Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

The Autism Detection in Early Childhood Tool: Level 2 autism spectrum disorder screening in a NICU Follow-up program

ObjectiveChildren born preterm are at increased risk for autism spectrum disorder (ASD). However, early diagnosis of ASD is challenging because conventional screening Level 1 tools are less reliable in this population. We sought to determine whether the Autism Detection in Early Childhood (ADEC) and Child Behavior Checklist (CBCL) could accurately identify children at risk for ASD in a NICU Follow-up setting and thus facilitate referral for formal ASD evaluation.MethodChildren aged 18–36 months were recruited from a NICU Follow-up program. All children received presumptive diagnoses based on DSM-5 criteria and were screened for ASD risk with the ADEC and CBCL. Children scoring in the “at risk” range on either tool were referred for a full diagnostic ASD evaluation.ResultsSixty-nine patients (median birth weight 1140 g; median gestational age 28 weeks) were included with 18 designated “at risk” for ASD. Nine (13 %) scored “at risk” on the ADEC and 12 (17 %) on the CBCL. Thirteen children underwent diagnostic ASD evaluation with 9 receiving a formal diagnosis of ASD. The ADEC demonstrated the best performance (sensitivity 89 %, specificity 98 %). The CBCL was less sensitive (sensitivity 50 %, specificity 90 %). Requiring elevated scores on both the CBCL and ADEC was specific but not sensitive (sensitivity 33 %, specificity 100 %).ConclusionThe ADEC performed well in identifying children at risk for ASD within this high-risk NICU cohort, adding benefit as an autism-specific screening tool over the CBCL alone.     

Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. We analyzed data from the Avon Longitudinal Study of Children and Parents (n?=?3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression (“feeling unhappy”, “feeling lonely”) and anxiety symptoms (“worrying about past”, “worrying about future”). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.

     

Knowledge of and Interest in Genetic Results Among Parkinson Disease Patients and Caregivers

The purpose of the study is to investigate Parkinson disease (PD) patients’ and caregivers’ knowledge of and interest in genetic testing. Gaucher disease (GD) results from recessive mutations in glucocerebrosidase (GBA). Both heterozygote GBA carriers and GD patients are at greater risk for PD. Studies regarding knowledge of and interest in genetic testing have been limited and have not offered genetic results to participants. In this study, 353 PD patients and 180 caregivers were recruited to a PD genetic study. The association between GD, GBA mutations and PD was described to participants who reported their familiarity with genetic terms, answered questions on genetic concepts, and indicated their interest in knowing if they may have GD (two GBA mutations) and other genetic information that could impact their health. Ninety-three-percent of participants were interested in receiving GBA results; however, only 51.6 % of PD participants and 55.6 % of caregivers knew that “scientists have identified genes associated with a higher risk of developing PD.” PD patients may benefit from education and genetic counseling on the implications of genetic testing.     

Personality variable differences between disease clusters

Previous studies of personality and health have focused mainly on the influence of psychological factors on single diseases such as cancer and coronary heart disease (CHD), thereby neglecting the problem of comorbidity (i.e. the combination of different diseases). The main focus of the present study was the discrimination between single‐ and multiple‐disease conditions on the basis of personality traits. An extensive battery of personality scales implicated in health was administered to a sample of n=5133 individuals of both genders between the ages of 40 and 65. Subjects also reported their health or illness status. A factor analysis of the personality scales yielded five dimensions clearly interpretable as “Emotional Lability”, “Type A Behaviour”, “Behavioural Control”, “Locus of Control over Diseases”, and “Psychoticism”. Hierarchical cluster analyses of the subsample of participants who reported suffering from more than one disease led to eight clusters representing individuals with different combinations of diseases. Generally, there were very few significant differences between healthy and single‐disease participants with regard to personality. However, mean factor scores calculated for “Emotional Lability” were higher across the multiple‐disease groups than in the healthy and single‐disease groups. No other personality factor showed this trend. In general the results reported here show the important role negative affectivity (e.g. Emotional Lability, Neuroticism, Depression) plays in differentiating between single and multiple diseases. Copyright © 2003 John Wiley & Sons, Ltd.     

