 250) and healthy controls (n = 95) completed online questionnaires assessing general fears, eating related fears, and avoidance behaviors. RESULTS All self-reported eating disorder diagnoses showed more eating related fears, general fears, and avoidance behaviors than healthy controls. Individuals with binge eating disorder showed less specific and general fears on some but by no means all scales, yet they showed less food avoidance behaviors than all other eating disorders and less eating restraint than anorexia nervosa and bulimia nervosa. CONCLUSIONS Eating related fears, general fears, and food avoidance behaviors were found to be transdiagnostic symptoms in self-reported eating disorders. Individuals with binge eating disorder also exhibit more fears and avoidance behaviors than healthy controls, but to a lesser extent than the other eating disorders. Specialized interventions targeting fears and avoidance may be promising add-on interventions not only in the treatment of anorexia nervosa, but in the treatment of all eating disorders.
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Affiliation(s)
- Hanna Melles
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Styk W, Wojtowicz E, Zmorzynski S. I Don't Want to Be Thin! Fear of Weight Change Is Not Just a Fear of Obesity: Research on the Body Mass Anxiety Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2888. [PMID: 36833584 PMCID: PMC9957053 DOI: 10.3390/ijerph20042888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Anxiety is one of the psychological factors associated with body weight experienced by people attempting to live up to expectations of an ideal body shape. The stigma of excessive or too low body weight and the stigmatization of people because of it is becoming a widespread problem with negative psychological and social consequences. One effect of the strong social pressure of beauty standards dependent on low body weight is the development of eating disorders and negative societal attitudes toward overweight or obese people. Research conducted to date has mainly focused on one dimension of weight-related anxiety-the fear of getting fat. Ongoing research has also revealed the other side of weight-related anxiety-fear of weight loss. Therefore, the purpose of the present project was to develop a two-dimensional scale to diagnose the level of weight-related anxiety and to preliminarily test the psychometric properties of the emerging constructs. Results: the BMAS-20 weight-related anxiety scale in both Polish and English versions was developed and its psychometric properties were confirmed. The components of body weight-change anxiety that emerged were: anxiety about getting fat and anxiety about losing weight. It was found that both AGF and ALW may have a protective function related to awareness of the negative consequences of poor eating and the health risks associated with it. Above-normal levels of anxiety may be a predictor of psychopathology. Both AGF and ALW are associated with symptoms of depression.
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Affiliation(s)
- Wojciech Styk
- Department of Psychology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Ewa Wojtowicz
- Polish Academy of Social Sciences and Humanities, 69 Banstead Road, Carshalton, London SM5 3NP, UK
| | - Szymon Zmorzynski
- Department of Cancer Genetics with Cytogenetic Laboratory, Medical University of Lublin, 20-059 Lublin, Poland
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27
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Söderqvist G, Naessén S. Androgens impact on psychopathological variables according to CPRS, and EDI 2 scores: In women with bulimia nervosa, and eating disorder not otherwise specified. J Steroid Biochem Mol Biol 2023; 226:106217. [PMID: 36368624 DOI: 10.1016/j.jsbmb.2022.106217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Bulimia nervosa (BN) is characterized by binge eating, compensatory behavior, over-evaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. Depression is the most common comorbid diagnosis in women with eating disorders. The role of androgens in the pathophysiology of depression has been recognized in recent years. However, the research on psychopathological comorbidity and androgen levels in bulimic disease is sparse. This study aimed to investigate, if there were any correlations between the androgens, testosterone (T), dehydroepiandrosterone sulphate (DHEAS), androstenedione (A4), 5α-dihydrotestosterone, (5α-DHT), and test scores of psychopathological variables, in women with bulimia nervosa (BN), eating disorder not otherwise specified of purging subtype (EDNOS-P) assessed by CPRS, and EDI 2. Women with DSM-IV diagnosis of BN (n = 36), EDNOS-P (n = 27), and healthy control subjects (n = 58) evaluated for fifteen psychopathological variables, i.a. depressive symptoms, impulsivity, personal traits, as well as serum androgen levels. All women were euthyroid, and polycystic ovarian syndrome (PCOS) diagnosis was excluded. Although androgen levels were almost equal for all three groups, significant correlations between core psychopathological symptoms (9/15) of bulimia nervosa and the most potent endogenous androgen, 5α-DHT, was found only in the EDNOS-P group. The role of 5α-DHT in women is not fully elucidated. Both animal and human studies have shown that the brain is able to locally synthesize steroids de novo and is a target of steroid hormones. Maybe these results can be interpreted in the light of differences in androgen receptor variability, metabolism and origin of T and 5α-DHT.
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Affiliation(s)
- Gunnar Söderqvist
- Department of Women's, and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Naessén
- Department of Women's, and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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28
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Finch JE, Xu Z, Baker JH. Understanding comorbidity between eating disorder and premenstrual symptoms using a network analysis approach. Appetite 2023; 181:106410. [PMID: 36460121 PMCID: PMC9790037 DOI: 10.1016/j.appet.2022.106410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
Eating disorder symptoms are associated with ovarian hormones and fluctuate predictably across the menstrual cycle. However, the specific symptoms that underlie these associations remain unclear. The current study aims to examine which specific eating disorder and premenstrual symptoms confer risk and maintain comorbidity using network analysis. Eating disorder and premenstrual symptoms were measured using the Eating Pathology Symptoms Inventory and the Daily Record of Severity of Problems, respectively, in a large sample of young adult females. Network analysis was used to explicate the structure of eating and premenstrual symptom networks separately and together. Eating disorder networks replicated previous literature and identified body dissatisfaction as a core feature, but was unique in identifying monitoring calories as an additional core feature. Central symptoms identified in the premenstrual symptom network were symptoms interference with daily life and activities and negative emotions brought on by hormone changes. Bridge symptoms between networks were identified as relating to eating behaviors, interference with daily activities, joint and muscle pain, and negative emotions brought on by hormone changes. This study suggests that the links between eating disorder and premenstrual symptoms extend past their individual effects on eating behavior and are indicative of a shared underlying mechanism.
