Mental Health Education and Utilization Among Patients with Vestibular Disorders.

To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate's degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.

Weight Bias Internalization and Psychosocial, Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations.

Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95-65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.

A meta-analysis of associations between weight bias internalization and conceptually-related correlates: A step towards improving construct validity.

Weight bias internalization (WBI), a process of weight-based self-devaluation, has been associated with adverse mental and physical health. However, there are limitations with the existing conceptualization and operationalization of WBI that raise questions about the implications of this evidence-base. To address these limitations, the present study investigated the construct validity of WBI by conducting a meta-analysis of associations between WBI (as currently operationalized) and conceptually-related correlates. Studies identified through October 2021 that provided zero-order correlations for associations between WBI and conceptually-related constructs were examined. Meta-regression determined whether these associations differed across WBI measures and demographic (age, sex/gender, race, BMI) and study-level (publication status, sample type, study quality) moderators. Data for 128 (sub)samples were identified (Msample size = 477.83, SD = 1679.90; Mage = 34.46, SD = 12.17; range = 10.21-56.60). Greater WBI exhibited large to very large associations with factors suggested to have considerable overlap with this construct (negative and positive body image, self-devaluation), general and weight-specific experiential avoidance, and individuals' anticipation of future weight stigma. Associations varied for other constructs that have been differentially included in conceptualizations of WBI (endorsing weight bias, weight stigma stereotype awareness, weight stigma experiences), and via measurement-related, demographic, and study-level factors. These findings provide important information that can advance WBI conceptualization and measure-refinement.

Using the acquired preparedness model to explore the role of eating expectancies and impulsivity in binge eating.

The acquired preparedness (AP) model of eating disorder (ED) risk suggests transaction between impulsive traits and eating expectancies, though there remains a lack of research investigating distinct facets of impulsivity within this framework. This study examined how different facets of impulsivity moderate associations between eating expectancies and binge-eating severity in daily life. Women with binge-eating symptoms (N = 40) completed surveys followed by 10 days of ecological momentary assessment (EMA). Generalized estimating equations examined the independent and interactive effects of impulsivity facets and eating expectancies on EMA-measured binge-eating severity. Significant interactions were found between eating expectancies and emotional and behavioral impulsivity, but not a cognitive facet. Results suggest that among women high in emotional impulsivity, those with greater eating expectancies report higher binge-eating severity. Conversely, among those with lower behavioral impulsivity, those with lower eating expectancies report lower binge-eating severity. Future prospective work is needed with non-clinical samples.

Development and initial validation of an underreporting of Disordered Eating Behaviors Scale.

The purpose of this study was to develop the Underreporting of Disordered Eating Behaviors Scale (UDEBS) to detect attempts by respondents to underreport eating patterns that reflect symptoms of an eating disorder. In "Study 1", the scale and validity measures were administered via an online survey to 692 undergraduates. In "Study 2", these measures were administered to 810 undergraduates using a simulation design where participants were randomized to four conditions: (1) answering as truthfully as possible, or as if they are trying to hide (2) Binge Eating Disorder (BED), (3) Anorexia Nervosa (AN), or (4) Bulimia Nervosa (BN). "Study 1" results suggested that men and women have divergent UDEBS distributions and item endorsement rates; therefore, separate analyses were performed by gender. Individuals who scored above one standard deviation (SD) on the UDEBS reported less body dissatisfaction and disordered eating (ps < 0.05) than those who scored one SD below. In "Study 2" women who were instructed to hide an eating disorder reported significantly higher UDEBS scores than women instructed to answer truthfully. There were no significant differences between conditions for men. The final 15-item scale indicated that women who complied with instructions to underreport produced scores 1.45 (BN) to 1.72 (AN) times greater than the truthful responding condition. This novel scale can potentially assist in detecting women who underreport in relation to disordered eating, which may be useful in research and clinical contexts where underreporting is a concern. Future research is needed with men and clinical samples.Level I Evidence obtained from an experimental study.

Evaluating study procedure training methods for a remote daily diary study of sexual minority women.