Understanding responses to predictive genetic testing: A grounded theory approach

Abstract

In view of the absence of data concerning the understanding and experience of families in which one or more members have undergone predictive genetic testing, a pilot study using a qualitative methodology was conducted with members of families at risk for the late-onset genetic disease, familial adenomatous polyposis (FAP). Semistructured interviews were conducted to elicit illness representations, with responses tape-recorded and analysed using a grounded theory approach. Several themes emerged. The most striking was that when genetic testing indicated an extremely low risk of developing the disease, there was a desire to continue regular bowel screening, even though it was experienced as extremely aversive. Possible explanations draw upon both other themes of the interviews, and psychological models. The role of “functional pessimism” and “uncertain wellness” in maintaining a high threat from the disease, and the role of reinforcement and the nature of tests in providing bowel screening with a high value are discussed.     

Phenotypic and genotypic heterogeneity in gaucher disease: Implications for genetic counseling

Genetic counseling for Gaucher disease is complicated by the vast degree of clinical heterogeneity encountered in the disorder. Recent advances in our understanding of the molecular genetics of Gaucher disease are particularly relevant to genetic counseling. Although the identification of mutations in the glucocerebrosidase gene has enabled genotypic screening of Gaucher patients, the ability to reliably predict patient outcome on the basis of DNA studies is often limited. An appreciation of both the spectrum of clinical manifestations in Gaucher patients and the limitations of the available genotypic information is necessary when counseling patients, families and at-risk individuals.     

The Utilization and Choices of Aneuploidy Screening in a Midwestern Population

The types, interpretation, and use of first- and second-trimester aneuploidy screening are often unclear for many women. This impairs appropriate decision making and understanding of the implications of prenatal genetic testing options. The purpose of this study was to examine the utilization of Stepwise Sequential screening in our Midwestern population, demographic factors associated with choice of screening and method of risk reporting and it’s potential impact on women’s choices. First trimester screening was performed for 2,634 women during the study period. Results were not reported or “framed” as “positive” or “negative”. Rather, the specific age-risk and screen-risk for T21 were relayed, along with options for follow-up Stepwise Sequential screening and invasive testing. Nearly 80 % of women declined Stepwise Sequential screening. Minorities and women of lower education were least likely to pursue further screening. Less than 4 % of the study population elected invasive testing. First trimester screening was associated with a 53 % reduction in amniocenteses and 20 % fewer CVS’s compared to pre-first trimester screening availability. Reporting age-and screen-risks for T21, rather than classifying results as “positive” or “negative” based on a pre-determined threshold, was associated with a low uptake of further testing.     

Patients’ Opinions on Genetic Counseling on the Increased Risk of Parkinson Disease among Gaucher Disease Carriers

Gaucher disease (GD) is an autosomal recessive disease caused by GBA mutations that is especially common in the Ashkenazi Jewish (AJ) population. The link between GBA mutations and Parkinson disease (PD), a later-onset neurodegenerative condition, is well established, and studies have shown that GBA carriers have an increased lifetime risk of developing PD. Carrier screening for GD is frequently offered to couples during or prior to pregnancy, especially to those of AJ descent. However, no studies have been performed to assess if prospective parents would want to learn about their risk of developing PD incidentally through carrier screening. It is also unknown if pre-test counseling on this topic would affect screening uptake. In order to answer these questions, a survey was administered to individuals who screened negative for GBA mutations. Of the 75 participants, 86.7% believed that patients should be informed about the increased risk of PD prior to having GD carrier screening, and 93.3% responded that this information would not have changed their decision to have carrier screening. These results indicate that healthcare providers should take into consideration patient preferences when determining how to counsel about GD carrier screening. Additionally, these results have implications for genetic counseling about other later-onset conditions that may be incidentally ascertained through carrier screening.     

The effect of organismic disadvantage on allocation behavior in children

Equity theory (Adams, 1965) suggests that when persons are asked to divide a given amount of reward between two other persons, one relatively more disadvantaged than the other at performing a task, they will make allocations that are disproportionate to the two persons' performance levels, giving the disadvantaged person a disproportionately larger share and the advantaged person a disproportionately smaller share of the reward. The theory attributes this effect to the allocator's perception that the disadvantaged individual expended a disproportionately greater amount of effort. A group of third- and fourth-graders and a group of seventh-graders were asked to divide rewards between pairs of children that were described to vary in age (“younger” vs. older) or ability (“unskilled” vs. skilled) or that were the “same” in age and ability and that were described to vary (5 vs. 15, or 0 vs. 20 baskets) or to be equal (10 vs. 10 baskets) in performance on a basketball-shooting task. Unlike the group of third- and fourth-graders, the seventh-graders generally made significantly larger allocations to the disadvantaged individuals (“younger” and “unskilled”) than to the “same” individuals, making the largest allocations under the most discrepant performance condition (0 vs. 20). Overall, the results suggested that the equity principle becomes more salient in children as age increases.     

