Secular trends in mental health problems among young people in Norway: a review and meta-analysis.

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Methods, strategies, and incentives to increase response to mental health surveys among adolescents: a systematic review.

BACKGROUND: This systematic review aimed to identify effective methods to increase adolescents' response to surveys about mental health and substance use, to improve the quality of survey information. METHODS: We followed a protocol and searched for studies that compared different survey delivery modes to adolescents. Eligible studies reported response rates, mental health score variation per survey mode and participant variations in mental health scores. We searched CENTRAL, PsycINFO, MEDLINE and Scopus in May 2022, and conducted citation searches in June 2022. Two reviewers independently undertook study selection, data extraction, and risk of bias assessments. Following the assessment of heterogeneity, some studies were pooled using meta-analysis. RESULTS: Fifteen studies were identified, reporting six comparisons related to survey methods and strategies. Results indicate that response rates do not differ between survey modes (e.g., web versus paper-and-pencil) delivered in classroom settings. However, web surveys may yield higher response rates outside classroom settings. The largest effects on response rates were achieved using unconditional monetary incentives and obtaining passive parental consent. Survey mode influenced mental health scores in certain comparisons. CONCLUSIONS: Despite the mixed quality of the studies, the low volume for some comparisons and the limit to studies in high income countries, several effective methods and strategies to improve adolescents' response rates to mental health surveys were identified.

The association between bullying and eating disorders: A case-control study.

OBJECTIVE: Childhood bullying is associated with a range of adverse mental health outcomes, and here we investigated the association between bullying exposure and eating disorders (EDs). METHOD: In this case-control study, we compared bullying history in individuals with EDs with community controls. Participants (n = 890, mean age = 29.50 ± 10.60) completed an online self-report battery assessing bullying history and lifetime history of bulimia nervosa (BN), binge-eating disorder (BED), and anorexia nervosa (binge-eating/purging (AN-BP) or restrictive (AN-R) subtype). Logistic regressions were performed to estimate odds ratios (ORs). RESULTS: In the combined ED sample, individuals with a history of any ED were significantly more likely than controls to have experienced bullying victimization during childhood or adolescence (ORs = 1.99-3.30), particularly verbal, indirect, and digital bullying. Bullying prior to ED onset was also significantly more common than bullying within the same time frame for controls (ORs = 1.75-2.16). Further analysis showed that these effects were due to individuals with BN or BED reporting significantly more lifetime (p < .001) and premorbid bullying (p = .002) than controls, while individuals in the other diagnostic subgroups did not differ significantly from controls. DISCUSSION: Our results confirm an association between bullying and binge-eating/purging ED subtypes. Prospective studies are needed to establish bullying as a risk factor for EDs.

Psychometric properties of the Norwegian version of the Patient Health Questionnaire-9 (PHQ-9) in a large female sample of adults with and without eating disorders.

BACKGROUND: Internationally, the Patient Health Questionnaire-9 (PHQ-9) is commonly used to assess the frequency and severity of depressive symptoms. However, psychometric properties of the Norwegian version of the PHQ-9 have only been assessed in adolescents. We present normative data for women and an evaluation of the psychometric properties (internal consistency, convergent validity, and factor structure) of the Norwegian PHQ-9 among women with and without eating disorders (ED). METHODS: In this case-control study, a total of 793 females aged 18-78 years (mean 30.39; SD 9.83) completed an online self-report assessment. Measures included the ED100K and Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology, and the Generalized Anxiety Disorder (GAD) scale and Difficulties in Emotion Regulation Scale Short Form (DERS-SF) to assess symptoms of anxiety and emotion regulation deficits. Participants were categorized into three groups, i.e., previous ED (19.7%, n = 148), current ED (36.3%, n = 272), and no history of ED (44.0%, n = 330), based on self-reported scores on the ED 100 K and the EDE-Q. RESULTS: Mean PHQ-9 total score for those with a previous history of ED was 10.67 (SD 6.33), for those with a current ED 16.61 (SD 5.84), and for those with no lifetime history of ED 6.83 (SD 5.58). Excellent internal consistency was demonstrated by Cronbach's alpha's for individuals with a previous ED (.88), for individuals with a current ED (.86), and for individuals with no history of ED (.88). Acceptable convergent validity was indicated based on significant correlations between the PHQ-9 and GAD-7 and DERS-SF. Confirmatory Factor Analyses revealed a mediocre fit for a one-factor structure of the PHQ-9, regardless of diagnostic status. CONCLUSIONS: The psychometric properties of the Norwegian version of the PHQ-9 are acceptable across females with and without ED, and the PHQ-9 can be recommended for use in clinical ED settings and for people without mental disorders.

