Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital...

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen

Eating Disorders do not just disappear: implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood

Results of the mental health module (BELLA-study) of the nationwide German Health Interview and Examination survey for Children and Adolescents (KiGGs)

ESCAP MADRID, 22/06/2015

Beate Herpertz-Dahlmann

Bella Study


Disclosure ESCAP Madrid 2015

Since 2012

Vifor Pharma Research Grant

German Research Society (DFG) Research Grant

German Ministry for Education and Research Grant

Research

EU FP 7 Research Grant

Seite 2

Bella Study


Background

High prevalence of eating disorders (DSM-IV) in female adolescents in Western countries (point prevalence)

(Machado et al. 2007; Swanson et al. 2011)approx. 3 - 6%

Increasing incidence in adolescence (UK, primary care, 15-19 y. )

(Micali et al. 2013)

Increase by 13% from 2000 to 2009)

2/1000 girls

Second most common new onset mental health disorder in adolescence after depression (UK)

(Micali et al. 2013)

11/1000 girls

for comparison: Incidence of diabetes mellitus type 1 (UK) 0.4/1000 girls

Seite 3

Bella Study


Aim of the BELLA- study

to investigate

the stability of eating-disordered behaviour from adolescence to young adulthood;

its effect on the development of over- and underweight; its contribution to the development of mental disorders, e.g.

depression; but also vice versa: association between adolescent

psychopathology and later disordered eating and BMI

(Herpertz-Dahlmann et al. 2009; 2015)

Seite 4

Bella Study


BELLA-Study Method

• Mental health module of the nationwide German Health Interview and Examination survey for Children and Adolescents (KiGGs)

• KiGGs: Population-based randomly chosen sample of 167 sampling units in cities and communities all over Germany;

• The final KiGGS study population included 17.641 children and adolescents between birth and the age of 17;

• BELLA-study: a randomly selected subsample of 2.863 families with children aged 7–17 years

• Computer-assisted interview with the children and adolescents and one of their parents

• additional questionnaires sent and returned by mail

Seite 5

Bella Study


Populations of first and second wave of the mental health module (BELLA-study) of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

2003 – 2006 2863 baseline data (7-17 years) (48,5%♀, 51,5%♂)

1734 (60,6% ) assessed (11-17 years) (48,7%♀, 51,3%♂)

2009 – 2013 775 (44,7%) Follow-up 2nd wave

771 sufficient data (45,5 %♀, 54,5 %♂)

Dropouts: lower SESRelatively more males

Slightly lower SCOFF scores(Herpertz-Dahlmannet al., ECAP 2015)

Seite 6

Bella Study


Disordered Eating

Definition Note: symptoms do not fulfill classification criteria (DSM or ICD)

Method of assessment

SCOFF – screening questionnaire (conspicuous value: ≥ 2 )

1) Do you make yourself sick because you feel uncomfortably full? (deliberate vomiting)

2) Do you worry you have lost control over how much you eat ? (loss of control over eating)

3) Have you recently lost more than one stone in a three-month period ? (weight loss)

4) Do you believe yourself to be fat when others say you are thin (body image distortion)

5) Would you say that food dominates your life? (high impact of food on life)

Body weight and height of probands measured in person at 1rst wave, at 6-year follow-up by telephone interview, self reported weight and height of the parents

Seite 7

Bella Study


Disordered Eating and associated mental disorders

Further assessment instrumentsDepression CES-DC The Centre for Epidemiological Studies

Depression scale for Children

Anxiety SCARED Screen for Anxiety-Related Emotional Disorders questionnaire

Depression (in young adults) PHQ Patient Health Questionnnaire, depression module

Seite 8

Bella Study


Descriptive data on the BELLA- sample at baseline and follow-up

Mean SD Min. Max.

Age (Baseline) (years) 14.3 2.0 11.0 18.0

Age (Follow-up) (years) 21.0 2.2 17.1 27.0

BMI (Baseline) kg/m² 20.6 3.9 13.5 42.6

BMI (Follow-up) kg/m² 22.7 3.7 15.3 46.2

Seite 9

SES (Baseline) %

Low 18.1

Medium 49.2

High 32.7


RESULTS

Bella Study


Stability of ED behaviour and attitudes (n=771)

SCOFF ≥ 2Baseline %

SCOFF ≥ 2 follow-up %

p =

All participants 19.3 13.8 0.002

Females 26.0 17.6 0.002

Males 11.3 9.2 0.41

Seite 11

Note: Decline more pronounced in females and in those with a higher BMI

Bella Study


Course of eating disordered behaviour Relationship between SCOFF/Baseline u. SCOFF/6-year-follow-up

Seite 12

Highly significant relationship between eating disordered

behaviour in adolescence and young adulthood ( p < 0.0001)

(Poisson regression model after adjusting for age, sex, and baseline

BMI)

Bella Study


Association between eating-disordered behaviour (SCOFF-score) at baseline and BMI at follow-up

Seite 13

Participants with higher SCOFF scores at baseline were highly likely to

become overweight or obese in young adulthood

OR.1.58; p= 0.001

Controlled for baseline and parental BMI

Bella Study


Eating-disordered behaviour at baseline (SCOFF-Score) and depression at follow-up

Seite 14

Individuals with higher SCOFF-Scores in

adolescence have a higher risk for depressive

symptoms in young adulthood (p=0.0006)

Bella Study


Association between symptom patterns (single SCOFF items) at baseline and later eating disordered behaviour

% Partic.

SCOFF Follow-up

overweight Follow-up

Low weight Follow-up

Depression Follow-upPHQ

Deliberate vomiting 4.5 0.06 0.05 0.02 0.003

Loss of control over eating

23.3 < 0.0001 0.03 0.42 0.0006

Weight loss 4.8 0.05 0.11 0.28 0.48

Body image distortion 19.3 < 0.0001 0.02 0.40 0.31

High impact of food on life

21.1 0.0004 0.22 0.07 0.25

Seite 15

Bella Study


Association between depressive symptoms in adolescence and low body weight in early adulthood

Seite 16

There is a significant relationship between depressive symptoms

In adolescence and very low body weight in early adulthood

(< 3. Perzentile)OR=1.13; p=0.02

1rst BMI-Quartile

3rd BMI-Quartile

Bella Study


Summary I: Eating Disorders do not just disappear…

1. There is a decline in disordered eating behavior between adolescence and young adulthood;

2. Disordered eating in adolescence is a significant predictor of disordered eating in young adulthood.

3. Probands with more severe disordered eating have a higher probability to suffer from overweight and obesity in young adulthood (even after controlling for BMI at baseline and parental BMI)

4. Disordered eating in adolescence is significantly associated with depression in young adulthood.

Seite 17

Bella Study


Summary II: Eating Disorders do not just disappear…

• Higher depression scores in adolescence are significantly associated with very low body weight (anorexia nervosa) in young adulthood.

There is urgent need for early detection and interventions targeting

disordered eating behaviour in adolescence.

Seite 18


Eating Disorders do not just disappear…..

Thank you very much for your attention!

For further questions:[email protected]

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital...

Documents

Transcript of Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital...