Rasmus Isomaa

The prevalence, incidence and development of eating disorders in finnish adolescents - a two-step 3-year follow-up study.

OBJECTIVE To investigate the prevalence, incidence and development of eating disorders and subclinical eating pathology. METHOD A two-step three-year follow-up study on eating disorders in adolescence (N = 595) was conducted in western Finland. A screening questionnaire followed by a semi-structured interview was used to determine the prevalence, incidence and development of eating disorders. RESULTS The lifetime prevalence rates for females age 18 were 2.6% for anorexia nervosa (AN), 0.4 for bulimia nervosa (BN), 7.7% for AN-NOS, 1.3% for BN-NOS and 8.5% for subclinical eating disorders. No prevalent case of DSM-IV eating disorders was found among the male participants. The incidence rate of any eating disorder in females age 15-18 was 1641 per 100 000 person-years. CONCLUSION Eating disorders are relatively common in female adolescents. As many as one in five adolescent females are or have been struggling with eating disorder related issues during their teenage years.

Longitudinal concomitants of incorrect weight perception in female and male adolescents.

The aim of the present study was to analyse the longitudinal concomitants of incorrect weight perception, depressive symptoms, social anxiety, self-esteem, and eating disorders in adolescents. A prospective follow-up study on 283 female and 312 male adolescents aged 15 comprising questionnaires directed at the whole study population and subsequent personal interviews with adolescents found to be screen-positive for eating disorders, at both baseline and three-year follow-up. Body mass index was combined with weight perception to classify adolescents with incorrect weight perception. Twenty-nine percent of females incorrectly perceived themselves as overweight and 14% of males incorrectly as underweight. Incorrect weight perception was in females related to depressive symptoms, social anxiety, eating disorders, and low self-esteem. Males with incorrect weight perception experienced more social anxiety at the follow-up than their counterparts with correct weight perception. Recognition of incorrect weight perception is important for prevention of depression, social anxiety, and eating disorders.

How Low Is Low? Low Self-Esteem as an Indicator of Internalizing Psychopathology in Adolescence:

Schools are among the most important setting for preventive interventions among adolescents. There are evidence-based intervention programs for adolescents at risk for and with early signs of mental health problems but one demanding task is to detect the ones who are in need of an intervention. The aim of the present study was to analyze associations between self-esteem, depressive symptoms, and social anxiety in order to determine clinically relevant cut-points for male and female adolescents’ self-esteem as measured with the Rosenberg Self-Esteem Scale (RSES). The participants of the present prospective study, started in 2002-2003, were 2070 adolescents aged 15 years (1,167 girls and 903 boys) at two study sites in Finland who participated at both baseline and 2-year follow-up. Self-esteem was related to depressive symptoms and social anxiety, and the RSES was able to discriminate between cases of depression and social phobia. The present study suggests a cutoff of 25 points to classify low self-esteem in both girls and boys. Low self-esteem may function as an indicator of various forms of internalizing psychopathology. The RSES is worth further examination as a potential screening tool for adolescents in risk of psychopathology.

Obesity and eating disturbances are common in 15-year-old adolescents. A two-step interview study

A two-step interview study of eating disorders (EDs) and sub-clinical EDs in 15-year-old adolescents was carried out in western Finland. The sample consisted of all ninth graders in a well-defined catchment area (n=606, 98.2% of eligible students). In the first step, a self-report questionnaire was administered at schools regarding mental health problems and life circumstances. The questions concerning anorectic and bulimic eating pathology were formulated according to the DSM-IV diagnostic criteria of EDs. The second step consisted of a semi-structured interview Rating of Anorexia and Bulimia-Teenager version (RAB-T) to which 128 subjects were invited, on the basis of their answers to questions about eating pathology in the questionnaire. The participation rate in the interview was 88.3%. The lifetime prevalence rate for anorexia nervosa (AN) in 15-year-old girls was 1.8% and the point prevalence rate 0.7%. No cases of AN were found among the boys. All criteria fulfilling cases of bulimia nervosa (BN) were not found in our sample. High rates of AN not otherwise specified (AN-NOS; 4.9%) and sub-clinical EDs (4.9%) were found among the girls; 6.7% of girls and 0.6% of boys were regarded as being “at risk” of developing EDs. Data on height and weight are based on current measurements taken at school healthcare; 22% of boys were overweight or obese compared with 16% of girls.

And then what happened? A 5-year follow-up of eating disorder patients

Abstract Background: Eating disorders (EDs) show a varying course and outcome. Within 10 years, between half and three-quarters of patients recover from their disorder. There is, however, a lack of consensus in how to define recovery. Aims: The aim of the present naturalistic study was to assess clinical and full recovery in ED patients 5 years after initiated treatment at a specialized outpatient unit for EDs. Methods: Data was collected at three time points: after the investigation period (T1), at the end of treatment (T2) and 5 years after the beginning of treatment (T3). Data at T1 and T2 were collected from patient records, and at T3 using a questionnaire. The number of participants was 71 and response rate 78%. Results: At T3, the proportion in clinical recovery was 83.1%, with no significant differences between diagnostic groups. The proportion in full recovery, i.e. in addition to a subjective account of being fully recovered, presenting no physical, behavioural or psychological ED symptoms, was 40.8%. Conclusions: For most ED patients, outpatient treatment is sufficient to enable recovery. How to define and measure recovery still warrants discussion.

Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking

Abstract Background: Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies. Aim: We aimed to examine these associations in a large-scale follow-up study among middle adolescents. Method: We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates. Results: Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period. Conclusions: Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.

Are eating disorders and their symptoms increasing in prevalence among adolescent population

Abstract Background: A debate concerns whether eating disorders are increasing in prevalence. The role of socio-economic status (SES) for adolescent eating disorders (ED) is another matter of debate. Aims: To ascertain whether self-reported eating disorders or their symptoms have increased in prevalence in adolescent population from the early 2000s to early 2010s. Methods: A person-identifiable classroom survey, Adolescent Mental Health Cohort study, was carried out among the 9th graders in comprehensive schools in Tampere, Finland, during academic year 2002–2003, and replicated among then 9th graders during academic years 2012–2013. Eating disorders were elicited with questionnaires tailored according to DSM-IV criteria for anorexia nervosa and bulimia nervosa. Results: No changes were observed between 2002–2003 and 2012–2013 in the prevalence of anorexia and bulimia, most of the symptoms of anorexia and bulimia, or the proportion of adolescents having received treatment due to eating disorders among the girls or the boys. Eating disorders, treatment contacts due to eating disorders, and eating disorder symptoms were not systematically associated with either low or high parental socio-economic status. Conclusion: Based on this dataset, eating disorders are not increasing in the adolescent population. Adolescent eating disorders are not associated with socio-economic status of their family.

Development and preliminary validation of a Finnish version of the Eating Disorder Examination Questionnaire (EDE-Q)

Abstract Background: Eating behaviour can be viewed as a continuum, ranging from extremely restrictive to extremely disinhibited eating. Valid and reliable instruments are needed to ensure detection of individuals with risk for eating disorders (ED). Self-report methods are the most feasible, cost, and time efficient. One of the most widely used self-reports is the Eating Disorder Examination Questionnaire (EDE-Q). Aim: The aim of this study was to develop a Finnish version of the EDE-Q version 6.0 and to assess its psychometric properties in adolescents, adults, and ED patients. Methods: The present study utilized data from three different samples: adolescents (n = 242), adults (n = 133), and ED patients (n = 52). The patient group comprised different EDs, but individual ED diagnoses were not studied separately. Data was collected January 2014 through June 2015. Results: The Finnish version of the EDE-Q showed acceptable-to-excellent internal consistency on all sub-scales in all three samples and discriminated patients from healthy individuals. Female participants generally scored higher than male and sex differences were more pronounced among the younger age group. Conclusions: The Finnish version of the EDE-Q can, based on this study, be regarded as reliable, valid, and functional. Further studies are needed to evaluate the population norms and to test the validity in individual ED diagnoses.

Capturing clinically significant eating pathology in adolescence

Background and Objectives: Several large-scale studies on adolescent mental health have used questionnaire items derived from DSM-IV criteria to assess eating disorders. The aim of the present brief report was to analyse the capacity of self-reported eating disorder symptoms to capture clinically significant eating disorders. Methods: All pupils in the ninth grade (N = 606, response rate 98.2%, mean age = 15.4) of comprehensive school in a defined area were invited to participate in the study. Adolescents who reported some form of eating pathology (n = 126) were invited to an interview (RAB). Results: Anorexia based on the self-report resulted in a positive predictive value of 60.0% for lifetime and 20% for current eating disorder, when compared to the results in the RAB. No case of BN was detected by the RAB, but self-reported BN symptoms were predictive of both EDNOS and subclinical eating pathology. Conclusions: Self-reported eating disorder symptoms seem to be relatively good predictors of broadly defined eating pathology, but may result in overestimation of clinical conditions.

Body dissatisfaction and disordered eating symptoms in Finnish preadolescents

ABSTRACT To evaluate whether body dissatisfaction is associated with disordered eating symptoms in Finnish preadolescents, and to assess the moderator effects of gender and body mass index on this association. We included 10,526 9- to 12-year-old preadolescents at baseline from the Finnish Health in Teens cohort. We used the Children’s Eating Attitudes Test for assessing disordered eating symptoms and a pictoral instrument for evaluating body dissatisfaction, comparing self-assessment of wanted and current body shape. Odds ratio (OR) for disordered eating symptoms were estimated using unconditional logistic regression. A high percentage of preadolescents reported body dissatisfaction: 30.0% wanted a smaller body and 9.3% wanted a larger body. Only 2.2% of the participants had disordered eating symptoms. Preadolescents who wanted a larger (OR = 2.83; 95% confidence intervals (CI): 1.68–4.78) or smaller body (OR = 4.48; 95% CI: 3.20–6.26) had a higher risk of having disordered eating symptoms, compared to preadolescents satisfied with their body. Among preadolescents who wanted a smaller body, the effect of body dissatisfaction was more pronounced among girls (OR = 5.00; 95% CI: 3.25–7.70) than boys, and among normal-weight (OR = 6.82; 95% CI: 4.53–10.25) and underweight (OR = 23.23; 95% CI: 5.31–101.61) than overweight preadolescents. Body dissatisfaction is associated with disordered eating symptoms especially among girls, and those who are underweight and normal-weight. Our study suggests that, in the prevention of eating disorders, special attention should be given to preadolescents with body dissatisfaction.