Appearance satisfaction mediates the relationship between recreational screen time and depressive symptoms in adolescents.

BACKGROUND: Research suggests there is an association between high levels of recreational screen time and depression among adolescents; however, mechanisms driving this association remain unknown. The present study examined appearance and weight satisfaction and disordered eating behaviors as mediators in the relationship between recreational screen time and depressive symptoms in adolescents. METHOD: Longitudinal data on screen time, depressive symptoms, disordered eating behaviors, and appearance and weight satisfaction from 304 adolescents (194 females, Mage = 13.40) were analyzed through a moment structure model. RESULTS: Results revealed appearance dissatisfaction mediated the direct effect of recreational screen time on depressive symptoms (Estimate = 0.48, SE = .18, 95% CI [0.12, 0.84]), and that recreational screen time was significantly related to lower appearance satisfaction (Estimate = -0.06, SE = .02, 95% CI [-0.10, -0.01]), which was significantly predictive of more severe depressive symptoms (Estimate = -1.49, SE = .62, 95% CI [-2.71, -0.28]). CONCLUSIONS: These findings suggest that modulating screen time may be an efficacious strategy to reduce appearance dissatisfaction and depressive symptoms during adolescence.

Coping in adolescents: A mediator between stress and disordered eating.

BACKGROUND: Adolescence is a developmental period that can place individuals at heightened risk of engaging in disordered eating patterns. Stress and coping have been included as etiological factors of eating pathology, yet the mechanism of this relationship in adolescent males and females remains understudied. AIMS: This study investigated the role of coping as a mediator in the stress-disordered eating relationship in a sample of adolescents. DEMOGRAPHICS/SETTINGS: Participants included 2262 grade 7-12 students from a larger cross-sectional study entitled, Research on Eating and Adolescent Lifestyles (REAL). METHODOLOGY/ANALYSES: Participants completed measures of perceived stress, life stressors, coping style, and disordered eating. Multiple mediator models of coping were analyzed to examine the extent to which coping mediated the stress-disordered eating relationship, for males and females separately. FINDINGS: Emotion-oriented coping was a significant partial mediator in the relationship between stress (perceived stress, life stressors) and disordered eating in male and female adolescents. Findings suggest adolescents experiencing high stress tend to engage in emotion-oriented coping, which may lead to greater levels of disordered eating. IMPLICATIONS: Interventions targeting effective coping strategies for dealing with different stress types may prevent youth from disordered eating, thus reducing their risk of eating disorders during a vulnerable period in development.

Examining Shared Pathways for Eating Disorders and Obesity in a Community Sample of Adolescents: The REAL Study.

Several psychosocial models have been proposed to explain the etiology of eating disorders (EDs) and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors (socio-environmental, psychological, and behavioral) expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth (60% female, 14.00 ± 1.61) from 41 schools in the Ottawa region, Canada. Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts.

Development of the Ottawa Disordered Eating Screen for Youth: The ODES-Y.

OBJECTIVE: To develop a concise screening tool that allows for early identification of disordered eating in youth. STUDY DESIGN: In this 2-step classification accuracy study, questions for the Ottawa Disordered Eating Screen-Youth, a 2-question screening tool (index test), were conceptualized by clinician-scientists from tertiary care pediatric eating disorder and weight-related clinics, and was validated using retrospective data (2004-2010) from a community-based study, the Research on Eating and Adolescent Lifestyles (REAL) study. RESULTS: Analyses of contrast between the index test and the reference standard using data from 2892 (1714 females) students between grade 7 and grade 12 revealed classification statistics of 67.1% for sensitivity, 85.9% for specificity, 4.7 for positive likelihood ratio, 0.38 for negative likelihood ratio, 50.6% for positive predictive value, and 92.4% for negative predictive value for females and 61.1% for sensitivity, 93.9% for specificity, and 9.9 for positive likelihood ratio, 0.41 for negative likelihood ratio, 32.3% for positive predictive value, and 98.0% for negative predictive value for males. CONCLUSIONS: Our findings suggest that the index test has utility as a short and accurate screening tool for earlier detection of disordered eating thoughts and behaviors in youth. Additional research is needed to best determine how the index test can be administered to youth across various health care, school, public health, and surveillance settings in clinically sensitive pragmatic ways.

Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence.

