Personality Is Associated with Driving Avoidance in the Canadian Longitudinal Study on Aging (CLSA).

As individuals age and become aware of changes in their driving capabilities, they are more likely to self-regulate their driving by avoiding certain driving situations (i.e., night driving, rush hour traffic, etc.). In this paper, we sought to examine the correlates of situational driving avoidance with a particular emphasis on the roles of personality traits, gender, and cognition within a large sample of mid-life and older adults from the Canadian Longitudinal Study on Aging (CLSA). Our findings show that women of older ages tend to report more driving avoidance and that personality traits, specifically extraversion, emotional stability, and openness to experience, may reduce driving avoidance. A negative association was also found between cognition and driving avoidance, such that individuals with higher cognition reported less driving avoidance.

Changes in executive function in the Canadian longitudinal study on aging over 3-years: A focus on social determinants of health.

Maintaining executive functions, including planning, inhibition, and decision-making skills, is important for autonomy and activities of daily living. There is a growing body of evidence linking social determinants and cognitive aging, but less is known about the potential role of social determinants in changes in executive functioning over time. Using data from the Canadian Longitudinal Study on Aging (CLSA), a large cohort of mid-aged and older adults, we examined changes in executive function over a 3-year period. Specifically, we focused on the role of social determinants (i.e., social positioning, social support, education) in explaining these changes. Executive function was measured at baseline and follow-up 3 years later using the Mental Alteration Test (MAT). We computed a reliable change index (RCI) and used a multiple linear regression model to examine the associations between known correlates and change in executive function over the 3-year period (n = 29,344). Older age, higher household income, and greater educational attainment predicted declines in executive function. Health factors (e.g., depression symptoms, physical activity levels) and many social determinants (sexual orientation, gender identity, race, and perceived social standing) were not associated with change in executive function. These results suggest that social determinants of health may be related to initial differences in cognitive functioning (i.e., cross-sectional differences) rather than more rapid cognitive aging.

Biopsychosocial Correlates of Subjective Cognitive Decline and Related Worry in the Canadian Longitudinal Study on Aging.

INTRODUCTION: Subjective cognitive decline (SCD), a self-reported decline in cognition in otherwise cognitively healthy people, has been acknowledged as a risk factor for Alzheimer's disease. Using data from the Canadian Longitudinal Study on Aging (CLSA), a large national study with participants' ages of 45-85 years at baseline, we sought to identify correlates of SCD and SCD-related worry. METHODS: In our primary analysis using a Poisson regression model, associations between biopsychosocial variables and SCD were identified (analytic sample: n = 21,920). In a second analysis using an ordinal regression model, associations between biopsychosocial variables and SCD-related worry were identified (analytic sample: n = 12,694). RESULTS: Multiple risk and protective factors of cognitive decline were not associated with SCD within our sample (i.e., physical activity, hypertension, vision problems), as well as minority stress variables such as sexual orientation and race. Rather, psychosocial variables (i.e., depression, perceived social status, and personality traits) showed a more consistent association with SCD within the sample. Greater SCD-related worry, which is believed to increase the risk of future dementia, was associated with specific personality traits, depression, age, gender, and sexuality. CONCLUSION: The results from this study confirm the association between multiple health variables and SCD but also emphasize the importance of considering psychological and social factors when conceptualizing SCD and its risk factors.

Social determinants of memory change: A three-year follow-up of the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVES: Changes in memory can interfere with activities of daily living and may be indicative of serious health concerns such as mild cognitive impairment or dementia. Risk factors for cognitive decline and dementia have been shown to cluster around inequalities, suggesting that minority groups may be at an increased risk for cognitive decline. We sought to clarify the relationship between social determinants and change in memory function over a 3-year follow-up period, after accounting for demographic and health variables. METHODS: We used baseline and first follow-up data from the Canadian Longitudinal Study on Aging (CLSA). Our primary analysis consisted of a multivariable linear regression model (n = 30,475). Demographic, health, education and occupation, social support, social identity, and social positioning variables (predictors) were measured at baseline. We computed a reliable change index (outcome) using the Rey Auditory Verbal Learning Test (RAVLT). RESULTS: Older age and some health considerations (e.g., higher body mass index, low hearing) were associated with a greater decline in memory over the three-year period. In contrast, some physical activity and better self-rated general health were associated with improvements in memory. Having a hobby and better perceived social standing were associated with greater memory improvement. Social identities who experience minority stress (sexual orientation, gender identity, and race) did not predict change in memory. DISCUSSION: Altogether, these results contribute to a growing body of evidence that points to older members of minoritized communities exhibiting initial differences in cognitive functioning (i.e., cross-sectional differences) but not more rapid cognitive aging.