BACKGROUND: Ecological momentary assessment (EMA) methods can be used to remotely assess physical and mental health in daily life for hard-to-reach, marginalized, and geographically dispersed populations in the U.S., such as sexual minority women (e.g., lesbian, bisexual). However, EMA studies are often complex, and engaging participants from afar can be a challenge. This study experimentally examined whether adding videos to written recruitment materials would improve consent rates, reduce dropout rates, and improve survey completion rates for an online daily diary study. METHODS: As part of a 2-week study of same-sex female couples' health, 376 women ages 18-35 were recruited from across the U.S. using a market research firm. Couples were randomized to an introductory information condition (written + video materials or written-only materials) prior to informed consent. RESULTS: Overall, 97.1% of eligible women reviewed introductory materials and of these 96.7% consented; consent rates did not differ by condition (written + video: 97.1%, written-only: 97.1%). Dropout rates were low (5.4%) and survey completion rates were high (90.4% of surveys completed); there were no group differences for study dropout (written + video: 3.6%, written-only: 7.0%) or survey completion (written + video: 92.5%, written-only: 88.4%). Data from women randomized to receive videos indicated more than half (53.3%) did not watch any of the five videos in full. However, among those who viewed the videos, time spent watching videos, watching more videos in full, and watching at least one video in full were each positive associated with survey completion rates. CONCLUSIONS: In summary, we had high consent rates, low dropout rates, and high survey completion rates regardless of video instructions. Although sexual minority women can be hard to reach, our potential participants appeared highly motivated to take part in research, and thus video recruitment materials were not necessary to improve participation. Future experimental research to maximize EMA study design and implementation could be important for populations less inclined to participate in EMA studies, or who are less familiar with research.

Examining the ecological validity of the Power of Food Scale.

PURPOSE: Appetite for palatable foods may impact eating-related behaviors in everyday life. The present study evaluated the real-world predictive validity of the Power of Food Scale (PFS) using ecological momentary assessment (EMA). METHODS: 30 women who reported binge eating completed the PFS and related measures. Subsequently, during a 14-day assessment period, participants completed five daily EMA surveys of appetite and binge eating via text message and web. RESULTS: Results of generalized estimating equations showed that higher PFS scores were associated with higher momentary levels of hunger, eagerness to eat, and urge to eat but were unrelated to fullness, preoccupation with thoughts of food, and binge eating. CONCLUSION: This study supported the ecological validity of the PFS by demonstrating its association with momentary measures of appetite in everyday life using EMA. Although the PFS may not be predictive of binge eating, future research should investigate PFS as a dispositional moderator, and explore associations between the PFS and overeating (i.e., binge eating without the loss of control component) and loss of control eating in non-clinical samples. LEVEL OF EVIDENCE: Level IV, multiple time series.

Gender and Black-White Race Differences in Young Adult Exercise Dependence Prevalence and Associated Disordered Eating.

Purpose: Exercise dependence, an unhealthy preoccupation with exercise that results in physiological and psychological symptoms, may be particularly prevalent among college students given sociocultural exercise and body ideals in this population. Yet few studies have examined this phenomenon in diverse college samples. The aims of the present study were to examine gender and Black-White race differences in the prevalence of exercise dependence and associated disordered eating. Method: Undergraduates (N = 839) completed online measures of exercise dependence and disordered eating. Chi square tests were used to test for differences in prevalence, and linear regression was used to examine race and gender moderating effects on the exercise dependence-disordered eating association. Results: More men reported exercise dependence symptoms than women. More White participants reported symptoms than Black participants. Of the four gender and race combinations examined, White men had the highest proportion and Black women the lowest proportion experiencing symptoms. Gender, but not race, moderated the exercise dependence-disordered eating association. Conclusions: Although more men experience exercise dependence symptoms, women experience stronger associations between exercise dependence symptoms and disordered eating. The number of students who reported exercise dependence symptoms underscores the need for further research in this population and the development of culturally sensitive interventions.

Changes in disordered eating behaviors over 10 or more years: A meta-analysis.

OBJECTIVE: The present meta-analysis evaluated changes in individuals' risk of engaging in distinct disordered eating behaviors (DEBs) in the long-term. METHOD: Longitudinal studies assessing changes in DEBs via ≥2 assessments with a time lag of ≥10 years were included. Risk ratios were calculated for baseline to 10-14.9-year (M = 11.04) follow-up and baseline to ≥15-year (M = 18.62) follow-up changes in the use of binge eating, multiple purging, self-induced vomiting, laxatives, diuretics, diet pills, compensatory exercising, fasting/dieting, and multiple DEBs; Cohen's d was used for continuous binge-eating plus purging variable changes. Subgroup and meta-regression analyses tested whether eating disorder (ED) clinical sample versus nonclinical sample status, female versus male sex/gender, higher versus lower study bias, and baseline mean age and body mass index influenced overall effect magnitude for analyses with sufficient data. RESULTS: Seventeen studies (26 [sub]samples) were included. Overall, individuals' risk of engaging in various restrictive eating and other compensatory behaviors decreased over time and the magnitudes of risk reductions for the use of certain compensatory DEBs were larger over longer follow-up durations. Specifically, for significant DEB change models, risk reductions spanned from 20.0-39.8% for 10-year follow-up and 24.7-74.8% for ≥15-year follow-up. However, nuances were found in the nature of these DEB changes as a function of DEB type, follow-up length, ED versus nonclinical sample composition, and baseline mean age. CONCLUSIONS: These findings provide important information that can help identify treatment priorities and suggest that targeted and tailored preventative ED treatments warrant consistent implementation at the community-level, particularly for youth.

