Using Passive and Active Data to Predict Post-Traumatic Stress Disorder Symptoms and Cannabis Use in Recently Discharged UK Veterans: A Protocol for the MAVERICK Feasibility Study.

Introduction: Post-traumatic stress disorder (PTSD) and comorbid cannabis use disorder (CUD) is a growing concern amongst UK veterans. Co-occurrence of problematic cannabis use, and PTSD is associated with greater PTSD symptom severity, decreased likelihood of cannabis use cessation, worse clinical outcomes, and increased societal burden. Despite increased screening efforts among veterans, there are no effective strategies for predicting risk for PTSD and problematic drug use escalation before these conditions develop, worsen, or become chronic. Methods: This feasibility study employs a 4-week (28 day) longitudinal design (daily data collection), multiple passive data collection features via a bespoke study smartphone app called MAVERICK, and active data collection via wearable technology to predict clinically meaningful escalations in cannabis use and PTSD symptoms in UK veterans. Questionnaire data will be collected between 06:00 and 10:00 each day. Passive data will be collected continuously in the background. Results: The study will begin recruitment in June 2023 and will require 18 months to complete. Study results are expected to be published in January 2024. Discussion: This trial will provide information on the feasibility and utility of a smartphone app (MAVERICK) to collect both active and passive data to predict PTSD symptoms and cannabis use in a UK veteran population. If the smartphone app is deemed feasible and acceptable to users, it has the potential to provide an effective measurement tool to mitigate risk of PTSD and problematic cannabis use among veterans.

Testing theoretical processes that maintain paediatric social anxiety: A comparison between children and adolescents with social anxiety disorder, other mental disorders, and non-clinical controls.

BACKGROUND: Paediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples. METHODS: 641 children and adolescents aged 6-17 years (Mage = 9.45 yr; 47.6% girls) engaged in a brief, impromptu speech and a social discussion with a confederate. Participants included 307 with SoAD, 285 with other mental disorders, and 49 non-clinical controls. Participants who completed each task self-reported their anticipated probability and cost of negative evaluation, self-focused attention, personal evaluation of social performance, and engagement in post-event rumination (assessed 1 h later). Independent raters also scored their social performance. Relationships between the variables were tested through path analysis. RESULTS: Participants with SoAD were more likely to avoid and reported significantly greater state anxiety than both comparison groups. They also reported higher levels of each of the putative maintaining processes than either comparison group. In contrast, independent observers did not discriminate between groups on their overt social performance. Path analyses demonstrated good fit of a priori models to the data for both social tasks. CONCLUSIONS: Paediatric SoAD is associated with strong expectation of the probability and cost of negative evaluation, excess self-focused attention, and more negative evaluation of one's own social performance. In turn, these putative processes are strong predictors of state anxiety and post-event processing in response to both a speech and social interaction.

The psychometric properties of the Mini Social Phobia Inventory in a treatment seeking sample of children and their caregivers.

The Mini Social Phobia Inventory (Mini-SPIN) is a short 3-item measure of social anxiety disorder (SAD). Using existing data, the current study examined the psychometric properties of the Mini-SPIN using a large, treatment seeking sample of children aged 6-16 years with data available for youth (n = 695, 170) and their caregivers (n = 703, 177) at pre-treatment and follow-up, respectively. The ability of the Mini-SPIN to discriminate between those with and without SAD was examined at pre-treatment and 6-month follow-up, across caregiver and child report. The criterion group validity, internal consistency and construct validity of the measure was also examined. Results revealed that at pre-treatment the Mini-SPIN demonstrated good discriminant validity in detecting cases of SAD from non-SAD (with cut-off of 4 on child report, and 6 on caregiver report). At 6-month follow-up, the discriminant ability of the Mini-SPIN was found to be less than acceptable for child reported scores, but acceptable for caregiver reported scores. The Mini-SPIN further demonstrated good criterion group validity, internal consistency and construct validity across caregiver and child report. Overall, the findings from the current study lend further support for the use of the Mini-SPIN as a screening tool for SAD.

Shorter communications: Exploring the impact of a brief smartphone-based alcohol intervention app (DrinksRation) on the quality of life of UK military veterans.

