Weight outcomes for adolescents with atypical anorexia nervosa in family-based treatment.

Background: Although over one-third of adolescents presenting with restrictive eating disorders have a history of being overweight, there is no evidence-based treatment for atypical anorexia nervosa (AAN). Family-Based Treatment (FBT) is a feasible treatment and is routinely applied to treat atypical anorexia nervosa in adolescents; however, identifying a treatment target weight within FBT for these patients is a challenge. Objective: This study aimed to 1) increase understanding regarding recommendations for weight gain versus weight stabilization in FBT for adolescents with AAN and 2) examine treatment outcomes in FBT for adolescents with AAN. Method: Using a retrospective design, we reviewed the files of 41 patients with AAN who were referred for FBT at a pediatric eating disorder program located within a tertiary care health centre. Results: We found variability in recommendations for weight gain, with 56% of the sample recommended to gain weight and 44% recommended to stabilize weight. Baseline BMI for age appeared to be a key factor in establishing recommendations for weight gain. AAN patients in our sample gained a significant amount of weight across treatment, with those recommended to gain weight showing more weight gain during treatment. Forty-nine percent of the sample completed FBT; those patients displayed a mean of 10kg of weight gain during treatment. Conclusions: Findings suggest that many patients gained weight during the course of FBT for AAN. Further study on weight changes during FBT for adolescents with AAN and increased diagnostic consistency for AAN will be important for this field.

Contexte: Bien qu'un tiers des adolescents présentant des troubles alimentaires restrictifs aient des antécédents d'être en surpoids, il n'y a pas de traitement fondé sur des données probantes pour l'anorexie mentale atypique (AMA). Le traitement basé sur la famille (TBF) est un traitement faisable et est régulièrement appliqué pour traiter l'AMA chez les adolescents; toutefois, identifier un poids cible de traitement dans un TBF pour ces patients est un problème. Objectif: La présente étude visait à 1) accroître la compréhension des recommandations pour le gain de poids contre la stabilisation du poids dans un TBF pour adolescents souffrant d'AMA et 2) examiner les résultats du traitement dans un TBF pour des adolescents souffrant d'AMA. Méthode: À l'aide d'une méthode rétrospective, nous avons révisé les dossiers de 41 patients souffrant d'AMA qui ont été renvoyés pour un TBF à un programme de troubles alimentaires pédiatrique situé près d'un centre de soins tertiaires. Résultats: Nous avons constaté une variabilité dans les recommandations de gain de poids, on a recommandé à 56 % de l'échantillon de gagner du poids et à 44 % de stabiliser leur poids. L'IMC à la base pour l'âge semblait être un facteur clé pour établir les recommandations de la prise de poids. Les patients d'AMA de notre échantillon prenaient une quantité significative de poids durant le traitement, et ceux à qui il était recommandé de prendre du poids montraient une plus grande prise de poids durant le traitement. Quarante-neuf pour cent de l'échantillon a terminé le TBF; ces patients ont affiché une moyenne de 10 kg de gain de poids durant le traitement. Conclusions: Les résultats suggèrent que de nombreux patients ont pris du poids au cours du TBF pour l'AMA. D'autres études sur les changements de poids durant le TBF pour adolescents souffrant d'AMA et une cohérence diagnostique accrue pour l'AMA seront importants dans ce domaine.

Sleep-Related Issues in Children and Adolescents Presenting at Community Mental Health Clinics.

OBJECTIVE: To examine sleep-related issues in children and adolescents presenting at community clinics with diverse mental health concerns using a brief sleep questionnaire and to examine whether sleep issues would improve with mental health interventions. METHOD: Study 1: A questionnaire-based study that used a modified version of the Pittsburgh Sleep Quality Index to measure sleep-related issues in youth aged 4-18 years presenting at community mental health clinics. Study 2: A pre/post-treatment study that used the same questionnaire to measure changes in sleep-related issues in youth aged 4-19 years participating in a group mental health intervention. The main outcome measure for both studies was global sleep score. RESULTS: Using the recommended cut-off score of 5, 31% of children aged 4-11 years and 71% of adolescents aged 12-18 years had problematic sleep. Sleep-related issues did not differ by presenting mental health concern. The group intervention was associated with improved sleep for parent-reported child sleep and self-reported adolescent sleep, but not for parent-reported adolescent sleep. CONCLUSIONS: Problematic sleep is very common in youth with mental health concerns. More research is needed to understand best practices for assessment and treatment of sleep issues that are comorbid with mental health issues in children and adolescents.