More physical activity (PA) and less screen time (ST) are positively associated with mental health in adolescents; however, research is limited by short-term designs and the exclusion of ST when examining PA. We examined: (a) changes in PA, ST, symptoms of depression, and symptoms of anxiety over four assessments spanning 11years, and (b) bidirectional relationships between initial PA, ST, and symptoms of depression and anxiety as predictors of change in each other during adolescence. Between 2006 and 2010, participants from Ottawa Canada (Time1; N=1160, Mean age=13.54years) completed questionnaires at four points covering the ages from 10 to 21years. Latent growth modeling was used. PA decreased over time whereas ST and symptoms of depression and anxiety increased over time. Controlling for sex, ethnicity, school location, zBMI, birth year, and parents' education, initially higher anxiety was associated with initially higher ST (covariance=.88, p<.05) and initially lower PA (covariance=-6.84, p=.07) independent of initial symptoms of depression. Higher initial depression was associated with higher initial ST (covariance=2.55, p<.05). Increases in anxiety were associated with increases in ST (covariance=.07, p=.06) and increases in depression (covariance=.41, p<.05). Examining bidirectional relationships, higher initial symptoms of depression predicted greater decreases in PA (b=-.28, p<.05). No other significant findings between initial PA, ST, anxiety, or depression were found as predictors of change in each other. Interventions targeting depression around age 13 may be useful to prevent further declines in PA. Similarly, interventions to reduce ST may be beneficial for concurrent reductions in symptoms of depression and anxiety, irrespective of PA.

Treatment of Maternal Depression in a Medication Clinical Trial and Its Effect on Children.

(Reprinted from the American Journal of Psychiatry 2015; 172:450-459, with permission from American Psychiatric Association Publishing).

Adapted Dialectical Behavior Therapy for Adolescents with Self-injurious Thoughts and Behaviors.

The purpose of this study was to explore clinical changes observed in suicidal adolescents treated with an adapted form of Dialectical Behavior Therapy for adolescents (A-DBT-A) in a tertiary care setting. We conducted an open-label naturalistic study including 61 adolescents with self-injurious thoughts and behaviors and associated features of borderline personality disorder, who underwent a 15-week course of A-DBT-A. Pre- and post-treatment measures were administered, the primary outcome being the total score on the Suicidal Ideas Questionnaire. Self-harm, symptoms of borderline personality disorder, resiliency measures, predictors of response, and predictors of attrition were also explored. Among participants who completed post-treatment measures, we found a significant reduction in suicidal ideation (n = 31, p < 0.001). Secondary outcomes also suggested improvement. Baseline substance use predicted attrition (HR 2.51; 95% CI 1.03-6.14; p < 0.05), as did baseline impulsivity score on the Life Problems Inventory (HR 1.03; 95% CI 1.004-1.06; p < 0.05). Overall, we observed clinical improvements in adolescents receiving A-DBT-A.

Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community.

OBJECTIVE: To estimate jointly the point prevalence of weight and eating disorders in a community sample of adolescents; to investigate psychosocial correlates of thinness, overweight, and obesity, and of full- and subthreshold eating disorders (EDs); and to examine the relationships between weight status and prevalence of EDs. METHOD: A total of 3,043 Canadian adolescents (1,254 males and 1,789 females; mean age = 14.19 years, SD = 1.61 years) completed self-report questionnaires, including the Eating Disorder Diagnostic Scale, and measures of psychosocial functioning. Objective weight and height were collected, and weight status was defined according to the International Obesity Task Force body mass index growth curve centiles. RESULTS: In all, 29.5% (95% CI = 26.7, 32.5) of males and 22.8% (95% CI = 20.5, 25.2) of females were overweight or obese. A total of 2.2% (95% CI = 1.5, 3.2) of males and 4.5% (95% CI = 4.4, 4.5) of females met DSM-5 criteria for an ED; in addition, 1.1% (95% CI = 0.7, 1.9) of males and 5.1% (95% CI = 4.0, 6.5) of females were identified with a subthreshold ED. Both full- and subthreshold EDs were significantly associated with markedly impaired psychosocial functioning. There was a significant relationship between prevalence of EDs and weight status, with an increased risk for a bulimic disorder in obese relative to normal-weight males (odds ratio [OR] = 7.86) and females (OR = 3.27). CONCLUSION: This study provides estimates for the prevalence of DSM-5 EDs in adolescents, further support for their impact on mental health, and new evidence for an association between bulimic disorders and obesity. Results call for an integrated approach in research and prevention regarding the whole spectrum of eating- and weight-related disorders.

Use of Electroconvulsive Therapy in Adolescents With Treatment-Resistant Depressive Disorders: A Case Series.