Alcohol misuse - defined as consuming more than 14 units of alcohol per week - is a well-established problem among veterans. This study investigated the change in quality of life among help-seeking UK veterans who completed a 28-day brief alcohol intervention delivered via a digital smartphone application (called DrinksRation) and have previously sought clinical help for a mental health disorder. This study was a secondary outcome analysis of data collected during a randomised control trial. In total, 123 UK veterans participated in the study and were randomly allocated to either the intervention or control arm. Participants completed self-report questionnaires regarding their alcohol use and quality of life (WHOQOL-BREF) at baseline, day 28 (end of intervention), day 84, and day 168. At the primary endpoint (day 84), we found significantly greater improvements in the intervention arm compared to the control arm for psychological quality of life (Cohen's d = 0.47), and environmental quality of life (d = 0.34). However, we observed no statistically significant differences between the intervention and control arm for social relationships and physical quality of life. Further, for day 168 we found no significant differences. Findings suggest that DrinksRation can increase quality of life among help-seeking veterans who have previously sought help for a mental health disorder, but the increases were modest and restricted to certain domains. Additional treatment may be needed for long-term and sustained improvements in quality of life.

A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID).

OBJECTIVE: This scoping review identifies and describes psychological interventions for avoidant restrictive food intake disorder (ARFID) and summarizes how outcomes are measured across such interventions. METHOD: Five databases (Cochrane, Embase, Medline, PsycInfo, Web of Science) were searched up to December 22, 2022. Studies were included if they reported on psychological interventions for ARFID. Studies were excluded if participants did not have an ARFID diagnosis and if psychological interventions were not delivered or detailed. RESULTS: Fifty studies met inclusion criteria; almost half were single-case study designs (23 studies) and most studies reported on psychological interventions for children and adolescents with ARFID (42 studies). Behavioral interventions (16 studies), cognitive-behavioral therapy (10 studies), and family therapy (5 studies), or combinations of these therapeutic approaches (19 studies) were delivered to support patients with ARFID. Many studies lacked validated measures, with outcomes most commonly assessed via physical health metrics such as weight. DISCUSSION: This review provides a comprehensive summary of psychological interventions for ARFID since its introduction to the DSM-5. Across a range of psychological interventions and modalities for ARFID, there were common treatment components such as food exposure, psychoeducation, anxiety management, and family involvement. Currently, studies reporting on psychological interventions for ARFID are characterized by small samples and high levels of heterogeneity, including in how outcomes are measured. Based on reviewed studies, we outline suggestions for clinical practice and future research. PUBLIC SIGNIFICANCE: Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance or restriction of food due to fear, sensory sensitivities, and/or a lack of interest in food. We reviewed the literature on psychological interventions for ARFID and the outcomes used to measure change. Several psychological interventions have been developed and applied to patients with ARFID. Outcome measurement varies widely and requires further development and greater consensus.

OBJETIVO: Esta revisión de alcance identifica y describe las intervenciones psicológicas para el Trastorno de Evitación y Restricción de la Ingesta de Alimentos (TERIA) y resume cómo se miden los resultados en dichas intervenciones. MÉTODO: Se hicieron búsquedas en cinco bases de datos (Cochrane, Embase, Medline, PsycInfo, Web of Science) hasta el 22 de diciembre de 2022. Se incluyeron los estudios que informaban sobre intervenciones psicológicas para TERIA. Se excluyeron los estudios si los participantes no tenían un diagnóstico de TERIA y si las intervenciones psicológicas no se administraban o detallaban. RESULTADOS: Cincuenta estudios cumplieron los criterios de inclusión; casi la mitad fueron diseños de estudio de caso único (23 estudios) y la mayoría de los estudios informaron sobre intervenciones psicológicas para niños y adolescentes que padecen TERIA (42 estudios). Se administraron intervenciones conductuales (16 estudios), terapia cognitivo-conductual (10 estudios) y terapia familiar (5 estudios), o combinaciones de estos enfoques terapéuticos (19 estudios) para apoyar a los pacientes con TERIA. Muchos estudios carecían de medidas validadas, y los resultados se evaluaron con mayor frecuencia mediante parámetros de salud física como el peso. DISCUSIÓN: Esta revisión proporciona un resumen exhaustivo de las intervenciones psicológicas para el TERIA desde su introducción en el DSM-5. A través de una gama de intervenciones y modalidades psicológicas para el TERIA, hubo componentes de tratamiento comunes como la exposición a los alimentos, la psicoeducación, el manejo de la ansiedad y la participación de la familia. Actualmente, los estudios que informan sobre las intervenciones psicológicas para el TERIA están dominados por muestras pequeñas y altos niveles de heterogeneidad, incluso en la forma en que se miden los resultados. Sobre la base de los estudios revisados, se esbozan sugerencias para la práctica clínica y la investigación futura.