Religion/Spirituality, Mental Health, and the Lifespan: Findings from a Representative Sample of Canadian Adults.

Theories of adult development and aging suggest that older adults turn towards religion and spirituality (R/S) to increase meaning and purpose in life, and to assist in coping with adverse experience. We sought to examine the relationship between R/S and positive mental health and mental illness (i.e., psychological distress) in adulthood, and to determine the potential moderating role of age. Data from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH), a national population health study, were used. A multivariable linear regression model revealed a significant R/S by age interaction for positive mental health (p = 0.001). Although R/S was associated with positive mental health among all participants, there was a stronger relationship between R/S and positive mental health for older adults. No statistically significant relationship between R/S and psychological distress was observed. Findings highlight the importance of R/S to positive mental health across the adult lifespan. The differential relationships among R/S, positive mental health, and mental illness underscore the utility of using the dual-continua of mental health and mental illness in order to understand their respective determinants.

Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada.

BACKGROUND: Very little research has described risk of suicidal ideation and suicide attempt among transgender youth using high-quality, nationally representative data. We aimed to assess risk of suicidality among transgender and sexual minority adolescents in Canada. METHODS: We analyzed a subsample of adolescents aged 15-17 years from the 2019 Canadian Health Survey on Children and Youth, a nationally representative, cross-sectional survey. We defined participants' transgender identity (self-reported gender different from sex assigned at birth) and sexual minority status (self-reported attraction to people of the same gender) as exposures, and their self-reported previous-year suicidal ideation and lifetime suicide attempt as outcomes. RESULTS: We included 6800 adolescents aged 15-17 years, including 1130 (16.5%) who indicated some degree of same-gender attraction, 265 (4.3%) who were unsure of their attraction and 50 (0.6%) who reported a transgender identity. Compared with cisgender, heterosexual adolescents, transgender adolescents showed 5 times the risk of suicidal ideation (95% confidence interval [CI] 3.63 to 6.75; 58% v. 10%) and 7.6 times the risk of suicide attempt (95% CI 4.76 to 12.10; 40% v. 5%). Among cisgender adolescents, girls attracted to girls had 3.6 times the risk of previous-year suicidal ideation (95% CI 2.59 to 5.08) and 3.3 times the risk of having ever attempted suicide (95% CI 1.81 to 6.06), compared with their heterosexual peers. Adolescents attracted to multiple genders had 2.5 times the risk of suicidal ideation (95% CI 2.12 to 2.98) and 2.8 times the risk of suicide attempt (95% CI 2.18 to 3.68). Youth questioning their sexual orientation had twice the risk of having attempted suicide in their lifetime (95% CI 1.23 to 3.36). INTERPRETATION: We observed that transgender and sexual minority adolescents were at increased risk of suicidal ideation and attempt compared with their cisgender and heterosexual peers. These findings highlight the need for inclusive prevention approaches to address suicidality among Canada's diverse youth population.

Prospective Associations between Physical Activity and Memory in the Canadian Longitudinal Study on Aging: Examining Social Determinants.

OBJECTIVES: To examine associations between physical activity (PA) and prospectively assessed memory in a cohort of cognitively healthy adults, after accounting for understudied social determinants. METHODS: We used data from the Canadian Longitudinal Study on Aging (CLSA). PA (exposure) and memory (outcome) were assessed using validated measures in 2013-2015 and 2015-2018, respectively. Respondents reported their daily number of hours spent engaging in five different PAs. We conducted multiple imputation and used linear regression (n = 41,394), adjusting for five categories of covariates: demographics, sensory health characteristics, health behaviors, health status, and social determinants (sex/gender, education, income, social support, perceived social standing, race, and sexual orientation). RESULTS: In crude models, nearly every intensity and duration of PA was associated with better memory. In fully adjusted models, protective associations were attenuated; however, some associations held: all durations of walking, most durations of light activities, moderate activities for ≥1 hour, and strenuous activities for 1 to <2 hours. DISCUSSION: Some forms of PA may be associated with better memory. The benefits of higher intensity PA may only be realized after social determinants are addressed.

Adverse childhood experiences and onset of migraine in Canadian adolescents: A cohort study.