Huntington Disease: Who Seeks Presymptomatic Genetic Testing,Why and What are the Outcomes?

The aims of this study were to: 1) quantify the characteristics of those seeking presymptomatic testing for HD, 2) identify their motivations for testing, 3) quantify the waiting times between the various steps within the testing process, and 4) quantify the outcomes of testing at a large state-wide genetic testing center in Australia. A review of medical charts for all referrals for presymptomatic testing of Huntington disease received over a 4 year period (2006–2010) was undertaken. A total of 152 cases met the study inclusion criteria; the mean age was 39 years, 46 % were male and 61 % underwent genetic testing. Of the males who were tested there was a non-significant trend towards having an affected mother vs father (62 %, p?=?0.09), whereas females tested were just as likely to have an affected mother or father. The most frequently cited reasons for seeking testing were “family planning”, “plan future”, and “need to know”. Some 11 % deferred testing following the psychological assessment. Of those at 50 % prior risk, 57.5 % tested positive; this was higher than expected and much higher than reported in other studies. The median times from referral to initial appointment, and then to results was 69 days and 144 days respectively. Overall, this review of medical charts shows the depth of information obtainable from routinely collected data and revealed that a high proportion of patients tested positive for HD at this centre.     

Alexithymia and levels of processing: Evidence for an overall deficit in remembering emotion words

Alexithymia is a multifaceted personality construct that is thought to reflect a deficit in the cognitive processing of emotions. The effects of low vs. high Alexithymia, neutral vs. positive vs. negative words processed, and perceptual vs. semantic processing on memory were investigated in a group of 82 students using the levels of processing paradigm and the Remember/Know procedure. No differences were observed between low and high Alexithymia students when neutral material was considered. However, for both levels of processing, high Alexithymia students recalled fewer emotion words (both positive and negative) when “Remember” responses were considered. “Know” responses were comparable across Alexithymia groups. The deficit in the ability to consciously access emotional material (the “Remember” responses) may help explain the impaired regulation of intense emotional states by high Alexithymia individuals.     

The Changing Age of Individuals Seeking Presymptomatic Genetic Testing for Huntington Disease

Huntington disease (HD) is a progressive neurodegenerative disorder. Presymptomatic genetic testing allows at-risk individuals to clarify their risk status. Understanding the characteristics and motivations of individuals seeking HD presymptomatic genetic testing better equips genetic counselors and other healthcare professionals to provide comprehensive and personalized care. The aims of this study were to (1) determine whether the average age when individuals seek presymptomatic HD genetic testing has decreased over time, (2) assess motivations for seeking testing, (3) explore whether there is a relationship between age and motivations, and (4) explore genetic counselors’ perceptions of the shift in age. Data from the US HD testing centers (N?=?4) were analyzed. A small but statistically significant decrease in age of individuals seeking presymptomatic testing was observed (p?=?0.045). HD community members (N?=?77) were surveyed regarding presymptomatic testing motivations. Younger individuals were more likely than older individuals to cite “To learn whether or not you would develop HD” and “To make choices about further education or a career” compared to older individuals (p?<?0.05). Conversely, older individuals more frequently cited “To give children a better idea of their risk” (p?<?0.002). Sixteen percent of genetic counselors surveyed (6/37) perceived a change in age of testing. All of these respondents had provided HD testing for ten or more years and anecdotally believed the age at testing has decreased over time. Study results help providers personalize counseling based on patient’s age and serve as a starting point for more research into the relationship between age at testing and motivations for testing.     