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Affiliation(s)
- Jody E Finch
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA.
| | - Ziqian Xu
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
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Sahlan RN, Sala M. Eating disorder psychopathology and resilience in Iranian college students: A network analysis. J Clin Psychol 2023; 79:497-513. [PMID: 35975401 DOI: 10.1002/jclp.23428] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample. METHOD Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms. RESULTS Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating. CONCLUSION Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
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30
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Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:8. [PMID: 36650572 PMCID: PMC9847054 DOI: 10.1186/s40337-022-00717-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. METHODS The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. RESULTS A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. CONCLUSION Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia. .,Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW, 2006, Australia.
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
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Wu L, Sun L, Wang J, Sun Y, Zhang X, Huang Y, Lu Y, Cao F. Psychological distress among women undergoing in vitro fertilization-embryo transfer: A cross-sectional and longitudinal network analysis. Front Psychol 2023; 13:1095365. [PMID: 36687877 PMCID: PMC9849569 DOI: 10.3389/fpsyg.2022.1095365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment were generally found to experience varying degrees of psychological distress across the treatment. Existing studies focused on total scores and diagnostic thresholds to characterize the symptoms' severity, which might hinder scientific progress in understanding and treating psychological distress. Aims We aimed to investigate (a) how depression and anxiety symptoms are interconnected within a network, and (b) the changes of the network (symptom connections and network centralities) over time, in women undergoing in vitro fertilization-embryo transfer. Methods A 4-wave longitudinal study was designed with 343 eligible women recruited from the Reproductive Medicine Center of a tertiary hospital in China. The network models were created to explore the relationship and changes between psychopathology symptoms both within and across anxiety and depression, with anxiety measured by the Generalized Anxiety Disorder-7 and depression measured by the Patient Health Questionnaire-9. Symptom network analysis was conducted to evaluate network and network properties, network centrality, and bridge centrality, as well as change trajectory network. Results For the strength centrality, "inability to control worry" and "worrying too much" were the most central symptoms at T1; however, these symptoms decreased. The centrality of "sadness" and "guilt" tended to increase steadily and became dominant symptoms. For bridge centrality indices, several bridge symptoms were identified separately from T1 to T4: "irritability," "concentration difficulties," "nervousness," and "restlessness;" "guilt" exhibited increased bridge symptoms. Furthermore, the change trajectory network indicated that "suicide ideation" became more closely related to guilt but not to worrying too much over time. Conclusion This study provides novel insights into the changes in central features, connections, and bridge symptoms during IVF-ET treatment and identified several bridge symptoms separately at different stages, which could activate the connection between psychopathology symptoms. The results revealed that sense of guilt was associated with worsening psychopathology symptoms, indicating that future psychological interventions should target guilt-related symptoms as a priority.
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Affiliation(s)
- Liuliu Wu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lijing Sun
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Juan Wang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Xuan Zhang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yongqi Huang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yan’e Lu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Fenglin Cao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China,*Correspondence: Fenglin Cao, ✉
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Zhang S, Zhang Y, Xue D, Zhang H, Chao M, Liu T. What Are the Differences in Psychological Outcomes Between People Who Posted COVID-19-Related Content on Social Media and Those Who Did Not? Psychiatry Investig 2023; 20:43-51. [PMID: 36721885 PMCID: PMC9890044 DOI: 10.30773/pi.2022.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/23/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE During the lockdown of cities and home quarantine, media became the only way for people to conveniently get coronavirus disease-2019 (COVID-19)-related information. And media engagement was closely related to psychological outcomes. But fewer researchers took COVID-19-related posting behaviors into consideration. Therefore, the present study aimed at examining the differences in psychological outcomes between people who posted COVID-19-related content on social media and those who did not. METHODS The present study included 917 participants (304 males, 613 females) who had answered the questionnaires of media engagement, positive affect, negative affect, depression, anxiety, stress, satisfaction with life, death anxiety, and meaning in life. RESULTS Results of t-tests showed that the Post group had lower levels of negative affect, anxiety, stress, and death anxiety than the Not Post (Npost) group. Network comparison tests indicated that the Npost group's network and the Post group's network differed in global strength, two edge-weights, and node centrality indices. CONCLUSION The results indicated that more attention should be paid to people who did not post any COVID-19-related content, especially when they have higher levels of stress and depression to prevent comorbidities. And for people who posted content, more attention should be paid when they have a higher level of negative affect.
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Affiliation(s)
- Shu Zhang
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yanwen Zhang
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin, China
| | - Dini Xue
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Huan Zhang
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin, China
| | - Miao Chao
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin, China
| | - Tour Liu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin, China
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Hoover LV, Ackerman JM, Cummings JR, Gearhardt AN. The Association of Perceived Vulnerability to Disease with Cognitive Restraint and Compensatory Behaviors. Nutrients 2022; 15:nu15010008. [PMID: 36615665 PMCID: PMC9824184 DOI: 10.3390/nu15010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Individual differences exist in perceived vulnerability to disease (PVD). PVD is associated with negative responses (e.g., disgust) towards individuals with obesity and heightened sensitivity regarding personal appearance. Through increasing fear of fat (FOF), PVD may be associated with cognitive restraint and compensatory behaviors. We utilized an adult sample (n = 247; 53.3% male sex assigned at birth) recruited through Amazon's MTurk prior to the COVID-19 pandemic to investigate associations between PVD, cognitive restraint and compensatory behaviors. Participants completed the Perceived Vulnerability to Disease Scale, Eating Disorder Diagnostic Scale, Dutch Eating Behaviors Questionnaire, and Goldfarb's Fear of Fat Scale. Mediation analyses were used to test our hypotheses. Perceived infectability (PVD-Infection) was associated with cognitive restraint and compensatory behaviors through increased FOF. Perceived germ aversion (PVD-Germ) was associated with cognitive restraint, but FOF did not mediate this association. Sex-stratified analyses revealed no significant sex differences. PVD may be an overlooked factor associated with cognitive restraint and compensatory behaviors in males and females. FOF was an important mediating factor in these associations. Increased engagement in cognitive restraint and compensatory behaviors may reflect attempts to reduce FOF. Future longitudinal research should explore whether PVD is a risk factor for cognitive restraint and compensatory behaviors.
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Cusack CE, Vanzhula IA, Levinson CA. The structure of eating disorder and somatic symptoms. J Affect Disord 2022; 319:397-406. [PMID: 36162678 DOI: 10.1016/j.jad.2022.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
Individuals with eating disorders (EDs) often present with somatic concerns in treatment, such as bloating, fullness, and feeling tight clothes on skin. However, most research generally focuses on general interoception (e.g., heartbeat) rather than sensations relevant to EDs (e.g., sensations related to the gastrointestinal system or body movement). In the current study (N = 181), we used network analysis to model the structure of ED symptoms and somatic concerns among individuals with anorexia nervosa, bulimia nervosa, and other specified feeding and eating disorder. Results showed that heightened sensitivity to somatic concerns had the highest strength centrality within a symptom network comprising ED and somatic symptoms. Exploratory graph analysis identified four symptom dimensions: cognitive-affective ED symptoms, behavioral ED symptoms, general interoception, and ED-specific proprioception. Findings suggest that heightened sensitivity to somatic concerns may maintain ED symptoms and mutually reinforce other somatic concerns. Implications concerning assessment and treatment of EDs are discussed.
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Affiliation(s)
- Claire E Cusack
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Irina A Vanzhula
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America.
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Tomei G, Pieroni MF, Tomba E. Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment. Int J Eat Disord 2022; 55:1641-1669. [PMID: 36256543 DOI: 10.1002/eat.23828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Network psychometrics has been enthusiastically embraced by researchers studying eating disorders (ED), but a rigorous evaluation of the methodological quality of works is still missing. This systematic review aims to assess the methodological quality of cross-sectional network analysis (NA) studies conducted on ED clinical populations. METHODS PRISMA and PICOS criteria were used to retrieve NA studies on ED. Methodological quality was evaluated based on five criteria: variable-selection procedure, network estimation method, stability checks, topological overlap checks, and handling of missing data. RESULTS Thirty-three cross-sectional NA studies were included. Most studies focused on populations that were female, white and, with an anorexia nervosa (AN) diagnosis. Depending on how many criteria were satisfied, 27.3% of studies (n = 9) were strictly adherent, 30.3% (n = 10) moderately adherent, 33.3% (n = 11) sufficiently adherent, and 9.1% (n = 3) poorly adherent. Missing topological overlap checks and not reporting missing data represented most unreported criteria, lacking, respectively, in 63.6% and 48.5% of studies. CONCLUSIONS Almost all reviewed cross-sectional NA studies on ED report those methodological procedures (variable-selection procedure, network estimation method, stability checks) necessary for a network study to provide reliable results. Nonetheless these minimum reporting data require further improvement. Moreover, elements closely related to the validity of an NA study (controls for topological overlap and management of missing data) are lacking in most studies. Recommendations to overcome such methodological weaknesses in future NA studies on ED are discussed together with the need to conduct NA studies with longitudinal design, to address diversity issues in study samples and heterogeneity of assessment tools. PUBLIC SIGNIFICANCE The present work aims to evaluate the quality of ED NA studies to support applications of this approach in ED research. Results show that most studies adopted basic procedures to produce reliable results; however, other important procedures linked to NA study validity were mostly neglected. Network methodology in ED is extremely promising, but future studies should consistently include topological overlap control procedures and provide information on missing data.
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Affiliation(s)
- Giuliano Tomei
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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Eating disorder psychopathology dimensions based on individual co-occurrence patterns of symptoms over time: a dynamic time warp analysis in a large naturalistic patient cohort. Eat Weight Disord 2022; 27:3649-3663. [PMID: 36469226 DOI: 10.1007/s40519-022-01504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and may increase our insight of the complex characteristics and dynamics over time. In the current study, an alternative non-linear method to perform longitudinal network analyses, the dynamic time warp approach, was used to examine whether robust dimensions of eating disorder psychopathology symptoms could be found based on the individual dynamic interplay of eating disorder symptoms co-occurrence patterns in time. METHODS The study sample included a naturalistic cohort of patients (N = 255) with all eating disorder subtypes who were assessed with the eating disorder examination questionnaire (EDE-Q) at a minimum of four times during treatment. Dynamic time warp analyses yielded distance matrices within each individual patient, which were subsequently aggregated into symptom networks and dimensions at the group level. RESULTS Aggregation of the individual distance matrices at the group level yielded four robust symptom dimensions: 1. restraint/rules, 2. secret eating/fasting, 3. worries/preoccupation, and 4. weight and shape concern. The items 'fear of weight gain' and 'guilt' were bridge symptoms between the dimensions 1, 3 and 4. CONCLUSION Dynamic time warp could capture the within-person dynamics of eating disorder symptoms. Sumscores of the four dimensions could be used to follow patients over time. This approach could be applied in the future to visualize eating disorder symptom dynamics and signal the central symptoms within an individual and groups of patients. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies. .
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Burger J, Ralph-Nearman C, Levinson CA. Integrating clinician and patient case conceptualization with momentary assessment data to construct idiographic networks: Moving toward personalized treatment for eating disorders. Behav Res Ther 2022; 159:104221. [PMID: 36327522 DOI: 10.1016/j.brat.2022.104221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Eating disorders are serious psychiatric illnesses with treatments ineffective for about 50% of individuals due to high heterogeneity of symptom presentation even within the same diagnoses, a lack of personalized treatments to address this heterogeneity, and the fact that clinicians are left to rely upon their own judgment to decide how to personalize treatment. Idiographic (personalized) networks can be estimated from ecological momentary assessment data, and have been used to investigate central symptoms, which are theorized to be fruitful treatment targets. However, both efficacy of treatment target selection and implementation with 'real world' clinicians could be maximized if clinician input is integrated into such networks. An emerging line of research is therefore proposing to integrate case conceptualizations and statistical routines, tying together the benefits from clinical expertise as well as patient experience and idiographic networks. The current pilot compares personalized treatment implications from different approaches to constructing idiographic networks. For two patients with a diagnosis of anorexia nervosa, we compared idiographic networks 1) based on the case conceptualization from clinician and patient, 2) estimated from patient EMA data (the current default in the literature), and 3) based on a combination of case conceptualization and patient EMA data networks, drawing on informative priors in Bayesian inference. Centrality-based treatment recommendations differed to varying extent between these approaches for patients. We discuss implications from these findings, as well as how these models may inform clinical practice by pairing evidence-based treatments with identified treatment targets.
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Affiliation(s)
- Julian Burger
- University of Amsterdam, Department of Psychology, Amsterdam, the Netherlands; University of Amsterdam, Amsterdam Centre for Urban Mental Health, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christina Ralph-Nearman
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, United States
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, United States.
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Vogel F, Reichert J, Schwenck C. Silence and related symptoms in children and adolescents: a network approach to selective mutism. BMC Psychol 2022; 10:271. [DOI: 10.1186/s40359-022-00956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Silence in certain situations represents the core symptom of selective mutism (SM). However, it is unclear what additional symptoms are part of this disorder. Although knowledge of symptoms is essential for diagnostics and intervention, to date, only scarce research exists on circumscribed symptoms of SM. Given the large overlap between SM and social anxiety disorder (SAD), it remains also unclear which symptoms can differentiate both disorders.
Methods
A network analysis of potential symptoms of SM was performed based on a mixed sample of N = 899 children and adolescents with and without indication of SM (n = 629 with silence in certain situations). In a preliminary analysis, we demonstrated that children with and without silence in certain situations do not differ with respect to their network structure, justifying an analysis on the entire mixed sample. Possible communities (symptom clusters) within the network and thus potential latent variables were examined, and symptoms were analyzed in terms of their centrality (the extent to which they are associated with other symptoms in the network). To investigate the differentiability of symptoms of the SM network from symptoms of SAD, we computed a network that additionally contains symptoms of SAD.
Results
In the resulting network on symptoms of SM, silence was, as expected, the symptom with the highest centrality. We identified two communities (symptom cluster): (1) symptoms associated with the fear response of freezing, (2) symptoms associated with speech production and avoidance. SM network symptoms and SAD symptoms largely formed two separate symptom clusters, with only selectivity of speaking behavior (more talkative at home and taciturn or mute outside the home) falling into a common cluster with SAD symptoms.
Conclusions
Silence appears to have been confirmed by analysis as a core symptom of SM. Additional anxiety-related symptoms, such as avoidance behavior or motor inhibition associated with freezing, seem to co-occur with silence. The two communities of SM potentially indicate different mechanisms of silence. The symptoms of SM appear to be distinguishable from those of SAD, although there seems to be overlap in terms of difficulty speaking in situations outside the home.
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Sahlan RN, Sala M. Eating disorder psychopathology and negative affect in Iranian college students: a network analysis. J Eat Disord 2022; 10:164. [PMID: 36376982 PMCID: PMC9664660 DOI: 10.1186/s40337-022-00683-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND ED psychopathology is becoming more prevalent in Iran. Negative affect has been found to be an important risk factor in eating disorder (ED) onset in research conducted in Western countries, and is also emerging as a potential vulnerability factor to ED psychopathology in Iran. Network theory offers a novel framework to understand the association between negative affect and ED psychopathology in Iran. The primary aim of the current study was to use network analysis to identify bridge symptoms (i.e., symptoms that activate or weaken symptoms in another cluster) across a negative affect and ED psychopathology network among Iranian college students. We also aimed to identify core symptoms (i.e., nodes that demonstrate the strongest connections to other nodes). METHOD Participants were Iranian college students (n = 637; 60.3% women) who completed the Farsi-eating disorder examination-questionnaire and Farsi-negative affect. We estimated a network of ED symptoms and negative affective states and identified bridge and central symptoms. RESULTS Hostility and shame emerged as central bridge symptoms across the negative affect and ED psychopathology clusters. The most central nodes were strong desire to lose weight, definite fear of losing control over eating, and binge eating episodes. CONCLUSION The negative affective states of hostility and shame may increase vulnerability to ED psychopathology among Iranian college students. Findings have important implications for ED prevention programs that should be examined in future research.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
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Adamkovič M, Fedáková D, Kentoš M, Bozogáňová M, Havrillová D, Baník G, Dědová M, Piterová I. Relationships between satisfaction with life, posttraumatic growth, coping strategies, and resilience in cancer survivors: A network analysis approach. Psychooncology 2022; 31:1913-1921. [PMID: 35524705 PMCID: PMC9790334 DOI: 10.1002/pon.5948] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cancer survivors' satisfaction with life should be seen through the psychological factors related to a person's capabilities to face and handle the situation. This study aimed to (1) examine the relationships of satisfaction with life, posttraumatic growth, resilience and coping strategies in a global network model, (2) find the bridge indicators between satisfaction with life and the other constructs, and (3) test for the invariance of the network structures across several moderating variables. METHODS In a heterogeneous sample of 696 cancer survivors (69% female; mean age = 53.1 ± 15.44 years; median time from being diagnosed = 4 years; breast cancer was the most frequent type of cancer) their satisfaction with life, resilience, coping strategies and posttraumatic growth was measured. In order to account for their complexity, the relationships between the constructs were explored using a network analysis approach. RESULTS The network analysis shows that satisfaction with life is strongly connected to resilience, moderately connected to coping strategies, and has a weak connection with posttraumatic growth. In the separate networks, the relationships between the psychological constructs were examined in greater detail. Besides some exceptions observed in the degree of disability, the networks were invariant across gender, age, years since being diagnosed, cancer type and treatment type. CONCLUSION The findings suggest that interventions focused on cancer survivors' coping strategies and resilience could help increase their satisfaction with life. However, further replication of the proposed and/or modified model is needed.
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Affiliation(s)
- Matúš Adamkovič
- Institute of Social SciencesCentre of Social and Psychological Sciences SASKošiceSlovakia
- Institute of PsychologyFaculty of ArtsUniversity of PrešovPrešovSlovakia
- Faculty of Humanities and Social SciencesUniversity of JyväskyläJyväskyläFinland
| | - Denisa Fedáková
- Institute of Social SciencesCentre of Social and Psychological Sciences SASKošiceSlovakia
| | - Michal Kentoš
- Institute of Social SciencesCentre of Social and Psychological Sciences SASKošiceSlovakia
| | - Miroslava Bozogáňová
- Institute of Social SciencesCentre of Social and Psychological Sciences SASKošiceSlovakia
| | - Dominika Havrillová
- Institute of Social SciencesCentre of Social and Psychological Sciences SASKošiceSlovakia
- Department of PsychologyFaculty of ArtsPavol Jozef Šafárik UniversityKošiceSlovakia
| | - Gabriel Baník
- Institute of PsychologyFaculty of ArtsUniversity of PrešovPrešovSlovakia
| | - Mária Dědová
- Department of PsychologyFaculty of ArtsUniversity of TrnavaTrnavaSlovakia
| | - Ivana Piterová
- Institute of Social SciencesCentre of Social and Psychological Sciences SASKošiceSlovakia
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Punzi C, Petti M, Tieri P. Network-based methods for psychometric data of eating disorders: A systematic review. PLoS One 2022; 17:e0276341. [PMID: 36315522 PMCID: PMC9621460 DOI: 10.1371/journal.pone.0276341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Network science represents a powerful and increasingly promising method for studying complex real-world problems. In the last decade, it has been applied to psychometric data in the attempt to explain psychopathologies as complex systems of causally interconnected symptoms. One category of mental disorders, relevant for their severity, incidence and multifaceted structure, is that of eating disorders (EDs), serious disturbances that negatively affect a person's eating behavior. AIMS We aimed to review the corpus of psychometric network analysis methods by scrutinizing a large sample of network-based studies that exploit psychometric data related to EDs. A particular focus is given to the description of the methodologies for network estimation, network description and network stability analysis providing also a review of the statistical software packages currently used to carry out each phase of the network estimation and analysis workflow. Moreover, we try to highlight aspects with potential clinical impact such as core symptoms, influences of external factors, comorbidities, and related changes in network structure and connectivity across both time and subpopulations. METHODS A systematic search was conducted (February 2022) on three different literature databases to identify 57 relevant research articles. The exclusion criteria comprehended studies not based on psychometric data, studies not using network analysis, studies with different aims or not focused on ED, and review articles. RESULTS Almost all the selected 57 papers employed the same analytical procedures implemented in a collection of R packages specifically designed for psychometric network analysis and are mostly based on cross-sectional data retrieved from structured psychometric questionnaires, with just few exemptions of panel data. Most of them used the same techniques for all phases of their analysis. In particular, a pervasive use of the Gaussian Graphical Model with LASSO regularization was registered for in network estimation step. Among the clinically relevant results, we can include the fact that all papers found strong symptom interconnections between specific and nonspecific ED symptoms, suggesting that both types should therefore be addressed by clinical treatment. CONCLUSIONS We here presented the largest and most comprehensive review to date about psychometric network analysis methods. Although these methods still need solid validation in the clinical setting, they have already been able to show many strengths and important results, as well as great potentials and perspectives, which have been analyzed here to provide suggestions on their use and their possible improvement.
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Affiliation(s)
- Clara Punzi
- Data Science MSc Program, Sapienza University of Rome, Rome, Italy
| | - Manuela Petti
- DIAG Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Paolo Tieri
- Data Science MSc Program, Sapienza University of Rome, Rome, Italy
- CNR National Research Council, IAC Institute for Applied Computing, Rome, Italy
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Dagnall N, Denovan A, Drinkwater KG. Paranormal belief, cognitive-perceptual factors, and well-being: A network analysis. Front Psychol 2022; 13:967823. [PMID: 36186327 PMCID: PMC9521162 DOI: 10.3389/fpsyg.2022.967823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
By assessing interrelationships among variables within a specified theoretical framework, network analysis (NA) provides nuanced insights into how associations between psychological constructs are related to outcome measures. Noting this, the authors used NA to examine connections between Paranormal Belief, cognitive-perceptual factors (Schizotypy, Transliminality, and Manic-Depressive Experience), and well-being (Life Satisfaction, Meaning in Life, Somatic Complaints, Perceived Stress, Depressive Symptoms). Data derived from a sample of 3,090 participants (mean age = 50.30, standard deviation = 15.20; 46.5% male, 53.1% female) who completed standardised self-report measures capturing the study constructs online. Transliminality, Unusual Experiences (positive schizotypy), and Depressive Experience demonstrated high expected influence centrality. This indicated that these factors were the most strongly connected and influential in the network. Moreover, Transliminality was a connecting variable between Paranormal Belief, positive schizotypy, and psychopathology. Depressive Experience bridged the relationship between Transliminality and well-being. The conceptual implications of these outcomes are discussed with regards to better understanding relationships between Paranormal Belief, cognitive-perceptual factors, and well-being.
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Affiliation(s)
- Neil Dagnall
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Andrew Denovan
- Department of Psychology, University of Huddersfield, Huddersfield, United Kingdom
| | - Kenneth G. Drinkwater
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
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Nevado A, del Rio D, Pacios J, Maestú F. Neuropsychological networks in cognitively healthy older adults and dementia patients. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:903-927. [PMID: 34415217 PMCID: PMC9485389 DOI: 10.1080/13825585.2021.1965951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
Neuropsychological tests have commonly been used to determine the organization of cognitive functions by identifying latent variables. In contrast, an approach which has seldom been employed is network analysis. We characterize the network structure of a set of representative neuropsychological test scores in cognitively healthy older adults and MCI and dementia patients using network analysis. We employed the neuropsychological battery from the National Alzheimer's Coordinating Center which included healthy controls (n = 7623), mild cognitive impairment patients (n = 5981) and dementia patients (n = 2040), defined according to the Clinical Dementia Rating. The results showed that, according to several network analysis measures, the most central cognitive function is executive function followed by attention, language, and memory. At the test level, the most central test was the Trail Making Test B, which measures cognitive flexibility. Importantly, these results and most other network measures, such as the community organization and graph representation, were similar across the three diagnostic groups. Therefore, network analysis can help to establish a ranking of cognitive functions and tests based on network centrality and suggests that this organization is preserved in dementia. Central nodes might be particularly relevant both from a theoretical and clinical point of view, as they are more associated with other nodes, and their disruption is likely to have a larger effect on the overall network than peripheral nodes. The present analysis may provide a proof of principle for the application of network analysis to cognitive data.
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Affiliation(s)
- Angel Nevado
- Experimental Psychology Department, Complutense University of Madrid, Madrid, Spain
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - David del Rio
- Experimental Psychology Department, Complutense University of Madrid, Madrid, Spain
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Javier Pacios
- Experimental Psychology Department, Complutense University of Madrid, Madrid, Spain
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Fernando Maestú
- Experimental Psychology Department, Complutense University of Madrid, Madrid, Spain
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
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Hou X, Wang G, Wang H, Liu J, Liu W, Ji S, Wang E, Qu D, Hu J. Which came first? Bulimia and emotional symptoms: A cross-lagged panel analysis. Int J Clin Health Psychol 2022; 22:100320. [PMID: 35892043 PMCID: PMC9305338 DOI: 10.1016/j.ijchp.2022.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Researchers have found growing evidence for the comorbidity link between bulimia and emotional symptoms among Chinese female youth. However, the prospective effect of one on the other is still unclear. Therefore, a cross-lagged model was used to examine the possible underlying mechanism between bulimia and two typical emotional problems (i.e., anxiety symptoms and depressive symptoms), respectively, in the present study. Methods A total of 471 female college students participated in the three waves of the present study. Self-reported questionnaires were delivered to assess their bulimia, anxiety symptoms, and depressive symptoms. Results After controlling for earlier levels of symptoms, our finding indicated that anxiety symptoms triggered more bulimia symptoms from Time 1 to Time 2. In turn, the reciprocal cycles occurred between anxiety symptoms and bulimia symptoms from Time 2 to Time 3. More interestingly, a similar pattern was found between depressive symptoms and bulimia. Conclusions The persistence and reciprocal cycle between bulimia and emotional symptoms are worthy of attention. Specifically, female youth with higher levels of emotional symptoms appear to be more profound at high risk for eating-related problems afterward. Further eating-related intervention programs may also need to take the level of female youth's emotional symptoms into consideration.
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Affiliation(s)
- Xiumei Hou
- Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Guoping Wang
- Third people's Hospital of Heze City, Heze, China
| | | | - Jindong Liu
- Third people's Hospital of Heze City, Heze, China
| | - Wei Liu
- Third people's Hospital of Heze City, Heze, China
| | - Shiyun Ji
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, P. R. China
| | - Enna Wang
- School of Education, Tianjin University, Tianjin, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jieyi Hu
- School of Humanities, Jinan University, Zhuhai, Guangdong, China
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45
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McInerney AM, Lindekilde N, Nouwen A, Schmitz N, Deschênes SS. Diabetes Distress, Depressive Symptoms, and Anxiety Symptoms in People With Type 2 Diabetes: A Network Analysis Approach to Understanding Comorbidity. Diabetes Care 2022; 45:1715-1723. [PMID: 35704532 DOI: 10.2337/dc21-2297] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this study, we aimed to explore interactions between individual items that assess diabetes distress, depressive symptoms, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis. RESEARCH DESIGN AND METHODS Participants (N = 1,796) were from the Montreal Evaluation of Diabetes Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the DDS-17 items, the nine items of the Patient Health Questionnaire (PHQ-9), and the seven items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central items, clusters of items, and items that may act as bridges between diabetes distress, depressive symptoms, and anxiety symptoms. RESULTS Regimen-related and physician-related problems were among the most central (highly connected) and influential (most positive connections) in the diabetes distress network. The depressive symptom of failure was found to be a potential bridge between depression and diabetes distress, being highly connected to diabetes distress items. The anxiety symptoms of worrying too much, uncontrollable worry, and trouble relaxing were identified as bridges linking both anxiety and depressive items and anxiety and diabetes distress items, respectively. CONCLUSIONS Regimen-related and physician-related diabetes-specific problems may be important in contributing to the development and maintenance of diabetes distress. Feelings of failure and worry are potentially strong candidates for explaining comorbidity. These individual diabetes-specific problems and mental health symptoms could hold promise for targeted interventions for people with type 2 diabetes.
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Affiliation(s)
- Amy M McInerney
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, U.K
| | - Norbert Schmitz
- Population-Based Medicine Department, University of Tübingen, Tübingen, Germany.,Douglas Research Centre, McGill University, Montreal, Canada
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46
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Ferreira F, Gysi D, Castro D, Ferreira TB. The nosographic structure of posttraumatic stress symptoms across trauma types: An exploratory network analysis approach. J Trauma Stress 2022; 35:1115-1128. [PMID: 35246860 DOI: 10.1002/jts.22818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/06/2021] [Accepted: 01/11/2022] [Indexed: 11/12/2022]
Abstract
The nosographic structure of posttraumatic stress disorder (PTSD) remains unclear, and attempts to determine its symptomatic organization have been unsatisfactory. Several explanations have been suggested, and the impact of trauma type is receiving increasing attention. As little is known about the differential impact trauma type in the nosographic structure of PTSD, we explored the nosology of PTSD and the effect of trauma type on its symptomatic organization. We reanalyzed five cross-sectional psychopathological networks involving different trauma types, encompassing a broad range of traumatic events in veterans, war-related trauma in veterans, sexual abuse, terrorist attacks, and various traumatic events in refugees. The weighted topological overlap was used to estimate the networks and attribute weights to their links. Coexpression differential network analysis was used to identify the common and specific network structures of the connections across different trauma types and to determine the importance of symptoms across the networks. We found a set of symptoms with more common connections with other symptoms, suggesting that these might constitute the prototypical nosographic structure of PTSD. We also found a set of symptoms that had a high number of specific connections with other symptoms; these connections varied according to trauma type. The importance of symptoms across the common and specific networks was ascertained. The present findings offer new insights into the symptomatic organization of PTSD and support previous research on the impact of trauma type on the nosology of this disorder.
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Affiliation(s)
- Filipa Ferreira
- Social Sciences Department, University Institute of Maia, Maia, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Deisy Gysi
- Center for Complex Network Research, Northeastern University, Boston, Massachusetts, USA
| | - Daniel Castro
- Social Sciences Department, University Institute of Maia, Maia, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Tiago Bento Ferreira
- Social Sciences Department, University Institute of Maia, Maia, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
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47
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A network approach can improve eating disorder conceptualization and treatment. NATURE REVIEWS PSYCHOLOGY 2022; 1:419-430. [PMID: 36330080 PMCID: PMC9624475 DOI: 10.1038/s44159-022-00062-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eating disorders are severe mental illnesses with the second highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psychiatric illness), have extremely heterogeneous presentations, and individuals often migrate from one specific eating disorder diagnosis to another. In this Perspective, we propose that understanding eating disorder comorbidity and heterogeneity via a network theory approach offers substantial benefits for both conceptualization and treatment. Such a conceptualization, strongly based on theory, can identify specific pathways that maintain psychiatric comorbidity, how diagnoses vary across individuals, and how specific symptoms and comorbidities maintain illness for one individual, thereby paving the way for personalized treatment.