BACKGROUND: Adverse childhood experiences (ACEs) are cross-sectionally associated with headache, including migraine, in pediatric populations. OBJECTIVE: The objective of this study was to determine whether ACEs are prospectively associated with incident health-professional diagnosed migraine and prevalence of non-migraine frequent headache in adolescence, either directly or indirectly through symptoms of depression and anxiety. METHODS: We used data from the National Longitudinal Survey of Children and Youth, a Canadian cohort study that followed children aged 0/1 at baseline, and the person most knowledgeable about them (PMK) until the child reached adolescence. The PMK reported on 14 ACEs (e.g., parental death) when the child was 4/5 and 6/7 years, and symptoms of depression and anxiety in late childhood (age 8/9 years), using a validated tool. Migraine (primary outcome) was ascertained via PMK report of a health-professional diagnosis, and non-migraine frequent headache (>1 time per week) was adolescent self-report, both measured at age 14/15. We estimated direct and indirect effects (IEs) on the log-odds scale through symptoms of depression and anxiety (mediator). We adjusted for sex, parental migraine, and economic deprivation. The analytic sample sizes were: n = 2058 (migraine) and n = 1730 (frequent headache). RESULTS: There were nunweighted  = 71 respondents with migraine (3.4%, 71/2058) and nunweighted  = 204 with non-migraine frequent headache (11.8%, 204/1730). Most respondents experienced no ACEs (weighted percentage = 55.7), followed by 1 ACE (weighted percentage = 34.7) and greater than or equal to two ACEs (weighted percentage = 9.6), respectively. There were direct associations between experiencing one (odds ratio [OR] = 1.71, 95% confidence interval [CI]: 1.01-2.87) and equal to or greater than two (OR = 2.33, 95% CI: 1.13-4.80) ACEs and migraine, but not for non-migraine frequent headache. There were no indirect relationships through symptoms of depression and anxiety for migraine (1 ACE: OR = 1.06, 95% CI: 0.99-1.13 and ≥2 ACEs: OR = 1.11, 95% CI: 0.98-1.28) or non-migraine frequent headache (1 ACE: OR = 0.99, 95% CI: 0.95-1.03 and ≥2 ACEs: OR = 0.98, 95% CI: 0.90-1.07). CONCLUSIONS: ACEs may confer an increased risk of migraine onset in adolescence. The association was not explained by symptoms of depression and anxiety in late childhood.

The gendered relationship between illicit substance use and self-harm in university students.

PURPOSE: To estimate associations between multiple forms of substance use with self-harming thoughts and behaviours, and to test whether gender is an effect modifier of these associations, both independently and along with perceived risk of cannabis use. METHODS: Data were drawn from the 2018 Norwegian Students' Health and Wellbeing Study (SHoT 2018). A national sample of n = 50,054 full-time Norwegian students (18-35 years) pursuing higher education completed a cross-sectional student health survey, including questions on past-year self-harm: non-suicidal thoughts of self-harm, non-suicidal self-harm, suicidal thoughts, and suicide attempt. Students reported their frequency of past-year alcohol use (range: never to ≥ 4 times/ week), illicit substance consumption, and perceived risk of cannabis use. The AUDIT and CAST screening tools measured problematic alcohol and cannabis consumption, respectively. We used logistic regression modelling adjusted for age, symptoms of depression and anxiety, and financial hardship (analytic sample range: n = 48,263 to n = 48,866). RESULTS: The most frequent alcohol consumption category (≥ 4 times/ week) was nearly always associated with more than a two-fold increased likelihood of self-harm. Less frequent alcohol consumption was associated with reduced odds of suicidal thoughts [monthly or less: OR = 0.87 (95% CI: 0.75-1.00), 2-4 times/month: OR = 0.79 (95% CI: 0.69-0.91), and 2-3 times/ week: OR = 0.83 (95% CI: 0.71-0.98)]. Problematic alcohol consumption was associated with most outcomes: odds ranging from 1.09 (95% CI: 1.01-1.18) for suicidal thoughts to 1.33 (95% CI: 1.00-1.77) for suicide attempt. There was evidence of multiple illicit substance by gender interactions: consumption of all but one illicit substance category (other drug use) was associated with all four forms of self-harm for women, but findings among men were less clear. Among men, only one illicit substance category (stimulant) was associated with most forms of self-harm. Women, but not men, who perceived cannabis use as a health risk were more likely to experience non-suicidal thoughts as cannabis consumption increased, and with harmful consumption patterns. CONCLUSION: Frequent alcohol consumption is associated with increased risk of self-harm and suicidality for young women and men. Associations between illicit substance use and self-harm and suicidality appear stronger in women compared to men.