OBJECTIVES: This study presents a comprehensive case series of adolescents who received electroconvulsive therapy (ECT) for treatment-resistant depression. METHODS: Conducting a chart review, we identified 13 adolescents who had ECT for treatment of depression over a 5-year interval (2008-2013) at a Canadian tertiary care psychiatric hospital. Details about participants' clinical profile, index course of ECT, outcome, side effects, and comorbidities were extracted and analyzed. RESULTS: Thirteen adolescents aged 15 to 18 years, received a mean of 14 (SD, 4.5) ECT sessions per patient. Based on the Beck Depression Inventory-II at baseline and after treatment with ECT, a reliable improvement was observed in 10 patients, with 3 achieving full recovery. Through mixed effects linear modeling, we found a decrease of 0.96 points (95% CI, -1.31 to -0.67, P < 0.001) on the Beck Depression Inventory-II total score for every ECT treatment received. The Montreal Cognitive Assessment was used for monitoring of cognitive function throughout the treatment. Adverse effects included transient subjective cognitive impairment (n = 11), headache (n = 10), muscular pain (n = 9), prolonged seizure (n = 3), and nausea and/or vomiting (n = 3). CONCLUSIONS: A clinically significant improvement was observed for 10 (77%) adolescents receiving ECT for treatment-resistant depression. These observations suggest that ECT is a potential treatment option for refractory depression in selected adolescents. More data are needed to draw conclusions about efficacy and possible predictors of treatment response.

Screen time is associated with depression and anxiety in Canadian youth.

OBJECTIVE: This study examined the relationships between screen time and symptoms of depression and anxiety in a large community sample of Canadian youth. METHOD: Participants were 2482 English-speaking grade 7 to 12 students. Cross-sectional data collected between 2006 and 2010 as part of the Research on Eating and Adolescent Lifestyles (REAL) study were used. Mental health status was assessed using the Children's Depression Inventory and the Multidimensional Anxiety Scale for Children-10. Screen time (hours/day of TV, video games, and computer) was assessed using the Leisure-Time Sedentary Activities questionnaire. RESULTS: Linear multiple regressions indicated that after controlling for age, sex, ethnicity, parental education, geographic area, physical activity, and BMI, duration of screen time was associated with severity of depression (ß=0.23, p<0.001) and anxiety (ß=0.07, p<0.01). Video game playing (ß=0.13, p<.001) and computer use (ß=0.17, p<0.001) but not TV viewing were associated with more severe depressive symptoms. Video game playing (ß=0.11, p<0.001) was associated with severity of anxiety. CONCLUSION: Screen time may represent a risk factor or marker of anxiety and depression in adolescents. Future research is needed to determine if reducing screen time aids the prevention and treatment of these psychiatric disorders in youth.

Treatment of maternal depression in a medication clinical trial and its effect on children.

OBJECTIVE: Observational studies show that when a depressed mother's symptoms remit, her children's psychiatric symptoms decrease. Using randomized treatment assignment, the authors sought to determine the differential effects of a depressed mother's treatment on her child. METHOD: The study was a randomized double-blind 12-week trial of escitalopram, bupropion, or the combination of the two in depressed mothers (N=76), with independent assessment of their children (N=135; ages 7-17 years). RESULTS: There were no significant treatment differences in mothers' depressive symptoms or remission. Children's depressive symptoms and functioning improved significantly among those whose mothers were in the escitalopram group (compared with those whose mothers were in the bupropion and combination treatment groups). Only in the escitalopram group was significant improvement of mother's depression associated with improvement in the child's symptoms. Exploratory analyses suggested that this may be due to changes in parental functioning: Mothers in the escitalopram group reported significantly greater improvement, compared with the other groups, in their ability to listen and talk to their children, who as a group reported that their mothers were more caring over the 12 weeks. Maternal baseline negative affectivity appeared to moderate the effect of maternal treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved in all treatment groups. Children of mothers with high negative affectivity improved significantly only for those whose mothers were in the escitalopram group. CONCLUSIONS: The effects of the depressed mother's improvement on her children may depend on her type of treatment. Depressed mothers with high anxious distress and irritability may require medications that reduce these symptoms in order to show the effect of her remission on her children.

Comparative distribution and validity of DSM-IV and DSM-5 diagnoses of eating disorders in adolescents from the community.

