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Hughes AM, Flint SW, Clare K, Kousoulis AA, Rothwell ER, Bould H, Howe LD. Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study. Lancet Reg Health Eur 2024; 40:100895. [PMID: 38745988 PMCID: PMC11092882 DOI: 10.1016/j.lanepe.2024.100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 05/16/2024]
Abstract
Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression. Findings In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years). Interpretation Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS. Funding The ESRC, MRC, NIHR, and Wellcome Trust.
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Affiliation(s)
- Amanda M. Hughes
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Ken Clare
- Leeds Beckett University, Leeds, UK
- Obesity UK, Halifax, UK
- European Coalition for People Living with Obesity, Dublin, Ireland
| | | | - Emily R. Rothwell
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Bould
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire, UK
| | - Laura D. Howe
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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Lotery E, Bell R, Combe G, Biddle L, Bould H. Qualitative study of the impact on recovery of peer relationships between female inpatients during treatment for anorexia nervosa in the United Kingdom. Int J Eat Disord 2024; 57:353-362. [PMID: 38062886 DOI: 10.1002/eat.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Admissions to hospitals for people with anorexia nervosa (AN) often last over 2 months, during which significant time is often spent with other patients, but there is little qualitative research on the impact on recovery of the inter-patient relationships. Our aim was to conduct qualitative interviews with people with a history of inpatient treatment for AN, focusing on the impact of interactions and relationships between patients during hospital admission on recovery, including short-term and long-term effects. METHOD We conducted nine semi-structured, one-to-one interviews, specifically exploring the helpful and unhelpful aspects of inter-patient relationships during inpatient treatment for AN. No type of relationship was either included or excluded. Participants were recruited as volunteers in response to an online advertisement; all who met the eligibility criteria were selected. Interviews were transcribed and analyzed using thematic analysis. RESULTS Thematic analysis identified five themes: (1) comparison and justification, (2) learnt unhelpful behaviors, (3) dealing with distress, (4) compassion, and (5) role-modeling. All participants expressed conflicting feelings about their relationships with other patients, but generally described developing more resilience to negative effects as they got closer to recovery. Positive effects, such as compassion, appeared to hold significance long term in participants' recovered lives. DISCUSSION The detailed exploration of themes in this study provides a deeper understanding of inter-patient relationships during inpatient treatment for AN. This could aid clinical decision-making when choosing appropriate treatment settings for individual patients as well as informing clinical practice in hospital. PUBLIC SIGNIFICANCE This study closely examines the effect on recovery of relationships with other patients during hospital treatment for AN, a severe eating disorder. Findings might help hospital staff to understand the feelings of those they look after and develop ways to protect patients from the negative effects of peer relationships and enhance the positive ones, to support recovery in hospital.
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Affiliation(s)
| | | | - Gillian Combe
- Oxford Health NHS Foundation Trust, Oxford, UK
- South East Region NHS England, England, UK
| | - Lucy Biddle
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
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Biddle L, Derges J, Cliffe B, Gooberman-Hill R, Linton MJ, Moran P, Bould H. "Pouring their heart out in Sainsbury's": qualitative study of young people's, parents' and mental health practitioners' experiences of adapting to remote online mental health appointments during COVID-19. BMC Psychiatry 2023; 23:641. [PMID: 37658298 PMCID: PMC10474770 DOI: 10.1186/s12888-023-05126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, technologies such as videoconferencing were used to deliver mental health appointments remotely online. For many people, this was a change from previous methods of mental healthcare receipt and delivery. We aimed to explore in-depth how practitioners, young people and parents in the UK experienced this transition. METHODS We used qualitative methods to collect data, triangulating between free-text online survey data (n = 38), focus groups (n = 5) (3 young adult groups (total n = 11); 2 practitioner groups (total n = 7)), and semi-structured interviews (practitioners n = 8; parents n = 4). Data were analysed using reflexive thematic analysis. RESULTS Participants held mixed views about remote appointments, which were encompassed within the five themes of: home as clinic; disrupted therapeutic relationships; difficulties with engagement; uncontained risk; and scope of care provision. While appointments at home could be regarded as more comfortable, naturalistic and accessible, it was also recognised that remoteness compromised practitioner control with consequences for their ability to monitor patient engagement, manage risk and ensure confidentiality when others were present in the home. This could create an additional burden for parents as they tried to facilitate appointments but felt unsupported in this role. Relatedly, remoteness was seen to hinder interpersonal communication, formation of trust, communication of empathy and opportunities to observe body language, all of which were deemed important to building and maintaining effective therapeutic relationships. Despite this, others thought the anonymity of a remote exchange may allow earlier disclosure. There was disagreement as to whether remote provision narrowed or expanded the scope of practice. CONCLUSIONS While some had positive views of remote mental health appointments, others found them challenging. Findings highlight key areas requiring attention and mitigation in future offerings of remote provision, namely: risk management, parental burden, and problematic engagement.
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Affiliation(s)
- Lucy Biddle
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK.
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK.
- Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Jane Derges
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Bethany Cliffe
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rachael Gooberman-Hill
- Translational Health Sciences, Bristol University Medical School, Learning and Research Building, Southmead Hospital, Bristol, UK
- Elizabeth Blackwell Institute, University of Bristol, Royal Fort House, Bristol, UK
| | - Myles-Jay Linton
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Paul Moran
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
- Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Helen Bould
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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House T, Wong HK, Samuel NW, Stephen ID, Brooks KR, Bould H, Attwood AS, Penton-Voak IS. The relationship between body dissatisfaction and attentional bias to thin bodies in Malaysian Chinese and White Australian women: a dot probe study. R Soc Open Sci 2023; 10:230674. [PMID: 37736527 PMCID: PMC10509588 DOI: 10.1098/rsos.230674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Studies suggest that an attentional bias to thin bodies is common among those with high levels of body dissatisfaction, which is a risk factor for, and symptom of, various eating disorders. However, these studies have predominantly been conducted in Western countries with body stimuli involving images of White people. In a preregistered study, we recruited 150 Malaysian Chinese women and 150 White Australian women for a study using standardized images of East Asian and White Australian bodies. To measure attentional bias to thin bodies, participants completed a dot probe task which presented images of women who self-identified their ethnicity as East Asian or as White Australian. Contrary to previous findings, we found no evidence for an association between body dissatisfaction and attentional bias to thin bodies. This lack of association was not affected by participant ethnicity (Malaysian Chinese versus White Australian) or ethnic congruency between participants and body stimuli (own-ethnicity versus other-ethnicity). However, the internal consistency of the dot probe task was poor. These results suggest that either the relationship between body dissatisfaction and attentional bias to thin bodies is not robust, or the dot probe task may not be a reliable measure of attentional bias to body size.
