Shiri Sadeh-Sharvit

Ethnic disparities in mental health treatment gap in a community-based survey and in access to care in psychiatric clinics

Background: Contrasting social status of ethnic groups differentially impacts the use of psychiatric services, including in Israel, despite its universal health system. However, relevant studies are limited. Aims: To examine ethnic differences in mental health treatment gap and in access to specialized care. Methods: Data were gathered from two sources. Study I included Mizrahi (Jews of North African/Asian origin, socially disadvantaged, n = 136) and Ashkenazi (Jews of European American origin, socially advantaged, n = 69) who were diagnosed with common mental disorders in the preceding 12 months in the Israeli component of the World Mental Health Survey. Study II included Mizrahi (n = 133) and Ashkenazi (n = 96) service users entering ambulatory mental health care. Results: Study I showed that the treatment gap was larger among Mizrahi compared with Ashkenazi respondents (28% standard error (SE) = 4.1 and 45% SE = 6.2, respectively, sought services) following adjustment for sociodemographic confounders (adjusted odds ratio (AOR) = 2.28, 95% confidence interval (CI) = 1.1–4.8). Study II showed that the access to specialized care lagged over a year among 40% of service users of both ethnic groups. No significant ethnic differences emerged in variables related to delay in accessing care. Conclusions: Treatment gap was larger among ethnically disadvantaged compared with the advantaged group. However, once in treatment, service users of both ethnic groups report similar barriers to care.

Maternal eating disorder history and toddlers’ neurodevelopmental outcomes: A brief report

ABSTRACT This study explored the neurodevelopmental outcomes of toddlers whose mothers have eating disorder histories and the contribution of maternal eating and comorbid psychopathology to the children’s cognitive functioning. Twenty-nine mothers with prenatal eating disorders and their toddlers (18–42 months old) were compared to a case-control matched group of mothers with no eating psychopathology and their toddlers. Measures included current maternal eating and co-occurring psychopathology, and a developmental assessment of each child. The children of mothers with eating disorders showed delayed mental and psychomotor development. Severity of maternal eating disorder symptoms emerged as a significant predictor of child development, but other maternal psychopathology did not. Findings suggest that maternal eating disorder history may play a unique role in the development of neurodevelopmental functions in their children.

Parent-based prevention program for the children of mothers with eating disorders: Feasibility and preliminary outcomes

ABSTRACT The children of mothers with eating disorders are at high risk of feeding and eating problems and broader developmental difficulties. The Parent-Based Prevention (PBP) of eating disorders targets risk factors and facilitates behavioral change in parents to mitigate potentially negative outcomes of their children. This pre/post uncontrolled study evaluated the feasibility and preliminary outcomes of PBP. PBP was found to be a feasible intervention for mothers with eating disorders and their spouses, with satisfactory retention rates. A total of 16 intact families were assessed at three measurement points for parents’ feeding practices, child outcomes, and maternal functioning. Both parents reported improved feeding practices as well as more positive perceptions of their children in comparison to baseline. These pilot findings suggest that PBP is linked with decreased risk of eating and mental problems among the offspring of mothers with eating disorders.

The Impact of Maternal Eating Disorders and Spousal support on Neurodevelopmental Trajectories in their Toddlers

The early cognitive development of the toddlers of mothers with eating disorders is compromised. This exploratory study examined the role that the psychological and support resources of mothers with eating disorders may play in the developmental delay found in their toddlers. Twenty-nine mothers with prenatal eating disorders and their toddlers (18-24 months old) were case-control matched with no eating psychopathology mother-child dyads. Measures included maternal stress and organization of the home environment, spousal and extended social support, as well as a developmental assessment of the children. Results indicated that mothers with eating disorders history had higher parenting-related stress and poorer adaptation of the home setting to match the child’s developmental needs. Extended social support was associated with improved child outcomes only in the case of low maternal stress, while spousal support was not associated with child outcomes regardless of maternal stress levels. These preliminary findings suggest that poorer maternal functioning and spousal support in mothers with eating disorders are linked with no adaptive neurodevelopmental trajectories in their young children. Future preventive intervention programs should focus on improving maternal, spousal and child functioning in these patients.

The interactions of mothers with eating disorders with their toddlers: identifying broader risk factors

ABSTRACT The connection between maternal eating disorders and feeding and eating problems among their children has been substantially demonstrated. This pilot study focused on the interactions between mothers with eating disorders and their toddlers in non-feeding situations. Twenty-eight dyads of mothers with prenatal eating disorders and their toddlers were compared to a case-matched control group with no eating disorder. Maternal current eating and co-occurring psychopathology, children’s symptoms and mother–child interactions were measured. Mothers with eating disorders were less sensitive to their children, tried to control their children’s behaviors more, and were less happy during mother–child interactions. The children in the maternal eating disorder group were rated as less responsive to their mothers and their mothers also reported more behavioral problems than those in the control group. Findings imply that maternal eating disorders may be linked with a wide range of adverse maternal and child behaviors beyond those associated with eating.

Subgrouping the users of a specialized app for eating disorders

ABSTRACT Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.

Mothers with Eating Disorders: The Environmental Factors Affecting Eating-Related Emotional Difficulties in Their Offspring

Eating disorders (EDs) have been explained by the Object Relations psychodynamic theory as resulting from maturation fears and separation difficulties in the origin family. The aim of this study was to understand from an Object Relations perspective, how mothers with EDs function with their toddlers, particularly with regard to disordered eating-related behavior. Twenty-nine dyads of mothers with EDs who had toddlers participated in a semi-structured interview, by which the environmental mechanisms of feeding, eating and emotional transactions were uncovered. The interviews revealed that some of the early needs of the mothers with EDs, that were unmet by their own parents, along with exaggerated anxiety about their children’s eating and weight were associated with maternal accounts of EDs contents and practices, markedly with regard to daughters. The mothers’ internal world was found to influence maternal practice in inadequate feeding of their toddlers. The findings imply that children of mothers with EDs should be viewed as potentially the next generation to express emotional difficulties through disrupted eating and body image.

Correlates of suicidal ideation in college women with eating disorders

OBJECTIVE To identify the correlates of suicidal ideation (SI) in a large sample of college women with eating disorders (EDs). METHOD A total of 690 female college students from 28 US colleges who screened positive for an ED, with the exception of anorexia nervosa, were assessed for SI. Univariate logistic regression analyses were performed to determine independent correlates of SI. Measures included: ED psychopathology, ED behaviors (i.e., binge eating, vomiting, laxatives, compulsive exercise), current co-morbid psychopathology (i.e., depression, anxiety, insomnia), weight/shape concerns, ED-related clinical impairment, and body mass index (BMI). All significant variables were included in a backward binary multivariate logistic regression model to determine which variables were most strongly associated with SI. RESULTS A total of 25.6% of the sample reported SI. All variables examined were significantly independently associated with SI, with the exception of compulsive exercise. Depression, anxiety, and vomiting remained as significant correlates of SI in the multivariate logistic regression model. DISCUSSION ED screening on college campuses should assess for suicidality, and prevention and treatment efforts should target vomiting and co-morbid depression and anxiety symptoms to reduce risk of SI for high-risk individuals.