Stressful life events among individuals with a history of eating disorders: a case-control comparison.

BACKGROUND: Experiencing stressful life events (SLEs) can negatively impact mental health and increase risk for psychiatric disorders including eating disorders (EDs). Previous research has shown that childhood sexual abuse is associated with some EDs, but less is known about the association between other non-sexual SLEs and EDs. METHOD: A case-control study of individuals with (n = 495, age mean ± SD = 29.1 ± 9.8 years) and without (n = 395, age = 30.2 ± 11.7) self-reported lifetime history of EDs was conducted to compare history of self-reported SLEs. Participants reported history of sexual (e.g., rape, other sexual assault) and non-sexual (e.g., emotional abuse, assault, bereavement) life events using an adaptation of the Stressful Life Events Screening Questionnaire. Individuals with EDs were divided into ED subtypes along the restricting - binge eating/purging spectrum to examine subtype differences. Logistic regressions were conducted for each SLE and ED subtype to obtain odds ratios (ORs). We report p-values corrected for multiple comparisons. RESULTS: Exposure to any SLE was significantly more common in individuals with EDs than in controls (OR = 2.47, p < .001). Specifically, rape, other sexual assault, and emotional abuse were significantly more common among individuals with a history of binge-eating/purging ED subtypes (ORs = 2.15-3.58, p's < .01) compared with controls. Furthermore, history of life-threatening disease and loss of a close relative/partner/friend were associated with some ED subtypes. The association between SLEs and EDs was stronger for individuals who had experienced multiple SLEs. CONCLUSION: By investigating a range of different SLEs, we showed that both sexual and non-sexual SLEs were more common in individuals with a history of EDs (binge-eating/purging subtypes) than controls. Results highlight the importance of assessing a variety of past SLEs in risk assessment for different EDs.

Associations of age, body mass index and biochemical parameters with brain morphology in patients with anorexia nervosa.

OBJECTIVE: Accumulating evidence shows that patients with anorexia nervosa (AN) have globally reduced brain mass, including lower cortical volume and thickness, which largely normalizes following weight restoration. The underlying mechanisms for these processes are unknown, and how age and severity of emaciation are associated with brain morphology in AN is poorly understood. We investigated associations of age, body mass index (BMI) and biochemical parameters with brain morphology among patients in treatment. METHOD: We included 85 patients (94% female) aged 12-48 (mean = 23) years with quality controlled magnetic resonance imaging (MRI) data. T1-weighted MRI images, clinical characteristics and biochemical parameters were retrospectively collected from hospital records. Brain morphology was measured using FreeSurfer, and associations investigated using regression models and correlations. RESULTS: Controlling for BMI, age showed significant associations with brain morphology generally concordant with typical brain developmental patterns. Controlling for age, BMI showed significant positive associations with cortical volume and thickness. There were no significant interaction effects between age and BMI. None of the biochemical parameters correlated significantly with brain morphology. CONCLUSION: Our findings suggest the presence of typical neurodevelopmental patterns in AN. Importantly, we showed that severity of emaciation is related to brain morphology reductions, underscoring the importance of weight restoration.