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Affiliation(s)
- T. House
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
- School of Psychological Science, University of Bristol, UK
| | - H. K. Wong
- School of Psychology, University of Nottingham Malaysia, Malaysia
| | - N. W. Samuel
- School of Psychology, University of Nottingham Malaysia, Malaysia
| | - I. D. Stephen
- NTU Psychology, Nottingham Trent University, Nottingham, UK
| | - K. R. Brooks
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
- Perception in Action Research Centre (PARC), Macquarie University, Australia
- Lifespan Health and Wellbeing Research Centre, Macquarie University, Australia
| | - H. Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - A. S. Attwood
- School of Psychological Science, University of Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - I. S. Penton-Voak
- School of Psychological Science, University of Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
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Burgess R, Culpin I, Costantini I, Bould H, Nabney I, Pearson RM. Quantifying the efficacy of an automated facial coding software using videos of parents. Front Psychol 2023; 14:1223806. [PMID: 37583610 PMCID: PMC10425266 DOI: 10.3389/fpsyg.2023.1223806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction This work explores the use of an automated facial coding software - FaceReader - as an alternative and/or complementary method to manual coding. Methods We used videos of parents (fathers, n = 36; mothers, n = 29) taken from the Avon Longitudinal Study of Parents and Children. The videos-obtained during real-life parent-infant interactions in the home-were coded both manually (using an existing coding scheme) and by FaceReader. We established a correspondence between the manual and automated coding categories - namely Positive, Neutral, Negative, and Surprise - before contingency tables were employed to examine the software's detection rate and quantify the agreement between manual and automated coding. By employing binary logistic regression, we examined the predictive potential of FaceReader outputs in determining manually classified facial expressions. An interaction term was used to investigate the impact of gender on our models, seeking to estimate its influence on the predictive accuracy. Results We found that the automated facial detection rate was low (25.2% for fathers, 24.6% for mothers) compared to manual coding, and discuss some potential explanations for this (e.g., poor lighting and facial occlusion). Our logistic regression analyses found that Surprise and Positive expressions had strong predictive capabilities, whilst Negative expressions performed poorly. Mothers' faces were more important for predicting Positive and Neutral expressions, whilst fathers' faces were more important in predicting Negative and Surprise expressions. Discussion We discuss the implications of our findings in the context of future automated facial coding studies, and we emphasise the need to consider gender-specific influences in automated facial coding research.
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Affiliation(s)
- R. Burgess
- The Digital Health Engineering Group, Merchant Venturers Building, University of Bristol, Bristol, United Kingdom
| | - I. Culpin
- The Centre for Academic Mental Health, Bristol Medical School, Bristol, United Kingdom
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - I. Costantini
- The Centre for Academic Mental Health, Bristol Medical School, Bristol, United Kingdom
| | - H. Bould
- The Centre for Academic Mental Health, Bristol Medical School, Bristol, United Kingdom
- The Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- The Gloucestershire Health and Care NHS Foundation Trust, Gloucester, United Kingdom
| | - I. Nabney
- The Digital Health Engineering Group, Merchant Venturers Building, University of Bristol, Bristol, United Kingdom
| | - R. M. Pearson
- The Centre for Academic Mental Health, Bristol Medical School, Bristol, United Kingdom
- The Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
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Warne N, Heron J, Mars B, Solmi F, Biddle L, Gunnell D, Hammerton G, Moran P, Munafò M, Penton‐Voak I, Skinner A, Stewart A, Bould H. Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways. J Child Psychol Psychiatry 2023; 64:797-806. [PMID: 36541428 PMCID: PMC10152493 DOI: 10.1111/jcpp.13738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition, and being bullied as mediators. METHODS We analysed Avon Longitudinal Study of Parents and Children data on 3,453 males and 3,481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships. RESULTS Emotional dysregulation at age 7 years was associated with disordered eating [fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)] and self-harm [fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)] at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm. CONCLUSIONS In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | | | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Marcus Munafò
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Ian Penton‐Voak
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Andy Skinner
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Integrative Cancer Epidemiology ProgrammeBristol Medical School, University of BristolBristolUK
| | - Anne Stewart
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
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Derges J, Bould H, Gooberman-Hill R, Moran P, Linton MJ, Rifkin-Zybutz R, Biddle L. Mental Health Practitioners' and Young People's Experiences of Talking About Social Media During Mental Health Consultations: Qualitative Focus Group and Interview Study. JMIR Form Res 2023; 7:e43115. [PMID: 37027182 PMCID: PMC10131638 DOI: 10.2196/43115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Increasing concerns among mental health care professionals have focused on the impact of young people's use of digital technology and social media on their mental well-being. It has been recommended that the use of digital technology and social media be routinely explored during mental health clinical consultations with young people. Whether these conversations occur and how they are experienced by both clinicians and young people are currently unknown. OBJECTIVE This study aimed to explore mental health practitioners' and young people's experiences of talking about young people's web-based activities related to their mental health during clinical consultations. Web-based activities include use of social media, websites, and messaging. Our aim was to identify barriers to effective communication and examples of good practice. In particular, we wanted to obtain the views of young people, who are underrepresented in studies, on their social media and digital technology use related to mental health. METHODS A qualitative study was conducted using focus groups (11 participants across 3 groups) with young people aged 16 to 24 years and interviews (n=8) and focus groups (7 participants across 2 groups) with mental health practitioners in the United Kingdom. Young people had experience of mental health problems and support provided by statutory mental health services or third-sector organizations. Practitioners worked in children and young people's mental health services, statutory services, or third-sector organizations such as a university counseling service. Thematic analysis was used to analyze the data. RESULTS Practitioners and young people agreed that talking about young people's web-based activities and their impact on mental health is important. Mental health practitioners varied in their confidence in doing this and were keen to have more guidance. Young people said that practitioners seldom asked about their web-based activities, but when asked, they often felt judged or misunderstood. This stopped them from disclosing difficult web-based experiences and precluded useful conversations about web-based safety and how to access appropriate web-based support. Young people supported the idea of guidance or training for practitioners and were enthusiastic about sharing their experiences and being involved in the training or guidance provided to practitioners. CONCLUSIONS Practitioners would benefit from structured guidance and professional development to enable them to support young people in feeling more willing to disclose and talk about their web-based experiences and their impact on their mental health. This is reflected in practitioners' desire for guidance to improve their confidence and skills to safely support young people in navigating the challenges of the web-based world. Young people want to feel comfortable discussing their web-based activities during their consultations with mental health practitioners, both in tackling the challenges and using the opportunity to discuss their experiences, gain support, and develop coping strategies related to web-based safety.
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Affiliation(s)
- Jane Derges
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
| | - Helen Bould
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- Gloucestershire Health and Care NHS Foundation Trust, Child and Adolescent Mental Health Services, Gloucester, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Rachael Gooberman-Hill
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Myles-Jay Linton
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Raphael Rifkin-Zybutz
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- Bethlem Royal Hospital, South London and the Maudsley NHS Foundation Trust, Beckenham, United Kingdom
| | - Lucy Biddle
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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8
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Astle DE, Moore A, Marryat L, Viding E, Mansfield KL, Fazel M, Pierce M, Abel KM, Green J, John A, Broome MR, Upthegrove R, Bould H, Minnis H, Gajwani R, Groom MJ, Hollis C, Liddle E, Sayal K, Berry V, Collishaw S, Dawes H, Cortese S, Violato M, Pollard J, MacCabe JH, Blakemore SJ, Simonoff E, Watkins E, Hiller RM, Townsend E, Armour C, Geddes JR, Thompson L, Schwannauer M, Nicholls D, Hotopf M, Downs J, Rahman A, Sharma AN, Ford TJ. We need timely access to mental health data: implications of the Goldacre review. Lancet Psychiatry 2023; 10:242-244. [PMID: 36931773 DOI: 10.1016/s2215-0366(23)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Duncan E Astle
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Pierce
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Population Health Science, Centre for Academic Mental Health and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- NIHR MindTech MIC & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth Liddle
- Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Vashti Berry
- Children & Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, University College London, London, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Matthias Schwannauer
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK; Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
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House T, Graham K, Ellis B, Bould H, Attwood AS, Stephen ID, Brooks KR, Penton-Voak IS. Is body dissatisfaction related to an attentional bias towards low weight bodies in non-clinical samples of women? A systematic review and meta-analysis. Body Image 2023; 44:103-119. [PMID: 36563472 DOI: 10.1016/j.bodyim.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Body dissatisfaction is defined as the negative subjective evaluation of one's body and is considered a risk factor for, and symptom of, eating disorders. Some studies show women with high body dissatisfaction display an attentional bias towards low weight bodies; however, this finding is not consistent, and results are yet to be systematically synthesised. We conducted a qualitative and quantitative synthesis of cross-sectional studies investigating the relationship between body dissatisfaction and attentional bias to low weight bodies in non-clinical samples of women. We searched PubMed, Scopus, Web of Science, PsycINFO, ProQuest, and OpenGrey for studies up until September 2022. We identified 34 eligible studies involving a total of 2857 women. A meta-analysis of 26 studies (75 effects) found some evidence from gaze tracking studies for a positive association between body dissatisfaction and attentional bias to low weight bodies. We found no evidence for an association from studies measuring attention using the dot probe task, electroencephalogram (EEG) recording, or the modified spatial cueing task. The results together provide partial support for the positive association between body dissatisfaction and attentional bias to low weight bodies in women. These findings can be used to inform future attentional bias research.