The Association Between Adverse Childhood Experiences (ACEs), Bullying Victimization, and Internalizing and Externalizing Problems Among Early Adolescents: Examining Cumulative and Interactive Associations.

Both adverse childhood experiences (ACEs) and bullying victimization are linked with mental health problems in adolescents. However, little is known about the overlap between the two factors and how this impacts adolescent mental health problems (i.e., internalizing and externalizing problems). The current study analyzed data from 8,085 participants (47.7% female; 44.1% racial/ethnic minority) in the Adolescent Brain Cognitive Development (ABCD) study, baseline (2016-2018, ages 9-10 years) to Year 2. Regression analyses were used to estimate associations between ACEs, bullying victimization and mental health problems, respectively, adjusting for sex, race/ethnicity, country of birth, household income, parental education, and study site. The findings showed that both ACEs and bullying victimization were independently associated with higher internalizing and higher externalizing problems. However, no significant interaction was found between ACEs and bullying victimization. Overall, the results align with the cumulative risk model of adversity, linking cumulative ACEs and bullying victimization to internalizing and externalizing problems in early adolescents.

Gender differences in structural and attitudinal barriers to mental healthcare in UK Armed Forces personnel and veterans with self-reported mental health problems.

PURPOSE: Structural and attitudinal barriers often hinder treatment-seeking for mental health problems among members of the Armed Forces. However, little is known about potential gender differences in structural and attitudinal barriers among members of the UK Armed Forces. The current study aimed to explore how men and women differ in terms of these barriers to care among a sample of UK Armed Forces personnel and veterans with self-reported mental health problems. METHODS: Currently serving and ex-serving members of the UK Armed Forces who self-reported a mental health problem were invited to participate in a semi-structured phone interview on mental health and treatment-seeking. The final sample included 1448 participants (1229 men and 219 women). All participants reported on their current mental health, public stigma, self-stigma, and barriers to mental healthcare. RESULTS: Overall, men and women reported similar levels of both structural and attitudinal barriers, with no significant differences detected. The highest scores for both men and women were observed in attitudinal barriers relating to self-stigma domains, which encapsulate internalised attitudes and beliefs about mental illness and treatment. CONCLUSIONS: Findings suggest that anti-stigma campaigns can be targeted simultaneously at both men and women within the Armed Forces. In particular, targeting self-stigma may be beneficial for health promotion campaigns.

Cyberbullying and eating disorder symptoms in US early adolescents.

OBJECTIVE: The objective of this study was to determine the association between cyberbullying and eating disorder symptoms in a national sample of 10-14-year-old early adolescents. METHOD: We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2, 2018-2020, N = 10,258/11,875, 49% female, 46% non-White). Data were collected using multi-stage probability sampling. Modified Poisson regression analyses examined the association between cyberbullying and self-reported eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5). RESULTS: Cyberbullying victimization was associated with worry about weight gain (prevalence ratio [PR] 2.41, 95% confidence interval [CI] 1.48-3.91), self-worth tied to weight (PR 2.08, 95% CI 1.33-3.26), inappropriate compensatory behavior to prevent weight gain (PR 1.95, 95% CI 1.57-2.42), binge eating (PR 1.95, 95% CI 1.59-2.39), and distress with binge eating (PR 2.64, 95% CI 1.94-3.59), in models adjusting for potential confounders. Cyberbullying perpetration was associated with worry about weight gain (PR 3.52, 95% CI 1.19-10.37), self-worth tied to weight (PR 5.59, 95% CI 2.56-12.20), binge eating (PR 2.36, 95% CI 1.44-3.87), and distress with binge eating (PR 2.84, 95% CI 1.47-5.49). DISCUSSION: Cyberbullying victimization and perpetration in early adolescence are associated with eating disorder symptoms. Clinicians may consider assessing for cyberbullying and eating disorder symptoms in early adolescence and provide anticipatory guidance. PUBLIC SIGNIFICANCE STATEMENT: Eating disorders often onset in adolescence and have among the highest mortality rates of any psychiatric disorder. In addition, cyberbullying has increased in prevalence among adolescents and significantly impacts mental health. In a national study of early adolescents, we found that cyberbullying victimization and perpetration are associated with eating disorder symptoms. Screening for and providing anticipatory guidance on cyberbullying and eating disorder symptoms in early adolescents may be warranted.