OBJECTIVES: DSM-5 changes for eating disorders (EDs) aimed to reduce preponderance of non-specified cases and increase validity of specific diagnoses. The objectives were to estimate the combined effect of changes on prevalence of EDs in adolescents and examine validity of diagnostic groupings. METHOD: A total of 3043 adolescents (1254 boys and 1789 girls, Mage = 14.19 years, SD = 1.61) completed self-report questionnaires including the Eating Disorder Diagnostic Scale. RESULTS: Prevalence of full-threshold EDs increased from 1.8% (DSM-IV) to 3.7% (DSM-5), with a higher prevalence of bulimia nervosa (1.6%) and the addition of the diagnosis of purging disorder (1.4%); prevalence of binge eating disorder was unchanged (0.5%), and non-specified cases decreased from 5.1% (DSM-IV) to 3.4% (DSM-5). Validation analyses demonstrated that DSM-5 ED subgroups better captured variance in psychopathology than DSM-IV subgroups. DISCUSSION: Findings extend results from previous prevalence and validation studies into the adolescent age range. Improved diagnostic categories should facilitate identification of EDs and indicate targeted treatments.

Psychopathology and functioning among children of treated depressed fathers and mothers.

OBJECTIVE: Recent findings suggest that remissions of maternal depression are associated with decrease in offspring psychopathology. Little is known about the offspring effects of decrease in paternal depression. METHOD: The offspring of married fathers and married mothers were compared. The analysis was restricted to married parents to control for the confounding effect of single parenthood which was more prevalent among depressed mothers. At baseline all parents met criteria for major depressive disorder (MDD), and participated in a 3 month randomized controlled trial to treat depression with a 6 month follow-up. Married parents (N=43) and their children aged 7-17 years (N=78) were assessed independently through direct interviews of children and parents at baseline and followed for 9 months. Child assessors were blind to the clinical status of parents and uninvolved in their treatment. RESULTS: At baseline, children of depressed fathers, compared to children of depressed mothers, had significantly fewer psychiatric disorders (11% vs. 37%; p=0.012) and less impairment as measured by the Columbia Impairment Scale (6.5 vs. 11.6; p=0.009). Over time, with treatment of parental depression, the prevalence of most child symptoms decreased among children of depressed mothers, but changed little among children of depressed fathers. LIMITATIONS: The main limitation of the study is the small number of fathers and their offspring included in the study. CONCLUSION: Maternal as compared to paternal depression had a greater impact on children. With treatment of parental depression the differential prevalence of child symptoms by parental gender narrowed over time. The clinical implication is that children may benefit from treatment of their depressed parents.

Partial hospitalization for youth with psychiatric disorders: treatment outcomes and 3-month follow-up.

A partial hospitalization program was developed for youth with moderate to severe psychiatric disorders. The objectives of this study were to prospectively assess changes from admission to discharge in the participants' clinical symptoms and psychosocial functioning, as well as the maintenance of any treatment gains at 3-month follow-up. In this naturalistic treatment study, 55 youth completed both the youth partial hospitalization program and the study. Diagnosis at admission was established by a psychiatrist based on a clinical assessment and a structured diagnostic interview. Clinician-rated and self-report measures of symptoms and psychosocial functioning were administered at admission, discharge, and follow-up to track changes over time. Clinically and statistically significant improvements were found in both symptoms and psychosocial functioning from admission to discharge on all study measures. Furthermore, these gains were maintained at 3-month follow-up. The results suggest that partial hospitalization programs can be an effective modality in treating youth with moderate to severe psychiatric disorders.

Parental bonds in children at high and low familial risk for panic disorder.

A rejecting and overprotective parenting style is considered to be an important risk factor for the development of anxiety disorders. This study examined the role of perceived parental bonding as a potential environmental risk factor for panic disorder (PD) in unaffected offspring with parental PD. Children with a biological parent with PD (n = 71) and children of parents with no psychiatric history (n = 80) participated in the study. Results indicate that high risk children do not perceive their parents as being more protective and less caring than low risk controls. The optimal bonding type (high care, low protection) was the most frequently reported parenting style across groups. The constraining type of maternal bonding (high care, high protection) was less frequently reported by high risk children (p < 0.05). Overall, these data suggest that parental PD does not compromise the parent-child bonds in never-ill offspring.

Children of treatment-seeking depressed mothers: a comparison with the sequenced treatment alternatives to relieve depression (STAR*D) child study.