OBJECTIF: Examiner les difficultés liées au sommeil chez des enfants et des adolescents se présentant à des cliniques communautaires avec divers problèmes de santé mentale, à l'aide d'un bref questionnaire sur le sommeil, et examiner si ces difficultés de sommeil s'amélioreraient par des interventions de santé mentale. MÉTHODE: Étude 1: Une étude basée sur un questionnaire qui utilisait une version modifiée de l'échelle de la qualité du sommeil de Pittsburgh pour mesurer les difficultés liées au sommeil chez des enfants et adolescents de 4 à 18 ans qui se présentent à des cliniques communautaires de santé mentale. Étude 2: Une étude pré/post traitement qui utilisait le même questionnaire pour mesurer les changements des difficultés liées au sommeil chez des enfants et adolescents de 4 à 19 ans qui participent à une intervention de groupe en santé mentale. La mesure principale du résultat pour les deux études était le score de sommeil total. RÉSULTATS: À l'aide du score d'inclusion recommandé de 5, 31 % des enfants de 4 à 11 ans et 71 % des adolescents de 12 à 18 ans avaient un sommeil problématique. Les difficultés liées au sommeil ne différaient pas par la présentation d'un problème de santé mentale. L'intervention de groupe était associée avec un sommeil amélioré pour le sommeil de l'enfant déclaré par le parent et celui auto-déclaré par l'adolescent, mais aucun parent n'a déclaré le sommeil de l'adolescent. CONCLUSIONS: Le sommeil problématique est très commun chez les jeunes ayant des problèmes de santé mentale. Il faut plus de pratique pour comprendre les pratiques exemplaires d'évaluation et de traitement des difficultés de sommeil qui sont comorbides avec des problèmes de santé mentale chez les enfants et les adolescents.

Development and Validation of the Bicultural Youth Acculturation Questionnaire.

OBJECTIVES: Acculturation is a multidimensional process involving changes in behaviour and beliefs. Questionnaires developed to measure acculturation are typically designed for specific ethnic populations and adult experiences. This study developed a questionnaire that measures acculturation among ethnically diverse populations of youth that can be included as a module in population surveys. METHODS: Questionnaires measuring acculturation in youth were identified in the literature. The importance of items from the existing questionnaires was determined using a Delphi process and this informed the development of our questionnaire. The questionnaire was then pilot tested using a sample of 248 Canadians aged 18-25 via an online system. Participants identified as East and South East Asian (27.8%), South Asian (17.7%) and Black (13.7%). The majority were 1st (33.5%) or 2nd generation immigrants (52.0%). After redundant items were eliminated, exploratory factor analysis grouped items into domains, and, for each domain, internal consistency, and convergent validity with immigrant generation then age at immigration estimated. A subset of participants re-completed the questionnaire for reliability estimation. RESULTS: The literature review yielded 117 articles that used 13 questionnaires with a total of 440 questions. The Delphi process reduced these to 32 questions. Pilot testing occurred in 248 Canadians aged 18-25. Following item reduction, 16 questions in three domains remained: dominant culture, heritage language, and heritage culture. All had good internal consistency (Cronbach's alphas > .75). The mean dominant domain score increased with immigrant generation (1st generation: 3.69 (95% CI: 3.49-3.89), 2nd: 4.13 (4.00-4.26), 3rd: 4.40 (4.19-4.61)), and mean heritage language score was higher among those who immigrated after age 12 than before (p = .0001), indicative of convergent validity. CONCLUSIONS: This Bicultural Youth Acculturation Questionnaire has demonstrated validity. It can be incorporated into population health surveys to elucidate the impact of acculturation on health outcomes among bicultural youth.

Community, family, and subjective socioeconomic status: Relative status and adolescent health.

OBJECTIVE: Relative socioeconomic status (SES) may be an important social determinant of health. The current study aimed to examine how relative SES, as measured by subjective SES, income inequality, and individual SES relative to others in the community, is associated with a wide range of adolescent health outcomes, after controlling for objective family SES. METHOD: Adolescents (13-16 years; N = 2,199) from the Quebec Child and Adolescent Health and Social Survey were included. Socioeconomic measures included adolescents' subjective SES; parental education and household income; community education/employment, income, and poverty rate; and community income inequality. Health outcomes included self-rated health, mental health problems, dietary and exercise health behaviors, substance-related health behaviors, reported physical health, and biomarkers of health. Best-fitting multilevel regression models (participants nested within schools) were used to test associations. RESULTS: Findings indicated that lower subjective SES was associated with poorer health outcomes. After accounting for family SES, lower community education/employment had an additional negative effect on health, while lower community income had a protective effect for certain health outcomes. There was less evidence for an independent effect of income inequality. CONCLUSIONS: Findings highlight the importance of measures of relative SES that span across a number of levels and contexts, and provide further understanding into the socioeconomic gradient in adolescence.