Correlates of Memory and Executive Function in Middle-Aged and Older Adults in the CLSA: A Minority Stress Approach.

OBJECTIVES: Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years. METHODS: Data were drawn from the baseline of the Canadian Longitudinal Study on Aging, a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing). RESULTS: Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking, and fruit/vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function. DISCUSSION: These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.

Personality traits and fears of death and dying predict ageism.

Ageism, or the discriminative attitudes toward specific age groups, often older adults, is a common prejudice with many negative consequences. This study explored the relationships between personality, fears of death and dying, and subscales of ageism (i.e., Avoidance, Discrimination, and Antilocution). Participants (N = 436) completed measures of personality, death and dying fears, and ageism. Multiple linear regressions showed that agreeableness, openness, and fearing others' death were negatively associated with ageism, whereas fearing the dying process of others was positively associated with ageism. This study demonstrates the distinct effects of personality and fears of death and dying on ageism.

Sexual orientation as a social determinant of suicidal ideation: A study of the adult life span.

OBJECTIVE: Rates of suicide attempts are highest among younger ages and women, and especially elevated among sexual minorities (lesbian, gay, and bisexual [LGB] people). We examined the prevalence of lifetime suicide ideation among sexual minorities and sought to determine whether this relationship depended on age and gender. METHOD: Using data from the Annual Component of the 2015-2016 Canadian Community Health Survey (CCHS), participants were asked whether they had seriously contemplated suicide (lifetime suicidal ideation: yes/no). In adjusted multiple logistic regression analyses, we entered a sexual orientation by gender and age (three-way) interaction. RESULTS: There was evidence of an interaction between sexual orientation, gender, and age on lifetime suicidal ideation (Wald χ2 : p = 0.009); the strength of the relationship between sexual orientation and suicidal ideation varied by gender and age. Lesbian/gay and bisexual respondents of both genders were more likely to report suicidal ideation across the life span, when compared to heterosexuals. This finding was strongest for bisexual respondents. CONCLUSION: The results highlight the relevance of sexual orientation as a social determinant of lifetime suicidal ideation. Suicide prevention and surveillance efforts should take into consideration that sexual minorities, especially bisexual persons, disproportionately consider harming themselves when compared to the heterosexual population.

Asceticism, perfectionism and overcontrol in youth with eating disorders.

PURPOSE: Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs. However, as limited evidence exists in adolescents, the aim of the present study was to examine these links in a clinical sample of adolescents with EDs. METHOD: A retrospective chart review was conducted on 178 adolescents (91% females; Mage = 15.73 years, SD = 1.31) receiving services at a tertiary care pediatric ED program. An examination of variability in mean levels of perfectionism, asceticism, and overcontrol across ED symptom groups (restrictive and binge/purge ED subtypes) was conducted to learn of diagnostic differences, while correlations were used to explore the association of these personality traits with comorbid anxiety and depressive symptoms. Hierarchical linear regression was used to assess whether overcontrol was related to length of stay (LOS) in an inpatient program. RESULTS: Results indicated that adolescents with binge-purge symptoms had higher levels of perfectionism, asceticism and overcontrol compared to those with restrictive symptoms, and that greater levels of perfectionism, asceticism and overcontrol were associated with elevated depression and anxiety symptoms. Additionally, overcontrol predicted greater LOS in the inpatient ED program. CONCLUSION: Results suggest the importance of assessing, monitoring and targeting overcontrol in treatment for adolescents with EDs given its impact on comorbid symptoms and LOS. LEVEL OF EVIDENCE: Level III, evidence obtained from case-control analytic studies.

Health trajectories of children with severe obesity attending a weight management program.

PURPOSE: The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health. METHODS: This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels. RESULTS: The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%. CONCLUSIONS: This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.

Differential Effects of Social Support by Sexual Orientation: A Study of Depression Symptoms Among Older Canadians in the CLSA.

This study examined differences in symptoms of mental illness, specifically depression, by sexual orientation and examined the protective role of social support among lesbian, gay, and bisexual (LGB) older Canadians. Data were drawn from the Canadian Longitudinal Study on Aging, a national study of adults aged 45-85 years at baseline (n = 46,157). We examined whether the effect of sexual orientation on depression symptoms was moderated by four types of social support: emotional/informational support, affectionate support, tangible support, and positive social interaction. LGB identification was associated with increased depression symptoms relative to heterosexual participants. After adjustment for covariates, bisexual identity remained a significant predictor of depression symptoms. Low emotional/informational social support was associated with increased depression symptoms, an effect that was most pronounced for lesbian and gay participants. The findings contribute to the growing body of research on the mental health of older LGB people.

