IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders.

Background: There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period. Methods: We recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum. Results: All participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: "anxiousness and fear," "shame and guilt," "sexual maladjustment," and "non-disclosure of eating problems." These phenomena persisted continuously throughout IVF, pregnancy, and motherhood. Conclusion: Women with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders.

Trajectories of severe eating disorders through pregnancy and early motherhood.

Background: During pregnancy and early motherhood, risks of relapse and worsening are high for women with a history of eating disorders (EDs), as are adverse sequelae for their babies. However, systematic descriptions of the processes that these women undergo through pregnancy, birth, and early motherhood are lacking, as are good descriptions of the various trajectories these women follow through pregnancy and early motherhood. This study addresses both these knowledge gaps. Methods: We used a longitudinal research interview design, recruiting a non-clinical sample of 24 women with a history of severe EDs from routine pregnancy controls in five public, local, family health care centers in Norway. The participants were interviewed twice, first during pregnancy and then 4-6 months after delivery. Data were analyzed according to grounded theory. The focus was on modeling the trajectories of EDs through pregnancy, birth, and early motherhood. All the participants were diagnosed (DSM-5) using the Eating Disorder Examination and then completed the Eating Disorder Examination Questionnaire. Results: Five perceived trajectories through pregnancy and early motherhood were identified: "The mastering mother," in which an ED pathology seems to be absent through pregnancy and early motherhood; "The inadequate mother," in which the ED pathology worsens before pregnancy, through pregnancy, and early motherhood; "The overwhelmed mother," in which the ED worsens during pregnancy and early motherhood; "The depressed mother," in which the ED is put on hold during pregnancy, but worsens in early motherhood; and "The succeeding mother," in which the ED worsens during pregnancy, but reduces in early motherhood. Discussion: ED trajectories through pregnancy and early motherhood vary greatly among women with a history of EDs. This may indicate different psychological dynamics through these phases. A model with five trajectories captures a large degree of the variation. The model may help clinicians' preparedness when dealing with these patients.

Bodies out of control: Relapse and worsening of eating disorders in pregnancy.

Background: Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one's body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient's experience. Little is known about how women with a history of eating disorder experience being pregnant. Method: We interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE). Results: On becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the "chaotic" "rigid" "perfect" "worried" "shameful" "motherhood fearing" and "the mother with lost identity" Perceived triggers of worsening or relapse were: "loss of control" "unpredictability" "competition" "change of appearance" "shame and nausea" and "loss of identity." Conclusion: Pregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.

Effects of a school-based intervention on levels of anxiety and depression: a cluster-randomized controlled trial of the MindPower program in ten high schools in Norway.

BACKGROUND: The previous decades have shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15-16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety. METHODS: We utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData). RESULTS: According to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData. CONCLUSIONS: No effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, research designs and more. Several empirically based, practical advices are presented. Clinical Trial registration 27/08/2018. Registration number NCT03647826.

Associations between poor gross and fine motor skills in pre-school and peer victimization concurrently and longitudinally with follow-up in school age - results from a population-based study.

BACKGROUND: Children with poor motor skills are at increased risk of peer victimization. However, it is unclear whether poor gross and fine motor skills are differently linked to peer victimization among pre-school and schoolchildren. AIMS: To investigate associations between poor gross and fine motor skills measured in pre-school and the associations to peer victimization measured concurrently and in school age. SAMPLE: Data from the Norwegian Mother, Father and Child Cohort Study (MoBa), and the Medical Birth Registry of Norway were used. Participants with complete questionnaires at 3, 5, and 8 years (n = 23 215) were included. METHODS: A longitudinal design and an autoregressive cross-lagged model were used to investigate if poor gross and fine motor skills at 3 and 5 years predicted peer victimization at 5 and 8 years. Because emotional difficulties are associated with both motor skills and peer victimization, the results were adjusted for emotional difficulties. RESULTS: Only poor fine motor skills at 3 years had a significant association to peer victimization at 5 years. Poor gross motor skills at 5 years had a stronger association to peer victimization measured concurrently compared to poor fine motor skills, and only poor fine motor skills at 5 years was significantly linked to peer victimization at 8 years. No gender difference was found between these paths. CONCLUSIONS: Teachers and parents should be aware that motor skills predict peer victimization, and that poor gross and fine motor skills have different associations to peer victimization measured at different ages.