Association of cyberbullying victimization and substance initiation: The Adolescent Brain Cognitive Development (ABCD) study.

BACKGROUND: Evidence shows that cyberbullying is an important risk factor for various adverse mental health outcomes, such as substance use. However, there is limited evidence from longitudinal studies that assessed whether cyberbullying victimization is associated with substance use initiation, especially among adolescent population. METHODS: Using data from the Adolescent Brain Cognitive Development Study, we assessed the association between cyberbullying victimization and substance use initiation among adolescents. In the cross-sectional analysis at year 2, multivariable logistic regressions were used to assess the association between cyberbullying victimization history and substance use initiation. Additionally, the association between year 2 cyberbullying victimization in the past 12 months/lifetime and year 3 substance use initiation was assessed using multivariable logistic regression. RESULTS: Adjusting for sociodemographic characteristics and the presence of depression/anxiety symptoms, lifetime history of cyberbullying victimization was significantly associated with substance use initiation (OR= 2.17, 95% CI: 1.68, 2.81). Recent cyberbullying victimization in the past 12 months was associated with two-times higher odds of initiating substances (OR= 2.31, 95% CI: 1.71, 3.12). In addition, both lifetime history of cyberbullying victimization and recent cyberbullying victimization at year 2 were associated with two times increased risk in substance use initiation at year 3 (OR = 2.22, 95% CI: 1.68, 2.93; OR = 2.34, 95% CI: 1.68, 3.26). CONCLUSION: There is a significant relationship between cyberbullying victimization and substance use initiation among adolescents. Cyberbullying victims are at an increased risk of initiating substance use later in life.

The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population.

BACKGROUND: Little is known about the prevalence and impairment associated with possible Avoidant/restrictive food intake disorder (ARFID) in community adolescent populations. We aimed to investigate the prevalence, health-related quality of life (HRQoL), and psychological distress associated with possible ARFID in a sample of adolescents from the general population in New South Wales, Australia. METHODS: A representative sample of 5072 secondary school students aged between 11 and 19 years completed the online EveryBODY survey in 2017. The survey included demographic data, eating behaviours, psychological distress and both physical and psychosocial health-related quality of life. RESULTS: The prevalence of possible ARFID was 1.98% (95% CI 1.63-2.41) and did not differ significantly across school years 7-12. The weight status of participants with possible ARFID did not differ significantly from those without possible ARFID. When measuring gender identity, the ratio of males to females with possible ARFID was 1:1.7. This was statistically significant, however, the effect size was very small. Psychological distress and HRQoL did not differ significantly between the possible ARFID and non-ARFID group. CONCLUSIONS: The prevalence of possible ARFID was found to be similar to that of anorexia nervosa and binge eating disorder in the general adolescent population. Adolescents who identify as girls rather than boys may be more likely to develop ARFID, replication with new samples is required to confirm these findings. The impact of ARFID on HRQoL may be minimal in adolescence and become more significant in adulthood, further research using longitudinal design, healthy control groups and/or diagnostic interviews is required.

Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community.

OBJECTIVE: To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders. METHODS: N = 963 Australian adolescents (11-19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12-month risk of (1) onset, and (2) persistence of a DSM-5 eating disorder. RESULTS: Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence-based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC = .75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence-based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC = .65). The most important factors were psychological distress and self-induced vomiting for weight control. DISCUSSION: We found preliminary evidence for the utility of a parsimonious model for 12-month onset of an eating disorder among adolescents in the community. Future research should include additional evidence-based risk factors and validate models beyond the original sample. PUBLIC SIGNIFICANCE: This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in diverse samples, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention.

Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review.

Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce.Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD.Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted.Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD.Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation.HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD).There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans.Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.

Primary Care Consultations Among UK Police Officers and Staff: Links With Adverse Mental Health and Job Strain.