OBJETIVO: El presente metaanálisis evaluó los cambios en el riesgo de los individuos de participar en distintas conductas alimentarias anormales (DEBs, por sus siglas en inglés) a largo plazo. MÉTODO: Se incluyeron los estudios longitudinales que evaluaban los cambios en las DEBs a través de evaluaciones ≥2 con un lapso de tiempo de ≥10 años. Se calcularon los cocientes de riesgo para los cambios de seguimiento basales a 10-14.9 años (M = 11.04) y basales a ≥15 años (M = 18.62) en el uso de atracones, purgaciones múltiples, vómitos autoinducidos, laxantes, diuréticos, píldoras de dieta, ejercicio compensatorio, ayuno/dieta y múltiples DEBs; Cohen's d se usó para atracones continuos más cambios variables de purgación. Los análisis de subgrupos y de metarregresión probaron si la muestra clínica del trastorno de la conducta alimentaria (TCA) versus el estado de la muestra no clínica, el sexo/género femenino versus masculino, el sesgo de estudio mayor versus menor, y la edad media basal y el índice de masa corporal influyeron en la magnitud del efecto general para los análisis con datos suficientes. RESULTADOS: Se incluyeron 17 estudios (26 [sub]muestras). En general, el riesgo de las personas de participar en diversas conductas alimentarias restrictivas y otros comportamientos compensatorios disminuyó con el tiempo y las magnitudes de las reducciones de riesgo por el uso de ciertos DEB compensatorios fueron mayores durante períodos de seguimiento más largos. Específicamente, para los modelos de cambio de DEB significativos, las reducciones de riesgo abarcaron desde 20.0-39.8% para 10 años y 24.7-74.8% para seguimientos de ≥15 años. Sin embargo, se encontraron matices en la naturaleza de estos cambios de DEB en función del tipo de DEB, la duración del seguimiento, TCA versus composición de la muestra no clínica y la edad media basal. CONCLUSIONES: Estos hallazgos brindan información importante que puede ayudar a identificar las prioridades de tratamiento y sugieren que los tratamientos preventivos de TCA específicos y personalizados justifican una implementación constante a nivel comunitario, particularmente para los jóvenes.

Denial of disordered eating behaviors, suicide, and non-suicidal self-injury in young women.

This study assessed the unique explanatory power of denial of disordered eating in understanding non-suicidal self-injury (NSSI) and suicidality. Undergraduate women (N = 360) completed an online survey about NSSI, suicide risk, disordered eating behaviors, and denial of disordered eating. Denial of disordered eating was associated with NSSI and suicidality above and beyond engagement in disordered eating alone and demographic covariates. This study provided support that denial of disordered eating behaviors assists in understanding risk for NSSI and suicidality. Campus programing might include psychoeducation about the negative consequences of denial and emphasize the importance of disclosure to trusted confidants.

Prospective changes in disordered eating and body dissatisfaction across women's first year of college: The relative contributions of sociocultural and college adjustment risk factors.

Sociocultural models have consistently been used to explain the etiology of disordered eating (DE) and body dissatisfaction (BD) among female college students, but less is known about how college adjustment factors, such as missing friends from home and stress about academic performance, relate to the progression of female students' DE and BD during the transition into college. The present study examined changes in DE thoughts and BD during the first year of college by merging the college adjustment and DE fields to evaluate the comparative impact of the two areas of research. Female undergraduates (N = 119) reported on DE risk factors, college adjustment factors, DE thoughts, and BD during their first (Time 1) and second (Time 2) semesters of college. Hierarchical regressions controlling for Time 1 outcome variables found that perceived stress at Time 1 enhanced the prediction of increases in DE severity beyond DE risk factors alone, suggesting that efforts targeted at making the transition to college easier may assist in decreasing DE severity for young women.

Is use of social networking sites associated with young women's body dissatisfaction and disordered eating? A look at Black-White racial differences.

Maladaptive patterns of social networking site (SNS) use, such as excessive reassurance seeking, are associated with body dissatisfaction and disordered eating. However, it is unclear how these processes play out among different racial groups. This study examined racial differences in SNS use and body dissatisfaction and disordered eating. Black (n=445) and White (n=477) female undergraduates completed online measures of SNS use (frequency and reassurance seeking), body dissatisfaction, and disordered eating. Black women reported less body dissatisfaction, marginally less disordered eating, and less frequent Facebook use than White women; there were no race differences in SNS reassurance seeking. More frequent Facebook use was associated with more body dissatisfaction (but not disordered eating), and more SNS reassurance seeking predicted both more body dissatisfaction and disordered eating. Associations were not moderated by race, suggesting maladaptive SNS use may have negative consequences for both Black and White women.