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Affiliation(s)
- T House
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia; School of Psychological Science, University of Bristol, United Kingdom.
| | - K Graham
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, United Kingdom
| | - B Ellis
- EPSRC CDT in Digital Health and Care, University of Bristol, United Kingdom
| | - H Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; Gloucestershire Health and Care NHS Foundation Trust, Centre for Academic Mental Health, University of Bristol, United Kingdom; MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, United Kingdom
| | - A S Attwood
- School of Psychological Science, University of Bristol, United Kingdom; MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, United Kingdom
| | - I D Stephen
- NTU Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - K R Brooks
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - I S Penton-Voak
- School of Psychological Science, University of Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom
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10
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Cadman T, Paul E, Culpin I, Sallis H, Bould H, Pearson R. Parental monitoring longitudinally associates with reduced risk of adolescent mental health problems. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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11
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Rifkin-Zybutz R, Turner N, Derges J, Bould H, Sedgewick F, Gooberman-Hill R, Linton MJ, Moran P, Biddle L. Original Research - Digital technology use and the mental health consultation: a survey of the views and experiences of clinicians and young people (Preprint). JMIR Ment Health 2022; 10:e44064. [PMID: 37067869 PMCID: PMC10152330 DOI: 10.2196/44064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Digital technologies play an increasingly important role in the lives of young people and have important effects on their mental health. OBJECTIVE We aimed to explore 3 key areas of the intersection between digital technology and mental health: the views and experiences of young people and clinicians about digital technology and mental health; implementation and barriers to the UK national guidance recommendation-that the discussion of digital technology use should form a core part of mental health assessment; and how digital technology might be used to support existing consultations. METHODS Two cross-sectional web-based surveys were conducted in 2020 between June and December, with mental health clinicians (n=99) and young people (n=320). Descriptive statistics were used to summarize the proportions. Multilinear regression was used to explore how the answers varied by gender, sexuality, and age. Thematic analysis was used to explore the contents of the extended free-text answers. Anxiety was measured using the Generalized Anxiety Disorder Questionnaire-7 (GAD-7). RESULTS Digital technology use was ubiquitous among young people, with positive and negative aspects acknowledged by both clinicians and young people. Negative experiences were common (131/284, 46.1%) and were associated with increased anxiety levels among young people (GAD-7 3.29; 95% CI 1.97-4.61; P<.001). Although the discussion of digital technology use was regarded as important by clinicians and acceptable by young people, less than half of clinicians (42/85, 49.4%) routinely asked about the use of digital technology and over a third of young people (48/121, 39.6%) who had received mental health care had never been asked about their digital technology use. The conversations were often experienced as unhelpful. Helpful conversations were characterized by greater depth and exploration of how an individual's digital technology use related to mental health. Despite most clinicians (59/83, 71.1%) wanting training, very few (21/86, 24.4%) reported receiving training. Clinicians were open to viewing mental health data from apps or social media to help with consultations. Although young people were generally, in theory, comfortable sharing such data with health professionals, when presented with a binary choice, most reported not wanting to share social media (84/117, 71.8%) or app data (67/118, 56.8%) during consultations. CONCLUSIONS Digital technology use was common, and negative experiences were frequent and associated with anxiety. Over a third of young people were not asked about their digital technology use during mental health consultations, and potentially valuable information about relevant negative experiences on the web was not being captured during consultations. Clinicians would benefit from having access to training to support these discussions with young people. Although young people recognized that app data could be helpful to clinicians, they appeared hesitant to share their own data. This finding suggests that data sharing has barriers that need to be further explored.
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Affiliation(s)
- Raphael Rifkin-Zybutz
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
| | - Nicholas Turner
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
| | - Jane Derges
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
| | - Helen Bould
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Gloucestershire Health and Care National Health Service Foundation Trust, Gloucester, United Kingdom
| | | | | | - Myles-Jay Linton
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Bristol University Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
- Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Lucy Biddle
- Population Health Sciences, Bristol University Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
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12
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Lavis A, McNeil S, Bould H, Winston A, Reid K, Easter CL, Pendrous R, Michail M. Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory study. BMJ Open 2022; 12:e065065. [PMID: 35896287 PMCID: PMC9335036 DOI: 10.1136/bmjopen-2022-065065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Self-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16-25 diagnosed with an eating disorder. It will explore participants' perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons' Advisory Group, who will be key to study delivery and dissemination. METHODS AND ANALYSIS This exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16-25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants' feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20-30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant's data from both phases compared alongside comparative analysis of the datasets as a whole. ETHICS AND DISSEMINATION The study gained ethical approval from the NHS HRA West Midlands-Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).
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Affiliation(s)
- Anna Lavis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheryllin McNeil
- Forward Thinking Birmingham, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School & Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | | | - Kalen Reid
- Youth Advisory Group, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Christina L Easter
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rosina Pendrous
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Maria Michail
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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13
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Biddle L, Rifkin-Zybutz R, Derges J, Turner N, Bould H, Sedgewick F, Gooberman-Hill R, Moran P, Linton MJ. Developing good practice indicators to assist mental health practitioners to converse with young people about their online activities and impact on mental health: a two-panel mixed-methods Delphi study. BMC Psychiatry 2022; 22:485. [PMID: 35854237 PMCID: PMC9297563 DOI: 10.1186/s12888-022-04093-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Online activity has been linked to poor mental health in children and young people, particularly those with existing vulnerability who may inadvertently or otherwise access harmful content. It is suggested health and social care practitioners should address online activity during mental health consultations, but guidance about acceptable or effective ways to do this is lacking. This study sought to derive good practice guidance to support mental health practitioners to engage young people in conversations about their online activities and impact on mental health. METHODS A mixed-methods Delphi (consensus) study was conducted with a panel of mental health practitioners (n = 21) and a panel of young people (n = 22). Practitioners worked with children or young adults in the UK, mostly in statutory services (80.9%), in varied clinical roles, with 2 - 30 years of experience and most were female (87.5%). Young people were mostly female (77.3%), 13-22 years old, reported varied mental health diagnoses and had sought help from services. Across 3 rounds, panellists completed questionnaires which involved rating agreement with statements and answering open-ended questions. Iterative analysis informed subsequent questionnaire content. The percentage of participants rating their level of agreement with each statement was calculated. The threshold for inclusion as a good practice indicator (GPI) was 75% across both panels. Thematic analysis was used for free-text data. RESULTS Twenty-seven GPIs emerged covering 'who' (which young people) should be asked about online activities, 'when', 'what' should be discussed, and with what 'outcome'. Panels agreed conversations should be initiated with all young people from first meeting and regularly thereafter, with 'red flags' indicating a conversation may be pertinent. Core topics were identified with additional areas for patients presenting with disordered eating or self-harm. Panels emphasised conversations should be fluid, normalised, and encourage reflection and self-awareness. CONCLUSIONS Mental health practitioners could empower young people to exercise agency in relation to online safety and capitalise on positive features. Findings also identify training needs for practitioners. Further research should explore real-world application of the GPIs and transferability to underrepresented groups within our panels, such as males and younger children. Ethnicity and deprivation were not recorded.
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Affiliation(s)
- Lucy Biddle
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK. .,The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Raphael Rifkin-Zybutz
- grid.5337.20000 0004 1936 7603Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK ,grid.415717.10000 0001 2324 5535South London and the Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Jane Derges
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK ,grid.5337.20000 0004 1936 7603Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
| | - Nicholas Turner
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Helen Bould
- grid.5337.20000 0004 1936 7603Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK ,grid.5337.20000 0004 1936 7603Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK ,grid.439779.70000 0004 1793 1450Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - Felicity Sedgewick
- grid.5337.20000 0004 1936 7603School of Education, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Bristol University Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Level 1, Bristol, UK
| | - Paul Moran
- grid.410421.20000 0004 0380 7336The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK ,grid.5337.20000 0004 1936 7603Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK ,grid.410421.20000 0004 0380 7336Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Myles-Jay Linton
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK ,grid.5337.20000 0004 1936 7603School of Education, University of Bristol, Bristol, UK
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Guy J, Bould H, Lewis G, Solmi F. Stigmatising views towards individuals with eating disorders: trends and associations from 1998 to 2008 using a repeated cross-sectional design. Br J Psychiatry 2021; 220:1-7. [PMID: 35049485 PMCID: PMC7613245 DOI: 10.1192/bjp.2021.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Eating disorders are stigmatised. Little is known about whether stigma has decreased over time and which groups hold more stigmatising beliefs. AIMS To explore whether stigma towards eating disorders has changed between 1998 and 2008 and whether it varies by sociodemographic characteristics. METHOD We used the Office for National Statistics Omnibus surveys 1998 and 2008. As outcomes, we selected four questions eliciting participants' views on issues of blame and ability to recover, and compared their mean scores across eating disorders, depression and alcohol dependence in both years. We used multivariable linear regressions to investigate associations between sociodemographic characteristics and each stigma domain. RESULTS In total, 2720 participants had data on all variables of interest. Compared with 1998, in 2008 stigmatising views towards eating disorders improved. In both years, participants believed it was easier to recover from eating disorders than depression or alcohol dependence. Respondents believed people with eating disorders were more to blame for their condition than those with depression, but less than those with alcohol dependence. Men, those with less formal education, and those from ethnic minority backgrounds were more likely to place greater blame on individuals for their mental illness. Men were more likely than women to think it was possible to recover from an eating disorder. CONCLUSIONS Stigmatising attitudes towards people with eating disorders have improved over time, but are still greater than those observed for other mental illnesses. Improving eating disorder mental health literacy could help to reduce these negative views and lead to improved quality of life, greater help-seeking and better prognosis.
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Affiliation(s)
- Jennifer Guy
- Gloucestershire Health and Care NHS Foundation Trust, Edward Jenner Court, Gloucester, Gloucester GL3 4AW
| | - Helen Bould
- Gloucestershire Health and Care NHS Foundation Trust, Edward Jenner Court, Gloucester, Gloucester GL3 4AW
- Centre for Academic Mental Health, Population Health Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom, BS82BN
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Francesca Solmi
- Division of Psychiatry, University College London, London, UK
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15
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Warne N, Heron J, Mars B, Kwong ASF, Solmi F, Pearson R, Moran P, Bould H. Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: a UK-based birth cohort study. J Eat Disord 2021; 9:155. [PMID: 34861897 PMCID: PMC8640708 DOI: 10.1186/s40337-021-00510-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Young adults and especially those with pre-existing mental health conditions, such as disordered eating and self-harm, appear to be at greater risk of developing metal health problems during the COVID-19 pandemic. However, it is unclear whether this increased risk is affected by any changes in lockdown restrictions, and whether any lifestyle changes could moderate this increased risk. METHODS In a longitudinal UK-based birth cohort (The Avon Longitudinal Study of Parents and Children, ALSPAC) we assessed the relationship between pre-pandemic measures of disordered eating and self-harm and mental health during the COVID-19 pandemic in 2657 young adults. Regression models examined the relationship between self-reported disordered eating, self-harm, and both disordered eating and self-harm at age 25 years and depressive symptoms, anxiety symptoms and mental wellbeing during a period of eased restrictions in the COVID-19 pandemic (May-July 2020) when participants were aged 27-29 years. Analyses were adjusted for sex, questionnaire completion date, pre-pandemic socioeconomic disadvantage and pre-pandemic mental health and wellbeing. We also examined whether lifestyle changes (sleep, exercise, alcohol, visiting green space, eating, talking with family/friends, hobbies, relaxation) in the initial UK lockdown (April-May 2020) moderated these associations. RESULTS Pre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with the reporting of a higher frequency of depressive symptoms and anxiety symptoms, and poorer mental wellbeing during the pandemic compared to individuals without disordered eating and self-harm. Associations remained when adjusting for pre-pandemic mental health measures. There was little evidence that interactions between disordered eating and self-harm exposures and lifestyle change moderators affected pandemic mental health and wellbeing. CONCLUSIONS Young adults with pre-pandemic disordered eating, self-harm and comorbid disordered eating and self-harm were at increased risk for developing symptoms of depression, anxiety and poor mental wellbeing during the COVID-19 pandemic, even when accounting for pre-pandemic mental health. Lifestyle changes during the pandemic do not appear to alter this risk. A greater focus on rapid and responsive service provision is essential to reduce the impact of the pandemic on the mental health of these already vulnerable individuals. The aim of this project was to explore the mental health of young adults with disordered eating behaviours (such as fasting, vomiting/taking laxatives, binge-eating and excessive exercise) and self-harm during the COVID-19 pandemic. We analysed data from an established study that has followed children from birth (in 1991 and 1992) up to present day, including during the pandemic when participants were 28 years old. We looked at the relationship between disordered eating and/or self-harm behaviours from before the pandemic and mental health problems (symptoms of depression and anxiety) and mental wellbeing during the pandemic. We also explored whether there were any lifestyle changes (such as changes in sleep, exercise, visiting green space) that might be linked to better mental health and wellbeing in young adults with disordered eating and self-harm. We found that young adults with prior disordered eating and/or self-harm had more symptoms of depression and anxiety, and worse mental wellbeing than individuals without prior disordered eating or self-harm. However, lifestyle changes did not appear to affect mental health and wellbeing in these young adults. Our findings suggest that people with a history of disordered eating and/or self-harm were at high risk for developing mental health problems during the pandemic, and they will need help from mental health services.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Alex S F Kwong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
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Warne N, Heron J, Mars B, Kwong ASF, Solmi F, Pearson R, Moran P, Bould H. Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: A UK-based birth cohort study. medRxiv 2021:2021.04.30.21256377. [PMID: 33972955 PMCID: PMC8109211 DOI: 10.1101/2021.04.30.21256377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young adults and especially those with pre-existing mental health conditions, such as disordered eating and self-harm, appear to be at greater risk of developing metal health problems during the COVID-19 pandemic. However, it is unclear whether this increased risk is affected by any changes in lockdown restrictions, and whether any lifestyle changes could moderate this increased risk. METHODS In a longitudinal UK-based birth cohort (The Avon Longitudinal Study of Parents and Children, ALSPAC) we assessed the relationship between pre-pandemic measures of disordered eating and self-harm and mental health during the COVID-19 pandemic in 2,657 young adults. Regression models examined the relationship between self-reported disordered eating, self-harm, and both disordered eating and self-harm at age 25 years and depressive symptoms, anxiety symptoms and mental wellbeing during a period of eased restrictions in the COVID-19 pandemic (May-July 2020) when participants were aged 27-29 years. Analyses were adjusted for sex, questionnaire completion date, pre-pandemic socioeconomic disadvantage and pre-pandemic mental health and wellbeing. We also examined whether lifestyle changes (sleep, exercise, alcohol, visiting green space, eating, talking with family/friends, hobbies, relaxation) in the initial UK lockdown (April-May 2020) moderated these associations. RESULTS Pre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with the reporting of a higher frequency of depressive symptoms and anxiety symptoms, and poorer mental wellbeing during the pandemic compared to individuals without disordered eating and self-harm. Associations remained when adjusting for pre-pandemic mental health measures. There was little evidence that interactions between disordered eating and self-harm exposures and lifestyle change moderators affected pandemic mental health and wellbeing. CONCLUSIONS Young adults with pre-pandemic disordered eating, self-harm and comorbid disordered eating and self-harm were at increased risk for developing symptoms of depression, anxiety and poor mental wellbeing during the COVID-19 pandemic, even when accounting for pre-pandemic mental health. Lifestyle changes during the pandemic do not appear to alter this risk. A greater focus on rapid and responsive service provision is essential to reduce the impact of the pandemic on the mental health of these already vulnerable individuals.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Alex S. F. Kwong
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | | | - Rebecca Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
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Henderson M, Bould H, Flouri E, Harrison A, Lewis G, Lewis G, Srinivasan R, Stafford J, Warne N, Solmi F. Association of Emotion Regulation Trajectories in Childhood With Anorexia Nervosa and Atypical Anorexia Nervosa in Early Adolescence. JAMA Psychiatry 2021; 78:1249-1257. [PMID: 34232251 PMCID: PMC8264752 DOI: 10.1001/jamapsychiatry.2021.1599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE People with anorexia nervosa often experience difficulties regulating their emotions. There is no longitudinal evidence as to whether these differences are already present in childhood or when they begin to emerge. OBJECTIVE To investigate the association between emotion regulation trajectories from 3 to 7 years of age and symptoms of anorexia nervosa and atypical anorexia nervosa in adolescence. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all children with complete exposure data in the Millennium Cohort Study, a UK general population birth cohort. Data were acquired from June 2001 to March 2016 and analyzed from June to November 2020. EXPOSURES Mothers reported on their children's emotion regulation skills at 3, 5, and 7 years of age using the Children's Social Behavior Questionnaire. Multilevel models were used to derive early childhood emotion regulation scores (ie, predicted intercept) and within-child changes in emotion regulation scores from 3 to 7 years of age (ie, predicted slope). MAIN OUTCOME AND MEASURES Symptoms consistent with a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa at 14 years of age, defined using a range of questions relative to body image, weight perception, and dieting behaviors (hereinafter referred to as broad anorexia nervosa). Univariable and multivariable logistic regression models tested the association between exposures and outcome. Regression models were adjusted for child and family sociodemographic and socioeconomic characteristics and mental health difficulties, prenatal and perinatal factors, child's cognitive development, and maternal attachment. RESULTS A total of 15 896 participants (85.7% of total sample; 51.0% boys; 84.5% White individuals) had complete data on the exposure and were included in the main analyses. Among those with complete exposure and outcome data (9912 of the analytical sample [62.4%]), 97 participants (1.0%; 86 [88.7%] girls and 85 [87.6%] White individuals) had symptoms consistent with a diagnosis of broad anorexia nervosa at 14 years of age. No evidence suggested that children with lower emotion regulation ability at 3 years of age had greater odds of later reporting symptoms of broad anorexia nervosa (odds ratio [OR], 1.21; 95% CI, 0.91-1.63). However, children whose emotion regulation skills did not improve over childhood and who had greater problems regulating emotions at 7 years of age had higher odds of having broad anorexia nervosa at 14 years of age (OR, 1.45; 95% CI, 1.16-1.83). CONCLUSIONS AND RELEVANCE These findings suggest that difficulties in developing age-appropriate emotion regulation skills in childhood are associated with experiencing broad anorexia nervosa in adolescence. Interventions to support the development of emotion regulation skills across childhood may help reduce the incidence of anorexia nervosa.
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Affiliation(s)
- Mariella Henderson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom,Gloucestershire Health and Care NHS (National Health Service) Foundation Trust, Gloucester, United Kingdom
| | - Eirini Flouri
- Institute of Education, University College London, London, United Kingdom
| | - Amy Harrison
- Institute of Education, University College London, London, United Kingdom
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ramya Srinivasan
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jean Stafford
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Francesca Solmi
- Division of Psychiatry, University College London, London, United Kingdom
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Kwong ASF, Pearson RM, Adams MJ, Northstone K, Tilling K, Smith D, Fawns-Ritchie C, Bould H, Warne N, Zammit S, Gunnell DJ, Moran PA, Micali N, Reichenberg A, Hickman M, Rai D, Haworth S, Campbell A, Altschul D, Flaig R, McIntosh AM, Lawlor DA, Porteous D, Timpson NJ. Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts. Br J Psychiatry 2021; 218:334-343. [PMID: 33228822 PMCID: PMC7844173 DOI: 10.1192/bjp.2020.242] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences. AIMS To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic. METHOD Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n = 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale. RESULTS Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23-26%) compared with a pre-pandemic level of 13% (95% CI 12-14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression. CONCLUSIONS These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
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Affiliation(s)
- Alex S. F. Kwong
- MRC Integrative Epidemiology Unit, University of Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, UK; and Division of Psychiatry, University of Edinburgh, UK
| | - Rebecca M. Pearson
- MRC Integrative Epidemiology Unit, University of Bristol, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, UK; and Division of Psychiatry, University of Edinburgh, UK
| | - Daniel Smith
- MRC Integrative Epidemiology Unit, University of Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, UK; and Division of Psychiatry, University of Edinburgh, UK
| | | | - Helen Bould
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and Gloucestershire Health and Care NHS Foundation Trust, UK
| | - Naomi Warne
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Stanley Zammit
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - David J. Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute of Health Research Biomedical Research Centre, University of Bristol, UK
| | - Paul A. Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; National Institute of Health Research Biomedical Research Centre, University of Bristol, UK; and Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Nadia Micali
- Great Ormond Street Institute of Child Health, University College London, UK; Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland; and Department of Paediatrics Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Switzerland
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Dheeraj Rai
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; National Institute of Health Research Biomedical Research Centre, University of Bristol, UK; and Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Simon Haworth
- 1MRC Integrative Epidemiology Unit, University of Bristol, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, UK; and Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Drew Altschul
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, UK
| | - Robin Flaig
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, UK; and Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, UK
| | | | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute of Health Research Biomedical Research Centre, University of Bristol, UK
| | - David Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, UK
| | - Nicholas J. Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
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19
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Stein K, Warne N, Heron J, Zucker N, Bould H. Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population-based cohort. Int J Eat Disord 2021; 54:915-924. [PMID: 33939186 PMCID: PMC8344098 DOI: 10.1002/eat.23513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16. METHOD The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders. RESULTS After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p = .197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p = .002), and after excluding those with pre-existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p = .002). DISCUSSION Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long-term outcomes than functional impairment.
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Affiliation(s)
- K. Stein
- Academic Clinical Fellow in Child and Adolescent Psychiatry, University of Oxford; Warneford Hospital, Oxford OX3 7JX
| | - N. Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN
| | - J. Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN
| | - N. Zucker
- Associate Professor of Clinical Psychology, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - H. Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN & Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
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20
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Warne N, Heron J, Mars B, Moran P, Stewart A, Munafò M, Biddle L, Skinner A, Gunnell D, Bould H. Comorbidity of self-harm and disordered eating in young people: Evidence from a UK population-based cohort. J Affect Disord 2021; 282:386-390. [PMID: 33421867 PMCID: PMC8150329 DOI: 10.1016/j.jad.2020.12.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Self-harm and eating disorders are often comorbid in clinical samples but their co-occurrence in the general population is unclear. Given that only a small proportion of individuals who self-harm or have disordered eating present to clinical services, and that both self-harm and eating disorders are associated with substantial morbidity and mortality, it is important to study these behaviours at a population level. METHODS We assessed the co-occurrence of self-harm and disordered eating behaviours in 3384 females and 2326 males from a UK population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants reported on their self-harm and disordered eating behaviours (fasting, purging, binge-eating and excessive exercise) in the last year via questionnaire at 16 and 24 years. At each age we assessed how many individuals who self-harm also reported disordered eating, and how many individuals with disordered eating also reported self-harm. RESULTS We found high comorbidity of self-harm and disordered eating. Almost two-thirds of 16-year-old females, and two-in-five 24-year old males who self-harmed also reported some form of disordered eating. Young people with disordered eating reported higher levels of self-harm at both ages compared to those without disordered eating. LIMITATIONS We were not able to measure whether participants identified their disordered eating as a method of self-harm. CONCLUSIONS Self-harm and disordered eating commonly co-occur in young people in the general population. It is important to screen for both sets of difficulties to provide appropriate treatment.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK,NIHR Applied Research Collaboration (ARC) West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anne Stewart
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford UK
| | - Marcus Munafò
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK,School of Psychological Science, University of Bristol, Bristol, UK,MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
| | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Applied Research Collaboration (ARC) West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andy Skinner
- School of Psychological Science, University of Bristol, Bristol, UK,MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK.
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21
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Affiliation(s)
- Francesca Solmi
- Division of Psychiatry, University College London, London, UK.
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Science, School of Policy Studies University of Bristol, Bristol, UK; Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - E Caitlin Lloyd
- Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies University of Bristol, Bristol, UK; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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22
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Solmi F, Bentivegna F, Bould H, Mandy W, Kothari R, Rai D, Skuse D, Lewis G. Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years: A UK general population cohort study. J Child Psychol Psychiatry 2021; 62:75-85. [PMID: 32361997 PMCID: PMC8425328 DOI: 10.1111/jcpp.13255] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Some people with eating disorders have difficulties with social communication. However, no longitudinal evidence regarding the direction of this association exists. We investigated trajectories of autistic social traits across childhood and adolescence in adolescents with and without disordered eating behaviours in early adolescence. METHODS We used data from the Avon Longitudinal Study of Parents and Children. Our disordered eating measure indicated presence of any, monthly and weekly disordered eating (fasting, purging, dieting, binge eating) at age 14 years. Autistic social traits were reported by mothers using the Social and Communication Disorders Checklist (SCDC) at age seven, 11, 14 and 16 years. We modelled SCDC score trajectories using multilevel negative binomial models adjusting for a number of child- and maternal-level confounders. RESULTS Of the 5,381 adolescents included in our sample, 421 (7.8%) experienced one or more disordered eating behaviours, and 148 (2.8%) weekly episodes. Adolescents with disordered eating had a 20% increase in SCDC scores (relative risk (RR) 1.23, 95% confidence interval (CI):1.14, 1.32) compared to those without disordered eating. This association was particularly apparent for those reporting weekly (RR 1.43, 95%CI: 1.27, 1.61) as opposed to monthly disordered eating (RR 1.12, 95%CI: 1.01, 1.22). CONCLUSIONS Greater autistic social traits in childhood could represent a risk factor for the development of disordered eating in adolescence. Although mechanisms of this association need to be elucidated, clinicians should be aware that autistic social traits could have predated the eating disorder when managing people with these conditions.
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Affiliation(s)
| | | | - Helen Bould
- Centre for Academic Mental HealthPopulation Health ScienceUniversity of BristolBristolUK,Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
| | - William Mandy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Radha Kothari
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Dheeraj Rai
- Centre for Academic Mental HealthPopulation Health ScienceUniversity of BristolBristolUK,NIHR Biomedical Research CentreUniversity of BristolBristolUK,Avon and Wiltshire PartnershipNHS Mental Health TrustBristolUK
| | - David Skuse
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Glyn Lewis
- Division of PsychiatryUniversity College LondonLondonUK
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23
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Bould H, Noonan K, Penton-Voak I, Skinner A, Munafò MR, Park RJ, Broome MR, Harmer CJ. Does repeatedly viewing overweight versus underweight images change perception of and satisfaction with own body size? R Soc Open Sci 2020; 7:190704. [PMID: 32431856 PMCID: PMC7211892 DOI: 10.1098/rsos.190704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 02/03/2020] [Indexed: 05/08/2023]
Abstract
Body dissatisfaction is associated with subsequent eating disorders and weight gain. One-off exposure to bodies of different sizes changes perception of others' bodies, and perception of and satisfaction with own body size. The effect of repeated exposure to bodies of different sizes has not been assessed. We randomized women into three groups, and they spent 5 min twice a day for a week completing a one-back task using images of women modified to appear either under, over, or neither over- nor underweight. We tested the effects on their perception of their own and others' body size, and satisfaction with own size. Measures at follow-up were compared between groups, adjusted for baseline measurements. In 93 women aged 18-30 years, images of other women were perceived as larger following exposure to underweight women (and vice versa) (p < 0.001). There was no evidence for a difference in our primary outcome measure (visual analogue scale own size) or in satisfaction with own size. Avatar-constructed ideal (p = 0.03) and avatar-constructed perceived own body size (p = 0.007) both decreased following exposure to underweight women, possibly due to adaptation affecting how the avatar was perceived. Repeated exposure to different sized bodies changes perception of the size of others' bodies, but we did not find evidence that it changes perceived own size.
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Affiliation(s)
- Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Katharine Noonan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK
| | - Ian Penton-Voak
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol BS8 1TU, UK
| | - Andy Skinner
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Marcus R. Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol BS8 1TU, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Rebecca J. Park
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew R. Broome
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Catherine J. Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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24
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Bould H, Mars B, Moran P, Biddle L, Gunnell D. Rising suicide rates among adolescents in England and Wales. Lancet 2019; 394:116-117. [PMID: 31227370 DOI: 10.1016/s0140-6736(19)31102-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/20/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Helen Bould
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (2)gether NHS Foundation Trust, Gloucester, UK.
| | - Becky Mars
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lucy Biddle
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - David Gunnell
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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25
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Bould H, Carnegie R, Allward H, Bacon E, Lambe E, Sapseid M, Button KS, Lewis G, Skinner A, Broome MR, Park R, Harmer CJ, Penton-Voak IS, Munafò MR. Effects of exposure to bodies of different sizes on perception of and satisfaction with own body size: two randomized studies. R Soc Open Sci 2018; 5:171387. [PMID: 29892352 PMCID: PMC5990741 DOI: 10.1098/rsos.171387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/02/2018] [Indexed: 05/18/2023]
Abstract
Body dissatisfaction is prevalent among women and associated with subsequent obesity and eating disorders. Exposure to images of bodies of different sizes has been suggested to change the perception of 'normal' body size in others. We tested whether exposure to different-sized (otherwise identical) bodies changes perception of own and others' body size, satisfaction with body size and amount of chocolate consumed. In Study 1, 90 18-25-year-old women with normal BMI were randomized into one of three groups to complete a 15 min two-back task using photographs of women either of 'normal weight' (Body Mass Index (BMI) 22-23 kg m-2), or altered to appear either under- or over-weight. Study 2 was identical except the 96 participants had high baseline body dissatisfaction and were followed up after 24 h. We also conducted a mega-analysis combining both studies. Participants rated size of others' bodies, own size, and satisfaction with size pre- and post-task. Post-task ratings were compared between groups, adjusting for pre-task ratings. Participants exposed to over- or normal-weight images subsequently perceived others' bodies as smaller, in comparison to those shown underweight bodies (p < 0.001). They also perceived their own bodies as smaller (Study 1, p = 0.073; Study 2, p = 0.018; mega-analysis, p = 0.001), and felt more satisfied with their size (Study 1, p = 0.046; Study 2, p = 0.004; mega-analysis, p = 0.006). There were no differences in chocolate consumption. This study suggests that a move towards using images of women with a BMI in the healthy range in the media may help to reduce body dissatisfaction, and the associated risk of eating disorders.
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Affiliation(s)
- Helen Bould
- Department of Psychiatry, University of Oxford, Oxford, UK
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | - Rebecca Carnegie
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | - Heather Allward
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Emily Bacon
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Emily Lambe
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Sapseid
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | | | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Andy Skinner
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Matthew R. Broome
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Rebecca Park
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | - Marcus R. Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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26
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Affiliation(s)
- Helen Bould
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | - Alan Stein
- Department of Psychiatry, Warneford Hospital, Oxford, UK
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Affiliation(s)
- Helen Bould
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | | | - Alan Stein
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, Oxford, UK
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Bould H, De Stavola B, Magnusson C, Micali N, Dal H, Evans J, Dalman C, Lewis G. The influence of school on whether girls develop eating disorders. Int J Epidemiol 2016; 45:480-8. [PMID: 27097749 PMCID: PMC4864880 DOI: 10.1093/ije/dyw037] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 01/30/2023] Open
Abstract
Background:
Clinical anecdote suggests that rates of eating disorders (ED) vary between schools. Given their high prevalence and mortality, understanding risk factors is important. We hypothesised that rates of ED would vary between schools, and that school proportion of female students and proportion of parents with post-high school education would be associated with ED, after accounting for individual characteristics.
Method:
Multilevel analysis of register-based, record-linkage data on 55 059 females born in Stockholm County, Sweden, from 1983, finishing high school in 2002-10. Outcome was clinical diagnosis of an ED, or attendance at a specialist ED clinic, aged 16-20 years.
Results:
The 5-year cumulative incidence of ED diagnosis aged 16-20 years was 2.4%. Accounting for individual risk factors, with each 10% increase in the proportion of girls at a school, the odds ratio for ED was 1.07 (1.01 to 1.13),
P
= 0.018. With each 10% increase in the proportion of children with at least one parent with post-high school education, the odds ratio for ED was 1.14 (1.09 to 1.19),
P
< 0.0001. Predicted probability of an average girl developing an ED was 1.3% at a school with 25% girls where 25% of parents have post-high school education, and 3.3% at a school with 75% girls where 75% of parents have post-high school education.
Conclusions:
Rates of ED vary between schools; this is not explained by individual characteristics. Girls at schools with high proportions of female students, and students with highly educated parents, have higher odds of ED regardless of individual risk factors.
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Affiliation(s)
- Helen Bould
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Bianca De Stavola
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Dal
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan Evans
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Glyn Lewis
- Faculty of Brain Sciences, University College London, London, UK
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Davies SJC, Pearson RM, Stapinski L, Bould H, Christmas DM, Button KS, Skapinakis P, Lewis G, Evans J. Symptoms of generalized anxiety disorder but not panic disorder at age 15 years increase the risk of depression at 18 years in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study. Psychol Med 2016; 46:73-85. [PMID: 26315278 PMCID: PMC4886844 DOI: 10.1017/s003329171500149x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years. METHOD Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data. RESULTS In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker. CONCLUSIONS Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
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Affiliation(s)
- S. J. C. Davies
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Geriatric Psychiatry Division, CAMH, University of Toronto, Toronto, Canada
| | - R. M. Pearson
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - L. Stapinski
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - H. Bould
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D. M. Christmas
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - K. S. Button
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - P. Skapinakis
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - G. Lewis
- Division of Psychiatry, University College London, London, UK
| | - J. Evans
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Bould H, Sovio U, Koupil I, Dalman C, Micali N, Lewis G, Magnusson C. Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort. Acta Psychiatr Scand 2015; 132:51-9. [PMID: 25572654 DOI: 10.1111/acps.12389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated whether parental eating disorders (ED) predict ED in children, using a large multigeneration register-based sample. METHOD We used a subset of the Stockholm Youth Cohort born 1984-1995 and resident in Stockholm County in 2001-2007 (N = 286,232), The exposure was a diagnosed eating disorder in a parent; the outcome was any eating disorder diagnosis in their offspring, given by a specialist clinician, or inferred from an appointment at a specialist eating disorder clinic. A final study sample of 158,697 (55.4%) had data on these variables and confounding factors and contributed a total of 886,241 person years to the analysis. RESULTS We found good evidence in support of the hypothesis that ED in either parent are independently associated with ED in their female children (HR 1.97 (95% CI: 1.17-3.33), P = 0.01) and that ED in mothers are independently associated with ED in their female children (HR 2.35 (95% CI: 1.39-3.97) P = 0.001). Numbers were too low to permit separate analysis of ED in parents and their male children. CONCLUSION Eating disorders in parents were associated with ED in children. This study adds to our knowledge about the intergenerational transmission of ED, which will help identify high-risk groups and brings about the possibility of targeted prevention.
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Affiliation(s)
- H Bould
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - U Sovio
- Department of Obstetrics & Gynaecology, The Rosie Hospital, Cambridge, UK
| | - I Koupil
- Centre for Health Equity Studies, Stockholm University/Karolinska Institute, Stockholm, Sweden
| | - C Dalman
- Division of Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - N Micali
- Behavioural and Brain Sciences Unit, UCL Institute of Child Health, London, UK
| | - G Lewis
- Mental Health Sciences Unit, Faculty of Brain Sciences, UCL, London, UK
| | - C Magnusson
- Division of Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Bould H, Koupil I, Dalman C, DeStavola B, Lewis G, Magnusson C. Parental mental illness and eating disorders in offspring. Int J Eat Disord 2015; 48:383-91. [PMID: 24965548 DOI: 10.1002/eat.22325] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 05/27/2014] [Accepted: 06/14/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate which parental mental illnesses are associated with eating disorders in their offspring. METHOD We used data from a record-linkage cohort study of 158,679 children aged 12-24 years at the end of follow-up, resident in Stockholm County from 2001 to 2007, to investigate whether different parental mental illnesses are risk factors for eating disorders in their offspring. The outcome measure was diagnosis of any eating disorder, either from an ICD or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic. RESULTS Mental illness in parents is a risk factor for eating disorders in female offspring (Adjusted Hazard Ratio (AHR) 1.57 (95% CI 1.42, 1.92), p < 0.0001). Risk of eating disorders is increased if there is a parental diagnosis of bipolar affective disorder (AHR 2.28 (95% CI 1.39, 3.72), p = 0.004), personality disorder (AHR 1.57 (95% CI 1.01, 2.44), p = 0.043) or anxiety/depression (AHR 1.57 (95% CI 1.32, 1.86), p < 0.0001). There is a lack of statistical evidence for an association with parental schizophrenia (AHR 1.41 (95% CI 0.96, 2.07), p = 0.08), and somatoform disorder (AHR 1.25 (95% CI 0.74, 2.13), p = 0.40). There is no support for a relationship between parental substance misuse and eating disorders in children (AHR 1.08 (95% CI 0.82, 1.43), p = 0.57). DISCUSSION Parental mental illness, specifically parental anxiety, depression, bipolar affective disorder, and personality disorders, are risk factors for eating disorders in their offspring.
