Kevin N. Alschuler

The relationship between binge eating and weight status on depression, anxiety, and body image among a diverse college sample: A focus on Bi/Multiracial women

Binge eating is associated with a host of adverse outcomes, but little is known about sex and racial differences among those who binge eat. The present study examined sex and racial group differences in binge eating based on weight status within a college-student population. It was hypothesized that White women would endorse higher rates of binge eating, depression, anxiety, and body image dissatisfaction than other groups. Participants completed a web-based survey assessing depression, anxiety, body image, weight history, physical activity, smoking, and body mass index. Participants included White, Black, and Bi/Multiracial college students. Findings highlighted sex and racial differences based on binge eating and weight status. Notably, Bi/Multiracial women who endorsed binge eating behavior and who were overweight reported greater levels of anxiety than all other groups and greater levels of depression than White women and White men. Additionally, Bi/Multiracial women and White women who endorsed binge eating behavior and who were overweight reported greater body image dissatisfaction relative to Black women and White men. Future research should further explore the nature and impact of sex and race differences on binge eating.

The co-occurrence of pain and depression in adults with multiple sclerosis.

PURPOSE/OBJECTIVE To define the rates of pain, depression, and their co-occurrence in persons with multiple sclerosis (MS). RESEARCH METHOD/DESIGN Participants were 161 persons with MS who previously participated in research and indicated a willingness to be contacted for future studies. Data were collected via postal survey and included the Patient Health Questionnaire-9 for depressive symptoms and a numerical rating scale (0-10) for pain. Descriptive statistics, chi-square analyses, and odds ratios were calculated to describe the prevalence, difference, and likelihood of depression, pain, and their comorbidity. RESULTS Some level of pain was experienced by 73% of the sample, with 40% of the entire sample reporting moderate or worse pain severity. Clinically significant levels of depressive symptoms were reported by 22% of the sample, and 8% reported sufficient symptoms to meet major depressive episode diagnostic criteria. Of persons meeting depression criteria, 86-100% reported experiencing any pain; 67-77% of persons meeting depression criteria reported experiencing pain of at least moderate severity. Of persons experiencing any pain, 11-34% met depression criteria; 15-37% of persons experiencing pain of at least moderate severity met depression criteria. CONCLUSIONS/IMPLICATIONS Pain and depression co-occur frequently in persons with MS. However, it is more common for individuals with depression to report pain than for individuals with pain to endorse symptoms of depression. Future studies should explore the implications of this co-occurrence, such as whether these individuals experience greater levels of disability, higher medical costs, or fewer benefits from treatment than persons with either condition alone.

Coping strategies and beliefs about pain in veterans with comorbid chronic pain and significant levels of posttraumatic stress disorder symptoms

The purpose of this study was to assess differences in beliefs about pain and coping strategies employed in veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD), compared to veterans with chronic pain alone. It was hypothesized that veterans with comorbid chronic pain and significant levels of PTSD symptomatology would report higher levels of maladaptive coping strategies and beliefs about pain when compared to veterans with pain alone.

Defining mild, moderate, and severe pain in persons with multiple sclerosis.

OBJECTIVE   To identify empirically derived cutoffs for mild, moderate, and severe pain in persons with multiple sclerosis (MS). Design.  Cross-sectional survey. SETTING .  Community-based survey. PARTICIPANTS   Convenience sample of 236 individuals with MS and pain. Intervention.  Not applicable. MAIN OUTCOME MEASURES   Zero to 10 Numeric Rating Scale for pain severity (both average and worst pain) and Brief Pain Inventory for pain interference. RESULTS   The optimal classification scheme for average pain was 0-2 = mild, 3-5 = moderate, and 6-10 = severe. Alternatively, the optimal classification scheme for worst pain was 0-4 = mild, 5-7 = moderate, and 8-10 = severe. CONCLUSIONS   The present study furthers our ability to use empirically based cutoffs to inform the use of clinical guidelines for pain treatment as well as our understanding of the factors that might impact the cutoffs that are most appropriate for specific pain populations. The results of the present study also add to the existing literature by drawing similarities to studies of other populations, but also by highlighting that clear, between-condition differences may exist that warrant using different cutoffs for patients with different medical conditions. Specifically, the present study highlights that cutoffs may be lower for persons with MS than other populations of persons with pain.