The Role of Positive Health Behaviors in the Relationship Between Early Life Stress and Migraine.

BACKGROUND: The use of diet and physical activity in alleviating the burden of migraine is unclear, therefore, more scientific study on the role of positive health behaviors in migraine management is needed. OBJECTIVE: To explore the potential moderating influence of positive health behaviors on the early life stress-migraine relationship in a sample of the Canadian adult population. METHODS: This study used data from the 2011-2012 Canadian Community Health Survey - Annual Component, a National cross-sectional survey. Adults ≥18 years of age residing in British Columbia were surveyed about stressors experienced as children/teenagers (eg, parental divorce and substance abuse exposure). Migraine was self-report of health-professional diagnosis. Positive health behaviors were measured using an index of transportation and leisure time physical activity, and self-reported frequency of vegetable and fruit consumption. Population survey weights were employed throughout and analytic models were adjusted for known confounders (nunweighted  = 11,910). RESULTS: The weighted prevalence of migraine was 9.7% (95% CI: 9.1%, 10.2%). Odds of migraine increased as number of stressors increased: 1 early life stressor (OR = 1.18, 95% CI: 1.01, 1.39), and ≥ 2 early life stressors (OR = 1.51, 95% CI: 1.29, 1.76), compared to no stress. There was evidence of effect modification by physical activity (χ2 (4) = 16.02, P < .001). The association between 1 early life stressor and migraine was lower for those who were physically active (moderately active: OR = 1.20, 95% CI: 0.90, 1.61; active: OR = 0.82, 95% CI: 0.61, 1.11). This difference was not apparent for those who experienced 2 or more early life stressors (moderately active: OR = 1.67, 95% CI: 1.28, 2.17; active: OR = 1.55, 95% CI: 1.21, 1.99). Across all levels of early life stress, physically active respondents had lower odds of migraine than moderately active respondents. There was no effect modification by vegetable, fruit, and total fruit/vegetable consumption. CONCLUSIONS: Stressors experienced early in life are associated with migraine, and physical activity may ameliorate this relationship, particularly for those with exposure to a minimal level of early life stress. A higher dose of physical activity may yield greater benefit than a less intensive dose (ie, moderate activity level). However, the cross-sectional nature of this study precludes us from inferring causality, and future investigation requires prospectively collected data.

Canadians Who Care: Social Networks and Informal Caregiving Among Lesbian, Gay, and Bisexual Older Adults in the Canadian Longitudinal Study on Aging.

Canada is experiencing population aging and evidence on the provision of care is based on data collected from majority populations. This analysis compared social networks and patterns of care provision between heterosexual and lesbian, gay, and bisexual (LGB) Canadians between the age of 45 and 85 years. Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), a large national study of health and aging. The results from analysis of baseline data showed that LGB participants were less likely to have children and reported seeing their friends more recently than heterosexual participants. Gay and bisexual men were more likely to provide care support in comparison to heterosexual men. LGB participants were more likely to provide care to friends. The results highlight the importance of considering distinct social networks in the development of policy and practice approaches to support a diverse aging population.

Bingeing, Purging, and Suicidal Ideation in Clinical and Non-Clinical Samples of Youth.

Suicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.

Characteristics and clinical trajectories of patients meeting criteria for avoidant/restrictive food intake disorder that are subsequently reclassified as anorexia nervosa.

OBJECTIVE: To examine the initial assessment profiles and early treatment trajectories of youth meeting the criteria for avoidant/restrictive food intake disorder (ARFID) that were subsequently reclassified as anorexia nervosa (AN). METHOD: A retrospective cohort study of patients assessed and treated in a tertiary care eating disorders (ED) program was completed. RESULTS: Of the 77 included patients initially meeting criteria for ARFID, six were reclassified as having AN (7.8%) at a median rate of 71 days after the first assessment. Patients in this cohort presented at very low % treatment goal weight (median 71.6%), self-reported abbreviated length of illness (median 6 months), and exhibited low resting heart rates (median 46 beats per minute). Nutrition and feeding focused worries related more to general health as opposed to specific weight and shape concerns or fears at assessment in half of those reclassified with AN. Treatment at the 6-month mark varied among patients, but comprised family and individual therapy, as well as prescription of psychotropic medication. CONCLUSION: Prospective longitudinal research that utilizes ARFID-specific as well as traditional eating disorder diagnostic measures is required to better understand how patients with restrictive eating disorders that deny fear of weight gain can be differentiated and best treated.

Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study.

Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.