Universal depression prevention: An umbrella review of meta-analyses.

Depression is a disabling, highly prevalent, frequently chronic, and difficult-to-treat disorder with an immense cognitive, social, and economic burden. Given that many of the advances in other non-communicable disorders like cancer have been in prevention rather than treatment, the prevention of depression is currently an unmet public health priority. We sought to provide an overview of the meta-analytic literature through conducting a systematic umbrella review of universally delivered preventive interventions for depression. The search was conducted on March 18, 2021 utilising the following databases (all accessed through EBSCOHost); Allied and Complementary Medicine Database, CINAHL Complete, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete and APA PsychArticles. The following search terms related to depression, prevention, and trial study design. Two authors independently screened articles and a third resolved discrepancies. Eligibility criteria sought to identify meta-analyses that investigated the prevention of depression (i.e., reduced incidence) through intervention studies that were universal, in that they were designed to be delivered to entire populations Six meta-analyses on psychological interventions, two school-based meta-analyses, and one eHealth meta-analysis were included in this umbrella review. Findings indicated that all identified studies were of good quality and one was of fair quality. One previous meta-review that examined physical activity to prevent depression was included in results, comprising eight meta-analyses. Preventive interventions have primarily and successfully utilized psychological therapeutic components, delivered at the school, community, and workplace settings. Both school- and eHealth-based interventions hold some utility for depression prevention. There is meta-analytic evidence that physical activity is efficacious for depression prevention. However, universal prevention is inconsistently defined. There is a pressing need for well-designed randomized controlled preventative interventions for depression before recommendations can be universally accepted with convincing level of evidence.

Trust Buffers Against Reduced Life Satisfaction When Faced With Financial Crisis.

Background: In light of the coronavirus disease 2019 (COVID-19) pandemic and its large economic consequences, we used a three-layer nested structural model (individual, community, and country), each with a corresponding measure of income, trust, and satisfaction, to assess change in their interrelationships following a global crisis; which, in this study, is the 2008/2009 financial crisis. Methods: With multilevel techniques, we analyzed data from two waves (2006 and 2012) of the European Social Survey (ESS) in 19 countries (weighted N = 73,636) grouped according to their levels of trust. Results: In high trust countries, personal life satisfaction (LS) was not related to personal, community, or national income before or after the crisis. In contrast, in low trust countries, LS was strongly related to all three forms of income, especially after the crisis. In all country groups, personal, social, and political trust moderated their respective effects of income on LS ("the buffer hypothesis"). Political trust moderated the effects of income more strongly in low trust countries. The moderating effect of political trust increased sharply after the crisis. After the crisis, national-level factors (e.g., political trust, national income) increased their importance for LS more than the factors at the local and individual levels. However, the relative importance of all the three forms of income to LS increased after the crisis, to the detriment of trust. Conclusion: Economic crises seem to influence personal LS less in high trust countries compared with low trust countries. Hence, high trust at a national level appears to buffer the negative impact of a financial crisis on personal satisfaction. Overall, the factors at the national level increased their impact during the financial crisis. When facing a global crisis, the actions taken by institutions at the country level may, thus, become even more important than those taken before the crisis.

Associations Between Language Difficulties, Peer Victimization, and Bully Perpetration From 3 Through 8 Years of Age: Results From a Population-Based Study.