Presence of eating disorder symptoms in patients with obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is common in patients with eating disorders (EDs). There is a lack of research investigating the presence of ED symptoms among patients with OCD, despite concerns that many of these patients may be at high risk for EDs. Our objective was to assess the presence of ED symptoms in patients receiving treatment for OCD. METHODS: Adult patients with OCD (n = 132, 71% females) and controls (n = 260, 90% females) completed the Eating Disorder Examination-Questionnaire (EDE-Q) at admission to a specialized OCD outpatient unit. A small subset of patients (n = 22) also completed the EDE-Q 3-months after end of treatment. RESULTS: At the group-level, mean EDE-Q scores did not differ significantly between female patients and controls. However, female patients compared to controls were significantly more likely to score above the EDE-Q cut-off (23% vs. 11%) and have a probable ED (9% vs. 1%), indicating elevated rates of ED symptoms in the clinical range. There was no evidence of elevated rates of ED symptoms in male patients, though sample sizes were small. Preliminary follow-up data showed that certain ED symptoms improved significantly from admission to 3-month follow-up. CONCLUSIONS: Our findings suggest that while ED symptoms are not generally elevated in female patients with OCD, a considerable subset of female patients may have a clinical ED or be at high risk of developing one. Clinicians should be alert to ED symptoms in female patients with OCD, and our findings raise the issue of whether ED screening of female patients with OCD is warranted.

Is bullying and teasing associated with eating disorders? A systematic review and meta-analysis.

OBJECTIVE: Involvement in bullying and teasing has been associated with adverse health outcomes, including eating disorders (EDs). The purpose of this systematic review and meta-analysis was to examine the association between bullying/teasing and EDs. METHOD: A systematic search was conducted. We included research articles that examined the association between bullying/teasing (victimization and perpetration) and EDs. Studies were required to compare ED cases with a reference group. We performed a qualitative synthesis of included studies. Additionally, a random-effects meta-analysis of odds ratios were performed to compare rates of bullying/teasing victimization between cases and healthy controls. RESULTS: A total of 22 studies were included for review. Compared to healthy controls, those with EDs were significantly more likely to have been bullied and teased. Evidence of this association was particularly strong for bulimia nervosa and binge-eating disorder, but was more mixed for anorexia nervosa. It was unclear whether such victimization was more common in EDs compared to psychiatric controls. The meta-analysis showed that compared to healthy controls, those with EDs were twofold to threefold significantly more likely to have been teased about their appearance and bullied prior to onset of their ED. Few studies examined bullying perpetration. A number of methodological shortcomings of studies were noted. DISCUSSION: Being victimized through bullying and teasing is associated with EDs, and may constitute a risk factor. Our review underscores the need for more studies, and highlights gaps in the literature. As many patients have been victims of bullying and teasing, addressing such experiences in treatment may be valuable.

OBJETIVO: El involucramiento en bullying y acoso ha sido asociado con efectos adversos en la salud, incluyendo los trastornos de la conducta alimentaria (TCA). El propósito de esta revisión sistemática y meta-análisis fue examinar la asociación entre bullying/acoso y TCAs. MÉTODO: Una búsqueda sistemática fue realizada. Incluimos los artículos de investigación que examinaron la asociación entre bullying/acoso (victimización y perpetración) y los TCAs. Se requirieron estudios para comparar los casos de TCA con un grupo de referencia. Realizamos una síntesis cualitativa de los estudios incluidos. Adicionalmente, se realizó un meta-análisis de los efectos aleatorios de los odds ratios para comparar las tasas de victimización de acoso/bullying entre los casos y los controles sanos. RESULTADOS: Se incluyeron un total de 22 estudios para la revisión. En comparación con los controles sanos, las personas con TCA tenían una probabilidad significativamente mayor de haber sido acosadas o ser víctimas de bullying. La evidencia de esta asociación fue particularmente fuerte para BN y TpA, pero fue más mixta para AN. No estaba claro si esa victimización era más común en los TCA en comparación con los controles psiquiátricos. El meta-análisis mostró que, en comparación con los controles sanos, los que tenían TCA tenían de dos a tres veces más probabilidades de haber sido objeto de acoso sobre su apariencia y de haber sufrido bullying antes del inicio del TCA. Pocos estudios examinaron la perpetración de acoso. Se observaron una serie de deficiencias metodológicas de los estudios. DISCUSIÓN: Ser víctima de acoso y bullying está asociado con los TCAs, y puede constituir un factor de riesgo. Nuestra revisión subraya la necesidad de más estudios y destaca las lagunas en la literatura. Como muchos pacientes han sido víctimas de acoso y bullying, puede ser valioso abordar tales experiencias en el tratamiento.