Prognostic value of coping strategies in a community-based sample of persons with chronic symptomatic knee osteoarthritis.

Summary Pain coping skills are demonstrated to be prognostic factors for changes in pain and/or function in persons with knee osteoarthritis. Abstract Radiographic knee osteoarthritis (OA) is a highly prevalent condition that has been the focus of a number of studies identifying factors that are prognostic of continued or worsening pain and function. Although prior prognostic studies have identified a number of demographic, physical, and psychological factors that are predictive of outcome, minimal focus has been placed on pain coping skills as prognostic factors, despite cross‐sectional evidence suggesting that pain coping skills are associated with pain and function in knee OA. The present study reports on the use of pain coping skills as prognostic factors for changes in pain and/or function over a 1‐year period. Participants were drawn from the Osteoarthritis Initiative, a prospective longitudinal cohort study of persons recruited from the community who either had knee OA or were at high risk for developing knee OA. Data from the Coping Strategies Questionnaire were compared against 1‐year change in pain, function, or both, using established criteria for defining whether the patient got better, worse, or stayed the same over the 1‐year period. Results revealed a significant effect for praying/hoping, increased behavioral activities, and pain catastrophizing as prognostic of pain outcomes; ignoring pain and praying/hoping were prognostic of function outcomes; and increased behavioral activities and pain catastrophizing were prognostic of a combined pain and function outcome. The findings provide important new evidence regarding the potential clinical relevance of a number of pain coping responses hypothesized to influence future pain and function in persons with arthritis.

Body mass index and waist circumference in persons aging with muscular dystrophy, multiple sclerosis, post-polio syndrome, and spinal cord injury

BACKGROUND Body mass index (BMI) and waist circumference (WC) are well-understood in the general population, but are not adequately understood among persons with disabilities. OBJECTIVE To describe and compare BMI and WC among individuals with muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), and spinal cord injury (SCI). BMI scores were also compared to normative data of the U.S. population, with consideration for age, sex, and mobility limitations. METHODS Persons with MD (n = 339), MS (n = 597), PPS (n = 443), and SCI (n = 488) completed postal surveys that included self-reported BMI and WC data. NHANES data were used to compare the current sample with a representative US sample. RESULTS Participants with PPS had higher BMI than participants with MD, MS, and SCI. In addition, participants with MS had significantly higher BMI relative to participants with SCI. BMI was significantly positively associated with age, years since diagnosis, mobility, and interactions of some of these factors. Relative to the general population, BMI was lower in MD, MS, and SCI across age groups, as well as in men with PPS and women ages 60-74 years with PPS. No significant differences were identified between MD, MS, PPS, and SCI in WC. CONCLUSIONS The presence of group differences in BMI and absence of group differences in WC suggests that BMI may not accurately represent health risk in SCI, MD, and possibly MS, because of biasing elements of the conditions, such as changes in body composition and mobility limitations.

Resilience Predicts Functional Outcomes in People Aging With Disability: A Longitudinal Investigation