Background and Purpose Schoolchildren with language difficulties experience more peer victimization compared to their typically developing (TD) peers. Whether these children also bully their peers (bully perpetration) more than TD children is unclear. Furthermore, little is known about peer victimization and bully perpetration among preschool children with language difficulties and how it may be related to different paths of language difficulties. This study aimed to investigate associations between language difficulties, peer victimization, and bully perpetration from preschool to school age as well as the risk of peer victimization and bully perpetration for children with different developmental paths of language difficulties and mild language difficulties compared to TD children. Method The sample was drawn from the Norwegian Mother, Father and Child Cohort Study. Participants with completed questionnaires at 3, 5, and 8 years of age (n = 22,628) were included. Paths between latent variables of language skills at 3, 5, and 8 years of age, peer victimization at 5 and 8 years of age, and bully perpetration at 8 years of age were examined with structural equation modeling. Logistic regression was used to investigate peer victimization and bully perpetration for predefined paths of language difficulties. Results Poor language skills at 3 and 5 years of age were associated with peer victimization at 5 years of age. Poor language skills at 5 and 8 years of age were associated with peer victimization and bully perpetration at 8 years of age. The association between poor language skills at 5 years of age and bully perpetration at 8 years of age was stronger for girls. Persistent paths of language difficulties at 3, 5, and 8 years of age showed the highest risk of peer victimization and bully perpetration. Conclusions Language difficulties are associated with peer victimization and bully perpetration. The risk of peer victimization and bully perpetration differs according to different developmental paths of language difficulties from preschool to school age.

Political Trust Influences the Relationship Between Income and Life Satisfaction in Europe: Differential Associations With Trust at National, Community, and Individual Level.

Background: A high level of well-being is associated with personal, community and national income, as well as personal, social and political trust. How these measures relate to each other within and between countries and within and across structural levels of society is largely unknown. To study this, we propose a three-layer nested socio-structural model. Each layer (individual, community, country) contains a measure of income, trust and satisfaction. Method: With this model, we analyzed data from two waves of the European Social Survey (ESS, 2006, 2012) in 19 countries (N = 72,461; weighted N = 73,307) with multilevel techniques. Indicators were personal, community, and national income; personal, social and political trust; and personal life satisfaction, social and political satisfaction. Results: Personal life satisfaction was associated with all income and trust variables. Greatest effect on personal life satisfaction, came from the national level, including political trust and income. However, 2/3 of the variance in personal life satisfaction came from income, that is personal, community and national. Within each socio-structural level, satisfaction was associated with income, but significantly modified by trust. When income and trust at all three levels were included, there was a significant association of the national layer on the social layer, and of the social layer on the individual layer as to the income-personal life satisfaction relationship. Consistent with the "the buffer hypothesis," all three forms of trust acted as a buffer against the effect of personal income on life satisfaction. Low-trust countries had strong income-personal life satisfaction associations and the moderating role of trust was also stronger. High- and medium-trust countries had no such associations. Likewise, direct associations between political and personal trust were much stronger in the low-trust countries. Conclusion: The model presented in this study provides authorities with a framework for policies that will improve the general well-being of their population. Trust and income strongly influence personal life satisfaction. Money is the most important. However, trust forcefully dampens the effect of income. Politicians who want to enhance their population's personal life satisfaction, should raise the levels of trust in their electorate.

Peer-Victimization of Young Children With Developmental and Behavioral Difficulties-A Population-Based Study.

OBJECTIVE: The aim is to investigate if young children with developmental and behavioral difficulties (DBDs) have greater risk of peer-victimization compared with typically developing (TD) children. METHOD: The sample was drawn from the Norwegian Mother and Child Cohort Study (MoBa). MoBa has collected population-based data on children's health and development for 114,500 children. We included children that were 5 years of age (n = 41,609). Multivariate logistic regression was used to estimate the effect of different DBDs and of co-occurring DBDs on peer-victimization compared with TD children. Categories of DBDs included autistic traits, emotional difficulties, behavioral difficulties, general learning difficulties, attention difficulties/impulsive behavior, motor development difficulties, language difficulties, and hearing and vision difficulties. Results were adjusted for socioeconomic status and the child's sex. RESULTS: Peer-victimization was 2.8% (933) among TD children, and 8.0% (615) among children with DBD. The highest risk of peer-victimization was found among children with autistic traits and children with five or more co-occurring DBDs (adjusted odds ratios [ORs] = 12.76; 95% confidence interval [CI] 8.64-18.84; p ≤ .001) and 17.37 (95% CI 12.15-24.82; p ≤ .001)], respectively. The lowest risk was found among children with hearing and vision difficulties and children with only one DBD [adjusted ORs = 1.98 (95% CI 1.71-2.29; p ≤ .001) and 1.95 (95% CI 1.70-2.22; p ≤ .001)]. CONCLUSION: Children with DBD have a substantially higher risk of peer-victimization compared with TD children. Peer-victimization varies with type of DBD and increases cumulatively by number of DBDs.

Measures that increase social equality are effective in improving life satisfaction in times of economic crisis.

BACKGROUND: The financial crisis of 2008/2009, for some also in 2011, was accompanied by increasing social inequality and unemployment, which strained the welfare generosity systems in many countries. Welfare generosity redistributes internal resources to decrease poverty and increase equal opportunities. This was used by many countries to combat the crisis. We investigated the effects of increased social inequality, unemployment and welfare generosity on life satisfaction (LS) before and after the crisis. METHODS: A representative sample from the European Social Survey (2002 to 2014) with data from 26 countries was used (N = 301,559). Time from start of crisis (either 2008 or 2010-2012) was determined separately for each case. LS was measured with a single question with 11 response alternatives. Social inequality was measured using the Gini index. Unemployment was measured by a single question (No/Yes). Welfare generosity was measured using expenditure on social protection (PPS) per inhabitant (Eurostat). Data were analyzed by multilevel analysis and multilevel mediation analysis. RESULTS: Welfare generosity was associated with decreased levels of social inequality. The negative relationship between social inequality and LS was weakened when controlling for welfare generosity after the financial crisis. This effect of welfare generosity was not seen for the negative impact of unemployment on LS. CONCLUSION: The financial crisis stimulated the use of welfare generosity in Europe and strengthened the positive relationship between welfare generosity and LS. Social inequality, unemployment and welfare generosity played significant mediator roles between the crisis and LS, with increased welfare generosity far more strongly associated with increased LS. Measures that increase social equality in a country and thereby increase equal opportunity for all social classes, may be assumed to be effective in improving the general LS of the population in a country in times of economic crisis.

The financial crisis in Europe: Impact on satisfaction with life.

BACKGROUND: The 2008 financial crisis in Europe came abruptly and surprisingly. Many countries also suffered a second recession during the period 2010-2012. We examined the impact of the crisis on life satisfaction (LS) by country and individual socioeconomic level. METHOD: We used a representative sample from the European Social Survey (2002-2014) with data from 26 countries ( N = 294,407). LS was measured with a single question with 11 response alternatives. Time from start of crisis (either 2008 or 2010-2012) was determined separately for each interview. Data were analyzed by multilevel analysis Results: There was a sharp decrease in LS in the beginning of the crisis in 2008, and another, but not so severe, decline in 2011, each of them of short duration. However, there was also a slight and progressive yearly decrease in LS that continued one to at least 3 years after either financial crisis that was independent of the effect of being unemployed. Associations varied considerably between countries. A negative decline after the financial crisis was especially evident among those in the most educated groups, and in those in the higher occupational levels. CONCLUSIONS: The 2008 financial crisis had a double effect on LS: (1) a sharp short-term decrease consistent with the Easterlin paradox; (2) a slighter long-term progressive decrease that was over and above the strong negative relationship with unemployment that lasted several years. The long-term decline in LS after the start of the financial crisis tended to occur especially in the higher socioeconomic groups.

Four Pathways to Anorexia Nervosa: Patients' Perspective on the Emergence of AN.

INTRODUCTION: Studies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with AN relate to the emergence of their illness. There is a need for more coherent systematic descriptions of the complexity of the patients' narratives about how their illness emerged. In this study, we sought to identify common components in the participants' narratives. By identifying different combinations of these components in the narratives, we sought to describe differences in patients' perceived pathways to AN. METHODS: Participants were 36 women aged 18-51 years who had been treated for AN within the past 2 years at five clinical institutions in Norway. Semi-open qualitative interviews were conducted, tape-recorded, transcribed and analysed using grounded theory techniques. RESULTS: We identified the following four distinct perceived pathways into AN: 'The Avoidant', 'The Achiever', 'The Transformer' and 'The Punisher'. The pathways could be regarded as four different projects for mastering life's challenges. DISCUSSION: Our results suggest that there seem to be at least four pathways into AN. This indicates that a common array of symptoms might cover very different psychological dynamics. These might need to be treated therapeutically in different ways and should probably be taken into account during the refinement of diagnostic tools. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Although patients with AN might present similar symptoms, patients' perspectives on the emergence of their problems indicate that a common array of symptoms cover a variety of subjective psychological dynamics. From the experienced patient's stance, there are at least four distinct pathways to the emergence of AN. Attempts to master the challenges of life were found to be a common denominator in the emergence of AN. Recognition and integration of the patient's understanding of her or his problems should be given high priority in treatment of AN.

Coping With Strain (CWS) course - its effects on depressive symptoms: A four-year longitudinal randomized controlled trial.

The Coping With Strain (CWS) course is a modification of the Coping With Depression (CWD) course. CWD is by far the most studied psycho-educational intervention to reduce and prevent depression, but CWD has never been tested in a randomized controlled trial in the workplace. This study seeks to examine the extent to which CWS, on a short-term and a long-term basis, reduces depressive symptoms in employees. After advertising at workplaces, 119 employees were randomized into Intervention Group I (IG1), which immediately participated in CWS, or Intervention Group II (IG2), which functioned as a control group for six months until its participation in CWS. The follow up period lasted for four years in both IG1 and IG2. Linear mixed models were fitted to the data. Depressive symptoms were significantly reduced during the course. The reduction of depressive symptoms was maintained over a period of four years in both IG1 and IG2, although there is a slight increase towards the end of the follow-up period. CWS is effective in reducing depressive symptoms among employees. The effects are long lasting and may be maintained over a period of four years.

Enhancing the Emotional and Social Skills of the Youth to Promote their Wellbeing and Positive Development: A Systematic Review of Universal School-based Randomized Controlled Trials.

BACKGROUND: The acquisition of social and emotional skills is associated with positive youth development, character education, healthy lifestyle behaviours, reduction in depression and anxiety, conduct disorders, violence, bullying, conflict, and anger. School-based interventions aimed to enhance these skills go beyond a problem-focused approach to embrace a more positive view of health; they could also improve the youth's wellbeing. AIM: To describe the main features and to establish the effectiveness of universal school-based RCTs for children and the youth, aimed to promote their psychosocial wellbeing, positive development, healthy lifestyle behaviours and/or academic performance by improving their emotional and social skills. METHODS: Systematic review by searching for relevant papers in PubMed/Medline with the following key words: "mental health" OR "wellbeing" OR "health promotion" OR "emotional learning" OR "social learning" OR "emotional and social learning" OR "positive youth development" OR "life skills" OR "life skills training" AND "school". Interval was set from January 2000 to April 2014. RESULTS: 1,984 papers were identified through the search. Out of them 22 RCTs were included. While most interventions were characterized by a whole-school approach and SAFE practices, few studies only used standardized measures to assess outcomes, or had collected follow-up data after ≥ 6 months. The results of all these trials were examined and discussed. CONCLUSION: Universal school-based RCTs to enhance emotional and social skills showed controversial findings, due to some methodological issues mainly. Nevertheless they show promising outcomes that are relatively far-reaching for children and youth wellbeing and therefore are important in the real world.

The process of help-seeking in anorexia nervosa: patients' perspective of first contact with health services.

In this study we explored circumstances, reflections, and reactions to first treatment contact in 34 women (aged 18-51) diagnosed with anorexia nervosa (AN) (DSM-IV). Using methods from grounded theory we identified how the meeting came about, what motivated the patients, and how they reacted to the conversation. The results suggest that (a) health care professionals need to demonstrate effective professional communication skills and proficient knowledge about eating disorders in early contacts; (b) treatment goals other than recovery from AN should be explored; and

Stratified medicine for mental disorders.

There is recognition that biomedical research into the causes of mental disorders and their treatment needs to adopt new approaches to research. Novel biomedical techniques have advanced our understanding of how the brain develops and is shaped by behaviour and environment. This has led to the advent of stratified medicine, which translates advances in basic research by targeting aetiological mechanisms underlying mental disorder. The resulting increase in diagnostic precision and targeted treatments may provide a window of opportunity to address the large public health burden, and individual suffering associated with mental disorders. While mental health and mental disorders have significant representation in the "health, demographic change and wellbeing" challenge identified in Horizon 2020, the framework programme for research and innovation of the European Commission (2014-2020), and in national funding agencies, clear advice on a potential strategy for mental health research investment is needed. The development of such a strategy is supported by the EC-funded "Roadmap for Mental Health Research" (ROAMER) which will provide recommendations for a European mental health research strategy integrating the areas of biomedicine, psychology, public health well being, research integration and structuring, and stakeholder participation. Leading experts on biomedical research on mental disorders have provided an assessment of the state of the art in core psychopathological domains, including arousal and stress regulation, affect, cognition social processes, comorbidity and pharmacotherapy. They have identified major advances and promising methods and pointed out gaps to be addressed in order to achieve the promise of a stratified medicine for mental disorders.

Hope and expectancies for future events in depression.

The present study investigated prospective cognition with the Hope scale (Snyder et al., 1991) and the Unrealistic Optimism Scale (Weinstein, 1980) in clinically depressed (CD; n = 61), previously depressed (PD; n = 42), and never depressed controls (ND; n = 46). In line with previous research, significant negative correlations between hope and symptoms of depression were found. Previously depressed reported lower levels of hope than NDs, but were more hopeful than CDs. In addition, relationships between depressive symptoms, dysfunctional attitudes, and expectations for the future were examined. As hypothesized, the CDs estimated their probability of experiencing positive events in the future as lower and their probability of experiencing negative events as higher than the two other groups. The PDs differed not from the NDs in their probability estimates. Implications of the findings are discussed.

The link between negative emotions and eating disorder behaviour in patients with anorexia nervosa.

BACKGROUND: Several theoretical models suggest that deficits in emotional regulation are central in the maintenance of anorexia nervosa (AN). Few studies have examined how patients view the relationship between negative affect and anorectic behaviour. We explored how patients with AN manage the aversive emotions sadness, anger, fear and disgust, and how they link these experiences to their eating disorder behaviours. METHODS: Qualitative data were collected through semi-structured interviews with 14 women aged 19-39 years diagnosed with AN (DSM-IV). Interviews were analyzed using Grounded Theory methods. RESULTS: The participants tended to inhibit expression of sadness and anger in interpersonal situations and reported high levels of anger towards themselves, self-disgust and fear of becoming fat. Different emotions were managed by means of specific eating disorder behaviours. Sadness was particularly linked to body dissatisfaction and was managed through restrictive eating and purging. Anger was avoided by means of restrictive eating and purging and released through anorectic self-control, self-harm and exercising. Fear was linked to fear of fatness and was managed through restrictive eating, purging and body checking. Participants avoided the feeling of disgust by avoiding food and body focused situations. CONCLUSION: Treatment models of eating disorders highlight the significance of working with emotional acceptance and coping in this patient group. Knowledge about how patients understand the relationships between their negative emotions and their anorectic behaviour may be an important addition to treatment programmes for AN.

Preferred therapist characteristics in treatment of anorexia nervosa: the patient's perspective.

OBJECTIVE: Previous research in eating disorders suggests that treatment satisfaction is closely related to the manner in which care is delivered. The present research is a systematic in depth study of health professional characteristics preferred by AN-patients. METHOD: Thirty-eight women with AN aged 18-51 were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-NVivo7 software program. RESULTS: Four factors associated with patients' satisfaction with their therapists were identified: "acceptance," "vitality," "challenge," and "expertise." Patients' responses suggested that treatment of AN requires therapists who are capable of using a complex set of behaviors when interacting with their patients. DISCUSSION: There is accumulating evidence that across treatment modality, the manner in which treatment is delivered is critical to therapeutic change. Our findings increase the understanding of factors that may be associated with treatment retention, further help seeking, and overall treatment outcome. These exploratory and informant-centered results could guide clinicians in developing a strong therapeutic alliance with AN-patients and promote increased knowledge about the mechanisms that engage this population.