Normal white matter microstructure in women long-term recovered from anorexia nervosa: A diffusion tensor imaging study.

OBJECTIVES: Studies point to white matter (WM) microstructure alterations in both adolescent and adult patients with anorexia nervosa (AN). These include reduced fractional anisotropy in several WM fiber tracts, suggesting reduced WM integrity. The extent to which these alterations are reversible with recovery from AN is unclear. There is a paucity of research investigating the presence of WM microstructure alterations in recovered AN patients, and results are inconsistent. This study aimed to investigate the presence of WM microstructure alterations in women long-term recovered from AN. METHOD: Twenty-one adult women who were recovered from AN for at least 1 year were compared to 21 adult comparison women. Participants were recruited via user-organizations for eating disorders, local advertisements, and online forums. Diffusion tensor imaging was used to compare WM microstructure between groups. Correlations between WM microstructure and clinical characteristics were also explored. RESULTS: There were no statistically significant between-group differences in WM microstructure. These null findings remained when employing liberal alpha level thresholds. Furthermore, there were no statistically significant correlations between WM microstructure and clinical characteristics. DISCUSSION: Our findings showed normal WM microstructure in long-term recovered patients, indicating the alterations observed during the acute phase are reversible. Given the paucity of research and inconsistent findings, future studies are warranted to determine the presence of WM microstructure alterations following recovery from AN.

Eating patterns in adolescents with type 1 diabetes: Associations with metabolic control, insulin omission, and eating disorder pathology.

OBJECTIVE: The purpose of this study was to investigate eating patterns among male and female adolescents with type 1 diabetes (T1D), and the associations with age, zBMI, eating disorder (ED) pathology, intentional insulin omission, and metabolic control. METHOD: The sample consisted of 104 adolescents (58.6% females) with child-onset T1D, mean age of 15.7 years (SD 1.8) and mean zBMI of 0.4 (SD 0.8). The Child Eating Disorder Examination (ChEDE) assessed meal/snack frequency and ED pathology. T1D clinical data was obtained from the Norwegian Childhood Diabetes Registry. RESULTS: A significantly lower proportion of females than males (73.8% vs 97.7%) consumed breakfast on a daily basis. Approximately 50% of both genders ate lunch and 90% ate dinner daily. Among females, skipping breakfast was significantly associated with higher global ED psychopathology, shape concerns, self-induced vomiting, binge eating, insulin omission due to shape/weight concerns, and poorer metabolic control. Less frequent lunch consumption was significantly associated with poorer metabolic control. Skipping dinner was significantly associated with older age, higher dietary restraint, eating concerns, self-induced vomiting, and insulin omission. Among males, less frequent consumption of lunch and evening snacks was associated with attitudinal features of ED, including shape/weight concerns and dietary restraint. DISCUSSION: Among adolescents with T1D, irregular or infrequent meal consumption appears to signal potential ED pathology, as well as being associated with poorer metabolic control. These findings suggest the importance of routinely assessing eating patterns in adolescents with T1D to improve detection of ED pathology and to facilitate improved metabolic control and the associated risk of somatic complications.