OBJECTIVES To investigate the links between resilience and depressive symptoms, social functioning, and physical functioning in people aging with disability and to investigate the effects of resilience on change in functional outcomes over time. DESIGN Longitudinal postal survey. SETTING Surveys were mailed to a community sample of individuals with 1 of 4 diagnoses: multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. The survey response rate was 91% at baseline and 86% at follow-up. PARTICIPANTS A convenience sample of community-dwelling individuals (N=1594; age range, 20-94y) with multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient Health Questionnaire-9 (to assess depressive symptoms) and Patient Reported Outcomes Measurement Information System (to assess social role satisfaction and physical functioning). RESULTS At baseline, resilience was negatively correlated with depressive symptoms (r=-.55) and positively correlated with social and physical functioning (r=.49 and r=.17, respectively). Controlling for baseline outcomes, greater baseline resilience predicted a decrease in depressive symptoms (partial r=-.12) and an increase in social functioning (partial r=.12) 3 years later. CONCLUSIONS The findings are consistent with a view of resilience as a protective factor that supports optimal functioning in people aging with disability.

Factors contributing to physical activity in a chronic low back pain clinical sample: a comprehensive analysis using continuous ambulatory monitoring.

Summary Chronic back pain patients indicated that a composite operant model significantly predicted physical activity as measured by actigraphy, while fear‐avoidance and pain models did not. ABSTRACT Back pain is one of the most common causes of disability in industrialized nations. Despite this, the variables that contribute to disability are not well understood and optimal measurement strategies of disability have not yet been determined. The present study sought to comprehensively assess the strongest predictors of physical activity as a proxy for disability. New patients in a chronic pain specialty clinic completed questionnaires to assess the predictors of physical activity and engaged in 5 days of home data collection wearing an accelerometer to assess physical activity in daily life, which is how disability was operationalized in this study. Analysis of repeated measures patient data revealed that, of 3 composite variables each representing a theoretical model, the model representative of operant factors significantly predicted physical activity. Subsequent analyses showed that pain sensitivity, fear avoidance, and solicitous spousal responses account for a significant amount of the variance in physical activity. These findings suggest that external sources of reinforcement or punishment may serve to influence physical behavior beyond that of internal cues such as fear avoidance or pain. Implications for treatment are discussed, including the potential benefits of specifically incorporating the patient’s sources of operant reinforcement or punishment into treatment.

Modeling Secondary Health Conditions in Adults Aging With Physical Disability

Objectives: To test a conceptual model of secondary health conditions, age, and function in persons aging with long-term physical disabilities. Methods: Surveys were collected from 1,862 adults with spinal cord injury, neuromuscular disease, multiple sclerosis, or post-polio syndrome. Structural equation modeling was used to build a model describing relationships among physical and psychosocial secondary health conditions, pain, functional impairments, chronic medical conditions, and age. Results: In total, 12 individual symptom or function domains (latent factors) were identified, grouped into 5 broader factors. Increasing age was associated with greater rates of physical and health problems and poorer function, and showed curvilinear relationships with pain and psychosocial difficulties. Discussion: These data support a biopsychosocial model of secondary health conditions in adults aging with physical disability and suggest a five-factor approach for conceptualizing secondary conditions and their impact. Results also emphasize the importance of age in symptom severity and impact.

Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy.

BACKGROUND Pain and fatigue are common symptoms experienced by persons with muscular dystrophy (MD). However, it is unclear from previous studies whether pain and fatigue have independent effects on physical functioning and depression, and whether age moderates the relationship of pain and fatigue with physical functioning and depression. OBJECTIVE This cross-sectional study aimed to describe the relationship of pain and fatigue to physical functioning and depression in persons 20-89 years old with MD. METHOD A convenience sample of 332 individuals with MD completed a questionnaire that included measures of physical functioning (PROMIS item bank items), depression (PHQ-9), pain intensity (0-10 NRS), and fatigue (0-10 NRS). RESULTS Pain and fatigue were each independently associated with physical functioning and depression. Depressive symptoms were most severe among middle-aged participants (45-64 years old) relative to older and younger participants. Physical functioning had a negative relationship with chronological age. CONCLUSIONS Symptoms of pain and fatigue are significantly and independently related to physical functioning and depression in persons with MD. Research is needed to determine if treatments that target both pain and fatigue in patients with MD have more beneficial effects than treatments that target only one of these symptoms.