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Affiliation(s)
- Helen Bould
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Bould H, DeStavola B, Magnusson C, Micali N, Dal H, Evans J, Dalman C, Lewis G. The influence of school in the development of eating disorders: a record-linkage study. Lancet 2015; 385 Suppl 1:S24. [PMID: 26312846 DOI: 10.1016/s0140-6736(15)60339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical impression is that rates of eating disorders vary between schools; we are not aware of any previous research on this topic. We aimed to investigate whether rates of eating disorders in 16-20-year-old girls vary between upper secondary schools, and to test the hypothesis that school characteristics are associated with rates of eating disorders, even after accounting for characteristics of individual students. METHODS This multilevel longitudinal study made use of record-linkage data from Stockholm County, Sweden. Participants were 55 824 Swedish-born girls completing secondary education in 2001-10 at 409 schools. Outcome was any diagnosed eating disorder at 16-20 years, as defined by an ICD (9 or 10) or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic. Multilevel modelling was used to separate individual and school level effects. The Stockholm Regional Ethical Review Board approved the study. FINDINGS A 4·4% variation in incidence of eating disorders between schools was seen; after taking individual risk factors into account variation between schools was 2·9% (95% CI 1·5-5·0). Schools with a higher proportions of girls than boys had an increased incidence of eating disorders: for each 10% increase in the proportion of girls at a school, the odds ratio for eating disorders was 1·07 (95% CI 1·01-1·13, p=0·017). For each 10% increase in the proportion of parents with post-secondary education, the odds ratio for eating disorders was 1·14 (1·09-1·19, p<0·0001). INTERPRETATION Our findings show that the contextual aspects of a school environment are associated with increased incidence of eating disorders. Incidence rates of eating disorders are higher in schools characterised by a high proportion of female students and of students with highly educated parents. To our knowledge, this is the first study to investigate whether rates of eating disorders vary between schools; however, use of registry data means that individuals who did not seek treatment would not have been studied. FUNDING HB was supported by a Wellcome Trust Institutional Strategic Support Fund (via the Elizabeth Blackwell Institute).
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Affiliation(s)
- Helen Bould
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Bianca DeStavola
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Nadia Micali
- Institute of Child Health, University College London, London, UK
| | - Henrik Dal
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Jonathan Evans
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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Bould H, Araya R, Pearson RM, Stapinski L, Carnegie R, Joinson C. Association between early temperament and depression at 18 years. Depress Anxiety 2014; 31:729-36. [PMID: 25111741 DOI: 10.1002/da.22294] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/13/2014] [Accepted: 06/25/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Early childhood temperament, particularly negative emotionality (high tendency to show distress), may be a risk factor for subsequent depression. METHODS Using data from a large UK cohort (Avon Longitudinal Study of Parents and Children), we examined the association between temperament on the Emotionality Activity Sociability Questionnaire at age 6 and ICD-10 depression at 18. Results were adjusted for a range of confounders. RESULTS Children with high emotionality scores at age 6 had a 20% (7-36%) increase in the odds of being diagnosed with depression at age 18. CONCLUSIONS Depression at 18 years has an early developmental diathesis, which means we may be able to identify children at risk of developing depression in young adulthood.
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Affiliation(s)
- Helen Bould
- Centre for Academic Mental Health, School of Social and Community Medicine, Bristol, UK
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Abstract
OBJECTIVE To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance. DESIGN Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment. SETTING Specialist paediatric CFS/ME service in the South West. PATIENTS Children aged 12-18 years with CFS/ME. MAIN OUTCOME MEASURE Depression was defined as scoring >9 on the HADS depression scale. RESULTS 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36). CONCLUSIONS Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.
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Affiliation(s)
- Helen Bould
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Abstract
OBJECTIVE To determine whether parents understand and adhere to preoperative fasting instructions. AIM To identify how we may reduce perioperative morbidity relating to failure to fast. BACKGROUND Children are routinely fasted preoperatively with the aim of reducing the risk of aspiration of gastric contents and its sequelae. METHODS Parents of children on the day case ward following elective surgery completed a survey asking: (i) For how long was your child asked to fast? (ii) How long did you ensure your child was fasted of food and clear fluids? (iii) What do you think is the purpose of fasting? We also asked the parents to complete a checklist of items they thought acceptable to consume when fasting. RESULTS Despite affirming fasting status in the preoperative check, 13.5% were not fasted. Parents reported advised fasting times of 1-24 h (median 6) for solids and 0.5-24 h (median 3) for fluids. Children were fasted of solids for 3-40 h (median 9.5) and of fluids for 0.5-24 h (median 5). Regarding the understanding of fasting, 9 referred to aspiration and 53 to the prevention of nausea or vomiting. Thirteen believed that fasting status altered the efficacy of anesthesia. During the fasting period, 4.9% would allow French fries, 22.3% toast/crackers, 17.5% cereal, 14.7% a sweet, 14.9% gum, and 12.6% tea with milk. CONCLUSIONS Children we believe to be fasted may not be. Parents may deliberately misrepresent the actual fasting status of their child. Adherence to fasting advice may be affected by parents' recall and understanding of fasting advice.
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Affiliation(s)
- Steve Cantellow
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
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Bould H, Wiles N, Potokar J, Cowen P, Nutt DJ, Peters TJ, Lewis G. Does baseline fatigue influence treatment response to reboxetine or citalopram in depression? An open label randomized controlled trial. J Psychopharmacol 2012; 26:663-9. [PMID: 22223618 DOI: 10.1177/0269881111431753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been suggested that antidepressants that increase noradrenergic transmission should be better than serotonergic antidepressants at treating fatigue in depression. We conducted a secondary analysis of an RCT in which patients with depression were randomly assigned to reboxetine (a noradrenaline reuptake inhibitor [NARI]) or citalopram (a selective serotonin reuptake inhibitor [SSRI]). We investigated the difference between citalopram and reboxetine in treating the symptom of fatigue in depression, and also in treating depression with high levels of baseline fatigue. We found no difference between citalopram and reboxetine in terms of improvement in fatigue at six weeks (0.11, 95% confidence interval (-0.28, 0.49); p = 0.59:), or at 12 weeks. Using the Beck Depression Inventory at 12 weeks as the outcome measure, we found some evidence in support of our hypothesis that reboxetine is more effective than citalopram in treating depression in those with high baseline fatigue (interaction term: -2.87, 95% confidence interval (-5.15, -0.60); p = 0.01). We conclude that there is no evidence of any difference between reboxetine and citalopram in their efficacy in treating fatigue as a symptom of depression, but that reboxetine may be more effective in treating depression with high levels of fatigue. Fatigue might be useful in the prediction of response to NARIs or SSRIs.
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Affiliation(s)
- Helen Bould
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Bould H, Panicker V, Kessler D, Durant C, Lewis G, Dayan C, Evans J. Investigation of thyroid dysfunction is more likely in patients with high psychological morbidity. Fam Pract 2012; 29:163-7. [PMID: 21890841 DOI: 10.1093/fampra/cmr059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mild or subclinical hypothyroidism [raised thyroid-stimulating hormone (TSH) but normal free thyroxine (T4)] affects 5-10% of adults. Symptoms are non-specific and TSH levels are needed for diagnosis. OBJECTIVES We explore the relationship between thyroid function and psychological distress and investigate the usefulness of an expert-designed Thyroid Symptom Questionnaire (TSQ) in identifying hypothyroidism. METHODS DEPTH (DEPression and THyroid) is a cross-sectional study of 325 patients recruited from general practices in Bristol, for whom thyroid function tests were requested by the GP. Subjects completed the TSQ, General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ) and had blood tests for TSH and free T4. RESULTS The mean age was 45.7 years; 252 subjects (78%) were female; median TSH was 1.6. Psychological morbidity in this population is high: 54.2% have a GHQ-12 score >3, indicating psychological distress. We found no relationship between TSH and psychological distress [adjusted odds ratio 1.02 (95% confidence interval 0.91-1.13), P = 0.78]. The prevalence of hypothyroidism was 6.2% (95% confidence interval 3.8-9.5%). We found no evidence of an unadjusted association between TSQ score and subclinical hypothyroidism [adjusted odds ratio of 1.09 (95% confidence interval 0.95-1.24), P = 0.23]. CONCLUSIONS Those referred for thyroid function tests, although no more likely than others to have hypothyroidism, have high rates of psychological distress. When mild (subclinical) hypothyroidism is detected in patients with psychological distress, it is important that GPs are aware that this is likely to be coincidental rather than causal and offer appropriate treatment.
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Affiliation(s)
- H Bould
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Oakfield Grove, Bristol, UK.
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Affiliation(s)
- Helen Bould
- Centre for Child and Adolescent Health, University of Bristol, Cotham Hill, Bristol, UK
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