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48
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Cao D, Bai C, Zhang G. Psychological Distress Among Infertility Patients: A Network Analysis. Front Psychol 2022; 13:906226. [PMID: 35837642 PMCID: PMC9274242 DOI: 10.3389/fpsyg.2022.906226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPsychological distress is common among infertility patients. Total scale scores are often used to represent the severity of anxiety, depression, or stress, which ignores important differences between specific symptoms, and relationships between symptoms. This study aimed to identify patterns of psychological distress experienced by infertility patients and to identify the most central symptoms of anxiety, depression, and stress.MethodFrom June to September 2016, 740 infertility patients were included in this cross-sectional study. Infertility patients were asked to complete the Generalized Anxiety Disorder-7, Patients Health Questionnaire-9 (PHQ-9), and Fertility Problem Inventory. Network analysis was used to examine the patterns of psychological distress in infertility patients and to test the most central symptoms of anxiety, depression, and stress.ResultsRestlessness was the most central symptom in infertility patients. “Feelings of guilt” had the highest strength among PHQ-9 symptoms. “Relationship concern stress” and “sexual concern stress” had the strongest connections in the network. Stability estimation indicated that the order of node strength centrality was more stable than the order of closeness and betweenness (the CS-coefficients were 0.75, 0.13, and 0.67, respectively). In addition, network structure and global strength were invariant across gender.LimitationsThe cross-sectional design did not permit identification of causal relationships. Patients in this study were recruited from one reproductive hospital; especially, most patients had low socioeconomic status, which limits generalizability of the findings.ConclusionThis study reinforces the need to better understand the underlying causes of psychological distress in infertile patients. A more detailed investigation of the relationship between these symptoms could provide information for psychosocial interventions aimed beyond “alleviating psychological distress.” We should consider the individual psychological symptom pattern and its potential causes in infertility patients instead of assuming a consistent psychological distress structure.
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Affiliation(s)
- Danfeng Cao
- Department of Obstetrics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Caifeng Bai
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Guoxiang Zhang
- Department of Obstetrics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- *Correspondence: Guoxiang Zhang,
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49
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Sahlan RN, Keshishian AC, Christian C, Levinson CA. Eating disorder and social anxiety symptoms in Iranian preadolescents: a network analysis. Eat Weight Disord 2022; 27:1855-1867. [PMID: 34787832 DOI: 10.1007/s40519-021-01329-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Network studies of eating disorder (ED) symptoms have identified central and bridge symptoms in Western samples, yet few network models of ED symptoms have been tested in non-Western samples, especially among preadolescents. The current study tested a network model of ED symptoms in Iranian preadolescents (ages 9 to 13), as well as a model of co-occurring social anxiety disorder (SAD) and ED symptoms. METHOD Preadolescent boys (n = 405) and girls (n = 325) completed the Children Eating Attitudes Test-20 and Social Anxiety Scale for Children. We estimated two network models (ED and ED/SAD networks) and identified central and bridge symptoms, as well as tested if these models differed by sex. RESULTS We found that discomfort eating sweets were the most central symptoms in ED networks. Concern over being judged was central in networks including both ED and SAD symptoms. Additionally, concern over being judged was the strongest bridge symptoms. Networks did not differ by sex. CONCLUSION Future research is needed to test if interventions focused on bridge symptoms (i.e., concern over being judged) as primary intervention points target comorbid ED-SAD pathology in preadolescents at risk for ED and SAD. LEVEL OF EVIDENCE Level III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Ani C Keshishian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Caroline Christian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.
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50
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Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord 2022; 27:1279-1295. [PMID: 34374966 PMCID: PMC9079014 DOI: 10.1007/s40519-021-01281-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Patients with eating disorders (ED) pose a high-risk group regarding relapse. The understanding of factors contributing to a better outcome is much-needed. Therapeutic alliance (TA) is one important, pantheoretical variable in the treatment process, which has shown to be connected with outcome. This review looks into a possible predictive effect of TA on outcome as well as related variables. METHODS A systematic review with pre-determined inclusion criteria following the PRISMA guidelines was conducted for studies published since 2014. Three previous reviews including studies up until 2014 were analyzed for studies matching our inclusion criteria. A total of 26 studies were included. RESULTS The results were heterogeneous between different patient groups. Regarding the predictive effect of TA, in adolescent samples, the TA of either the patients or their parents seems to impact outcome as well as completion. For adults, results are mixed, with a tendency to a greater impact of TA for anorexia nervosa (AN) patients, while some samples of adult bulimia nervosa (BN) patients did not find any relation between TA and outcome. CONCLUSION The effect of TA on clinical outcome depends on the patient group. TA has a greater impact on adolescents, irrespective of diagnosis, and on adults with AN. The examined studies have different limitations which include small sample sizes and questionable study design. The examination of motivation as a potential influencing factor is recommended. LEVEL OF EVIDENCE Level I, systematic review.
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