Media experiences and associations with mental health among the bereaved of the MH17‐disaster: A latent profile analysis

Research has shown that the amount of media exposure is associated with post‐event mental health problems. Whether bereaved individuals have negative experiences with media reports and whether they are associated with post‐event mental health is unclear. This study evaluated these experiences and associations following the MH 17‐disaster. How media reports were experienced (nine topics, modified MAS ), depression symptoms (QIDS ‐SR ), functional problems (WSAS ) and event‐related coping‐self‐efficacy (CSE ) were assessed about one year post‐disaster (May‐August 2015) among Dutch bereaved (N  = 152). A substantial minority reported negative experiences such as reports made me angry (30%) and made me sad (48%). Latent profile analysis with symptoms, problems and coping self‐efficacy as indicators, identified four classes of post‐disaster mental health: a Well‐functioning^{(class 1)}, 35.1%; a Mild‐problems^{(class 2)}, 30.4%; a Sub‐clinical^{(class 3)}, 27.0%; and a Clinical^{(class 4)}, 7.4%. Differences in symptoms, problems and coping self‐efficacy levels between classes were large according to Cohen's d s. Multivariate logistic regression (MLR ) showed that the Clinical^{(class 4)} compared to the Well‐functioning^{(class 1)}, more often that felt that reports strongly “embarrassed me,” “made me feel sad,” “filled me with fear” and “served as a magnifying glass.” Future research should assess opportunities and effects of limiting media consumption.     

Personality heterogeneity in adolescents with disruptive behavior disorders

We first confirmed adolescents diagnosed with disruptive behavior disorders (oppositional defiant, conduct disorder; n = 158) had lower constraint and higher negative emotionality, and greater psychiatric comorbidity and psychosocial dysfunction, relative to adolescents without (n = 755), in a population-based sample enriched for externalizing psychopathology (mean age = 17.90 years; 52% female). We then explored whether different personality types, defined by patterns of personality identified via latent profile analysis, were differently associated with clinical features in adolescents with a disruptive behavior disorder diagnosis. Four distinct personality types (“disinhibited,” “high distress,” “low distress,” “positive”) were meaningfully different from one another. Results highlight personality heterogeneity as a means of identifying individuals at greatest risk for the most deleterious forms of externalizing psychopathology.     

Affective reactivity to cry sounds predicts young women’s reactivity and behavior in a simulated caregiving task

Different populations of adults (experienced vs. inexperienced caregivers, men vs. women, abusive vs. nonabusive parents, etc.) have been reported to differ in their affective reactions to the sounds of infant crying. These differences are thought to impact caregiving behavior and, in some instances, to affect long-term outcomes for infants. There can be great intra-group variation, however, even when group differences are significant; modeling developmental process will require a finer grained approach. We have undertaken a pair of studies intended to validate the Negative Affect Scale (NA) from the PANAS as a measure of individuals’ affective reactivity to cry sounds. In Study 1, 306 young women who were not yet mothers listened either to infant crying or to birdsong. The results supported the NA as a measure of reactivity to crying. In Study 2, a new sample of 301 young women listened to crying in a screening task; a group of “high reactors” (n = 21) and a group of “low reactors” (n = 22) then participated in a simulated caregiving situation. Individuals’ affective reactivity to the caregiving simulation mirrored their affective reactivity in the screening task, and rates and overall organization of caregiving behavior differed between the groups. Changes in negative affect, then, appear to be both a result of infant crying and a determinant of some aspects of caregiving behavior. Further studies will extend these laboratory results to real infants and their caregivers, and further validate the NA as a measure of individual differences in reactivity to cry sounds.     

Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study

Objective

Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways.

Method

Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years.

Results

Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%).

Conclusion

This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.     

Examining Trajectories of Early Adolescents’ Life Satisfaction in South Korea Using a Growth Mixture Model

Various aspects of early adolescence can have a key impact on adult life satisfaction. This study applied a growth mixture model to examine the trajectories of early adolescents’ life satisfaction and test the effects of individual (sex, subjective achievement, and self-esteem) and social factors (school adjustment and peer attachment) thereon. For this purpose, a growth mixture model was used on the fifth- (grade five), sixth- (grade six), and seventh- (grade seven) year panel data of 1917 grade one students from the Korean Children and Youth Panel Survey (2010–2016, National Youth Policy Institute), excluding missing samples. Participants were 990 boys (51.6%) and 927 girls (48.4%). The results indicated that the trajectories of life satisfaction could be categorized into three groups: “High Level-decreasing” (57.19%), “Moderate Level-stable” (37.62%), and “Low Level-increasing” (5.19%). Predictors for each class exhibited that female students and individuals with higher levels of self-esteem and school adjustment were more likely to be in the “Low Level-increasing” and “Moderate Level-stable” groups compared to male students and those reporting lower levels of self-esteem and school adjustment. Moreover, students with higher peer attachment were more likely to be in the “Low Level-increasing” group compared to the “High Level-decreasing” group. Educational implications to achieve positive life satisfaction by determining the influence of the predictors for each trajectory are outlined.