OBJECTIVE: The current study examined links between adverse mental health, job strain, and likelihood and frequency of primary care consultations among police employees. METHODS: We conducted secondary data analysis on the Airwave Health Monitoring Study data ( n = 33,730). Measures included self-report data on mental health, job strain, job support, and primary care consultations in the past 12 months. Data were analyzed using a zero-inflated Poisson regression framework. RESULTS: Findings showed that overall, help seeking was low based on mental health status and job strain. Adverse mental health was associated with more primary care consultations. Police employees with high, active, or passive job strain reported more primary care consultation compared with police employees with low strain. CONCLUSIONS: Findings suggest that more work to reduce stigma of taking the initial step of help seeking would be beneficial.

Examination of bidirectional relationships between fear of negative evaluation and weight/shape concerns over 3 years: A longitudinal cohort study of Australian adolescents.

OBJECTIVE: Adolescents commonly experience both fear of negative evaluation and weight/shape concerns. However, evidence concerning the prospective associations between these constructs during adolescence is limited. The current study examined the bidirectional relationships between fear of negative evaluation and weight/shape concerns over a 3-year period in adolescents. METHOD: Australian high school students (n = 2073; 55% girls) completed self-report measures at three timepoints, each 1 year apart. RESULTS: Findings showed a bidirectional relationship, whereby increases in fear of negative evaluation predicted exacerbated weight/shape concerns, and vice versa. Results point towards a vicious maintenance cycle between fear of negative evaluation and weight/shape concerns. DISCUSSION: Findings from the current study highlight the importance of considering both fear of negative evaluation and weight/shape concerns in the development of health promotion and prevention programs designed to reduce the occurrence and adverse effects of body dissatisfaction or improve general mental health. PUBLIC SIGNIFICANCE: Many adolescents experience some level of fear of negative evaluation (i.e., worry about being judged by others) and worry about their weight and/or shape. This study examined the prospective relationship between both constructs. Findings showed a bidirectional relationship, whereby higher fear of negative evaluation predicted increased weight/shape concerns, and vice versa. Programs designed to reduce body dissatisfaction might be improved by targeting both fear of negative evaluation and weight/shape concerns.

Adverse childhood experiences and early adolescent cyberbullying in the United States.

INTRODUCTION: With the increasing use of social media and online platforms among adolescents, the relationship between traumatic life events and cyberbullying remains unclear. This study aimed to determine the associations between adverse childhood experiences (ACEs) and cyberbullying victimization among a racially/ethnically and socioeconomically diverse sample of early adolescents. METHODS: We analyzed longitudinal data from 10,317 participants in the Adolescent Brain Cognitive Development (ABCD) study, baseline (2016-2018, ages 9-10 years) to Year 2. Logistic regression analyses were used to estimate associations between ACEs and cyberbullying victimization, adjusting for sex, race/ethnicity, country of birth, household income, parental education, and study site. RESULTS: In the sample (48.7% female, 46.0% racial/ethnic minority), 81.3% of early adolescents reported at least one ACE, and 9.6% reported cyberbullying victimization. In general, there was a dose-response relationship between the number of ACEs and cyberbullying victimization, as two (adjusted odds ratio [AOR]: 1.45, 95% confidence interval [CI]: 1.13-1.85), three (AOR: 2.08, 95% CI: 1.57-2.74), and four or more (AOR: 2.37, 95% CI: 1.61-3.49) ACEs were associated with cyberbullying victimization in adjusted models. In models examining the specific type of ACE, sexual abuse (AOR: 2.27, 95% CI: 1.26-4.11), physical neglect (AOR: 1.61, 95% CI: 1.24-2.09), and household mental health problems (AOR: 1.39, 95% CI: 1.18-1.65) had the strongest associations with cyberbullying victimization. CONCLUSION: Adolescents who have experienced ACEs are at greater risk for experiencing cyberbullying. Interventions to prevent cyberbullying could use a trauma-informed framework, including inter-peer interventions to break this cycle of trauma.

Associations among relationship status, gender, and sexual attraction in Australian adolescents' eating pathology.

OBJECTIVE: Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology. METHODS: Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, Mage  = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey. RESULTS: Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant. CONCLUSIONS: Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association. PUBLIC SIGNIFICANCE: The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology.

Difficulties with emotion regulation and weight/shape concerns as predictors of eating disorder behaviors among adolescents.