OBJECTIVE: To estimate the prevalence of current psychiatric disorders among children and adolescents (collectively called children) of mothers entering treatment for depression; to examine maternal predictors of child psychopathology among children of depressed mothers; and to determine consistency of findings with a similar child study ancillary to Sequenced Treatment Alternatives to Reduce Depression (STAR⁎D) from seven United States sites (STAR⁎D-Child). METHOD: Mothers (N = 82) with major depressive disorder (MDD) enrolled in a treatment study in Ottawa (Ontario, Canada) or New York City, and their eligible children (N = 145) (aged 7 through 17 years) were assessed independently when the mother enrolled. RESULTS: Among the children of depressed mothers, 42% had at least one current psychiatric diagnosis, including affective (15%), anxiety (19%), behavioral (23%), and/or substance use (2%) disorders. In all, 40% of the children were rated as impaired by clinical assessors. Mothers' comorbid anxiety disorders predicted the highest rates of current disorders in the child in both studies. The severity of the mother's depression predicted behavioral problems in the child. The current and lifetime rates of psychiatric disorders in the children of depressed mothers were compared to rates found in STAR⁎D Child and findings were consistent. Both studies used similar diagnostic assessments. CONCLUSION: Given the high prevalence of offspring psychiatric disorders, inquiring about the mental health of the children when a depressed mother comes for treatment, and referring children for treatment when appropriate, are important.

Internalization of the thin and muscular body ideal and disordered eating in adolescence: the mediation effects of body esteem.

This study investigates body esteem factors (weight-esteem and appearance-esteem) as mediators of the relationship between 'internalization of the ideal body figure' and disordered eating behaviors (restrained, emotional and external eating) in a community sample of adolescent males (n=810) and females (n=1137) from the Ontario Research on Eating and Adolescent Lifestyles (REAL) study. Mediation models were examined using a bootstrapping approach to test indirect effects and indirect contrasts. In males, weight-esteem partially mediated the relationship between muscular ideal and restrained eating; appearance-esteem partially mediated effects in the emotional and external eating regressions. In females, both weight-esteem and appearance-esteem partially mediated the relationship between thin ideal and all three forms of disordered eating; weight-esteem was a stronger mediator for restrained eating, and appearance-esteem a stronger mediator for emotional and external eating. Body esteem is important to consider for prevention and treatment of disordered eating in both genders.

Evidence-based pharmacotherapy of eating disorders.

The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician.

Family meals and body mass index among adolescents: effects of gender.

Family meals have been identified as a protective factor against obesity among youth. However, gender specificities with respect to the relationship between the frequency of family meals and body mass index (BMI) have not been investigated. The purpose of this study was to examine the relationship between the frequency of family meals and BMI in male and female adolescents, while controlling for potential confounding factors associated with BMI, such as parental education, adolescent's age, and snack-food eating. Research participants were 734 male and 1030 female students (mean age, 14.12 years, SD = 1.62) recruited from middle schools and high schools in the capital region of Canada. Participants completed validated, self-report measures to assess the frequency of family meals and the risk factors associated with increased BMI, which was derived from objective measures of height and weight. After controlling for proposed confounding variables, a higher frequency of family meals was associated with lower BMI in females, but not in males. A Z-transformation test of the homogeneity of adjusted correlation coefficients showed a significant trend (p = 0.06), indicating that the relationship between family meals and BMI is stronger in females than males, consistent with our regression analyses. Our findings suggest that eating together as a family may be a protective factor against obesity in female adolescents, but not in male adolescents. Findings from this study have important implications for parents and health care practitioners advocating for more frequent family meals as part of a comprehensive obesity prevention and treatment program for female adolescents.

Self-silencing and anger regulation as predictors of disordered eating among adolescent females.

The main purpose of this study was to examine how self-silencing, emotional regulation, and body-esteem differentiated healthy eating from different patterns of disordered eating. A community sample of adolescent females was classified as either: 1) Restrained Eaters (n=104, M(age)=14.48); 2) Emotional Eaters (n=125, M(age)=14.52); or, 3) Healthy Eaters (n=396, M(age)=13.71). A discriminant function analysis revealed two significant functions. The first function differentiated the two disordered eating groups (i.e., the restrained and emotional eaters) from the healthy group, with the disordered eating groups scoring significantly higher on levels of self-silencing and anger regulation, and lower on body-esteem. The second function differentiated between the restrained and emotional eaters, with the emotional eaters reporting higher levels of externalized self-perception and anger, and lower levels of body-esteem. The results suggest that body-esteem and anger suppression were the most influential variables in differentiating between groups. The findings are discussed in terms of the implications for disordered eating prevention and treatment programs.