Province-level income inequality and health outcomes in Canadian adolescents.

OBJECTIVE: To examine the effects of provincial income inequality (disparity between rich and poor), independent of provincial income and family socioeconomic status, on multiple adolescent health outcomes. METHODS: Participants (aged 12-17 years; N = 11,899) were from the Canadian National Longitudinal Survey of Children and Youth. Parental education, household income, province income inequality, and province mean income were measured. Health outcomes were measured across a number of domains, including self-rated health, mental health, health behaviors, substance use behaviors, and physical health. RESULTS: Income inequality was associated with injuries, general physical symptoms, and limiting conditions, but not associated with most adolescent health outcomes and behaviors. Income inequality had a moderating effect on family socioeconomic status for limiting conditions, hyperactivity/inattention, and conduct problems, but not for other outcomes. CONCLUSIONS: Province-level income inequality was associated with some physical and mental health outcomes in adolescents, which has research and policy implications for this age-group.

Objective and subjective socioeconomic gradients exist for sleep in children and adolescents.

OBJECTIVE: Socioeconomic position (SEP) is inversely associated with many health outcomes, yielding a socioeconomic gradient in health. In adults, low SEP is associated with short sleep duration, poorer sleep quality, and difficulty initiating and maintaining sleep. Relatively little is known about this relation in youth. The aim of the present study was to examine whether socioeconomic gradients exist for various sleep indices among a healthy sample of children and adolescents. METHOD: Participants took part in the larger Healthy Heart Project and included 239 youth (69.6% Caucasian; 45.6% female), aged 8-17 years (M = 12.6, SD = 1.9). Parental income and education were used to measure objective SEP. The Subjective Social Status Scale-Youth Version was used to measure subjective SEP. Sleep duration, sleep quality, daytime sleepiness, and sleep disturbances were assessed through self- and parent-report. RESULTS: In children, objective SEP was related with sleep duration (ß = .35, p < .01), although subjective SEP was related with daytime sleepiness (ßavg = .33, p < .01) and parent-reported sleep duration (ß = .23, p < .05). In adolescents, subjective SEP was related with sleep quality (ß = .28, p < .01) and parent-reported sleep duration (ß = -.18, p < .05), even after controlling for objective SEP. CONCLUSIONS: Socioeconomic gradients were observed for multiple sleep measures in youth. Objective parental SEP was related with sleep complaints (e.g., sleep disturbances), and subjective SEP was related with sleep quality and daytime sleepiness. Findings suggest sleep may be one pathway underlying the socioeconomic gradient in health. Future research should aim to elucidate how distinct sleep constructs may explain how socioeconomic status "gets under the skin" to affect health.

Subjective socioeconomic status and adolescent health: a meta-analysis.

OBJECTIVE: To comprehensively and quantitatively examine the association between subjective socioeconomic status (SES) and health outcomes during adolescence. METHODS: Forty-four studies met criteria for inclusion in the meta-analysis. Information on study quality, demographics, subjective SES, health outcomes, and covariates were extracted from each study. Fisher's Z was selected as the common effect size metric across studies. Random-effect meta-analytic models were employed and fail-safe numbers were generated to address publication bias. RESULTS: Overall, subjective SES was associated with health during adolescence (Fisher's Z = .10). The magnitude of the effect varied by type of health outcome, with larger effects observed for mental health outcomes, self-rated health, and general health symptoms; and nonsignificant effects observed for biomarkers of health and substance-use-related health behaviors. Of the measures of subjective SES employed in the reviewed studies, perception of financial constraints, was most strongly associated with adolescent health outcomes. Analysis of covariates indicated that inclusion of objective SES covariates did not affect the association between subjective SES and health. CONCLUSIONS: This meta-analysis has implications for the measurement of subjective SES in adolescents, for the conceptualization of subjective and objective SES, and for the pathways between SES and health in adolescents.

Generation of immigration and body mass index in Canadian youth.

OBJECTIVE: To investigate the role of acculturation, as measured by generational status, on body mass index (BMI) in a sample of Canadian youth. METHODS: Population-based data from the National Longitudinal Survey of Children and Youth were used. Participants were divided into 2 age ranges: children aged 6-11 years (n = 14,287) and adolescents aged 12-17 years (n = 12,155). Youth were classified into one of five generations of immigration: first-generation, second-generation, mixed-generation, third-generation, and Aboriginal. Parent- and self-report height and weight were used to calculate BMI Z-scores. RESULTS: Generation of immigration was significantly related to BMI Z-score in both childhood and adolescence. First-generation immigrants had more weight gain compared to other groups during adolescence, but not during childhood. CONCLUSIONS: Acculturation, as measured by generation of immigration, is an important predictor of BMI in Canadian children and adolescents.