BACKGROUND: Difficulties with emotion regulation are a proposed key transdiagnostic factor of mental health difficulties, including eating disorders. However, it remains unclear whether difficulties with emotion regulation prospectively predict engagement in eating disorder behaviors. The current study examined whether difficulties with emotion regulation were associated with eating disorder behaviors after 1 year, in addition to weight and shape concerns. METHOD: A community sample of high school students (n = 3,074; 53.2% girls) completed self-report measures of eating behaviors, weight/shape concerns, and difficulties with emotion regulation at two timepoints, 1 year apart. RESULTS: Findings indicated that greater difficulties with emotion regulation were uniquely associated with engaging in binge eating, fasting, and purging after 1 year. However, only greater weight and shape concerns, not difficulties with emotion regulation, were uniquely associated with engaging in driven exercise. Limited associations were detected for the frequency of eating disorder behaviors. Additionally, exploratory analyses were conducted to examine potential onset and persistence of eating disorder behaviors. Few gender differences were observed across analyses, with the exception of driven exercise, which was linked to difficulties with emotion regulation only among adolescent boys, but not girls. CONCLUSIONS: Findings suggest that difficulties with emotion regulation are a distinct factor in the occurrence of some eating disorder behaviors among adolescents. Exploratory findings further suggest that difficulties with emotion regulation appear to be particularly involved in the persistence of these behaviors in adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparison of Transdiagnostic Treatment and Specialized Social Anxiety Treatment for Children and Adolescents With Social Anxiety Disorder: A Randomized Controlled Trial.

OBJECTIVE: Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic cognitive-behavioral therapy (CBT) treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes. METHOD: A total of 200 children and adolescents (mean age = 9.5 years, SD = 2.2 years; 47% boys) diagnosed with social anxiety disorder as either their principal or additional disorder were randomly allocated to either the generic or the modified treatment. Both treatments were based on a manualized, empirically validated program (Cool Kids) and comprised 10 sessions over 12 weeks. Assessments comprised structured diagnostic interview and parent and youth reports, and covered diagnoses, symptoms, life impairment, and assessment of maintaining processes at posttreatment and 6-month follow-up. RESULTS: The treatments did not differ significantly on the primary outcome (remission of social anxiety disorder) at either posttreatment (remission in generic = 41%; modified = 44%) or follow-up (remission in generic = 51%; modified = 69%), although the latter approached significance (p = .08). They also did not differ at either time point on most secondary measures of outcome. The only maintaining process that changed more under modified treatment was attention to the current task. CONCLUSION: Despite some positive hints in the data, there was little evidence that the modified intervention significantly improved treatment of pediatric social anxiety disorder, despite incorporating strategies to address putative maintaining mechanisms. The similar improvement between treatments on most maintaining processes suggests that new and innovative strategies may be needed to better target these processes. CLINICAL TRIAL REGISTRATION INFORMATION: Efficacy of Cognitive Behavioural Treatment for Socially Anxious Youth; https://www.anzctr.org.au/; 12616001065482.

Social Epidemiology of Early Adolescent Cyberbullying in the United States.

OBJECTIVE: To determine the prevalence and sociodemographic correlates of cyberbullying victimization and perpetration among a racially, ethnically and socioeconomically diverse population-based sample of 11-12-year-old early adolescents. METHODS: We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2; N = 9429). Multiple logistic regression analyses were used to estimate associations between sociodemographic factors (sex, race/ethnicity, sexual orientation, country of birth, household income, parental education) and adolescent-reported cyberbullying victimization and perpetration. RESULTS: In the overall sample, lifetime prevalence of cyberbullying victimization was 9.6%, with 65.8% occurring in the past 12 months, while lifetime prevalence of cyberbullying perpetration was 1.1%, with 59.8% occurring in the past 12 months. Boys reported higher odds of cyberbullying perpetration (AOR 1.71, 95% CI 1.01-2.92) but lower odds of cyberbullying victimization (AOR 0.80, 95% CI 0.68-0.94) than girls. Sexual minorities reported 2.83 higher odds of cyberbullying victimization (95% CI 1.69-4.75) than nonsexual minorities. Lower household income was associated with 1.64 (95% CI 1.34-2.00) higher odds of cyberbullying victimization than higher household income, however household income was not associated with cyberbullying perpetration. Total screen time, particularly on the internet and social media, was associated with both cyberbullying victimization and perpetration. CONCLUSIONS: Nearly one in 10 early adolescents reported cyberbullying victimization. Pediatricians, parents, teachers, and online platforms can provide education to support victims and prevent perpetration for early adolescents at the highest risk of cyberbullying.