ascertaining the link between depression and eating disorders, with particular focus on young adults and teens. Not much information is available on the subject of eating disorder (ED)-diagnosed persons’ nutritional status and food consumption. The objectives of this study were:
To explain eating disorder-diagnosed teens’ nutritional intake and To study the relationship of depression with ED among teens without as well as with ED.
A number of data sources were employed for individual papers examined for this research. This examination facilitates the drawing of a few key inferences. ED’s high stability and its major link to obesity and declining psychological health among adults highlight the necessity of timely problem identification and treatment in childhood and teenage. Depressed youngsters must be especially observed to detect restrictive ED development. Further, adult females depicting a lifetime ED diagnosis showed double the likelihood to report migraines as compared to unrelated members of this very cluster; comorbid major depressive disorder (MDD) accounts for this association. Further studies need to deal with intermediary elements which may account for the mechanisms through which such linkages develop. Research findings highlighted the need to prevent, treat and detect ED in a timely manner, not just in obese/overweight teens, but in all patients exhibiting internalizing symptoms and abnormal eating.
Depressed youngsters must be especially observed to detect restrictive ED development. Experts have often related eating issues to weak metabolic control. Depression is becoming increasingly common among type 1 diabetics (T1D); it is worth mentioning that an alarming prediction for this century is depression and diabetes’s emergence as a highly prevalent health issues. But scant information exists on depression’s occurrence among T1Ds. While young T1Ds commonly exhibit ED and depressive symptoms, their impact on metabolism control and their interrelationship haven’t been adequately studied (Christina, et al., 2015). Metabolic control may be indirectly or directly weakened by EDs through induced depression. ED symptoms’ complexity has led to growing interest in attempting to comprehend the mechanisms behind the complete eating psychopathology. Contemporary scholars largely acknowledge the existence of several risk pathways linked to eating psychopathology growth and continuance (Costa, Maroco, Pinto Gouveia, & Ferreira, 2016). This analytical work will study the link between depression and ED in teens, also concisely studying the role of migraine on depression and eating practices.
Literature constantly cites linkages between depression and ED. Prevalence researches report as much as 80% comorbidity between the two conditions.
i. Between Men and Women
Depression was found to be more prevalent in young female T1D patients than males, but a sounder link existed between metabolic control and single depression among males (Lyoo, et al., 2012). Depression-diabetes coexistence increased diabetes-related complications and mortality among T1D females. Depression and ED symptoms are assumed to be more prevalent among T1D females than males (Christina, et al., 2015).
ii. Adolescence to Young Adulthood
Longitudinal research which looks into ED’s course from teenage to the young adulthood stage is limited with heterogeneous outcomes, probably because of fairly small size of samples, patient selection and differences in research designs. While fresh researches have revealed stability in ED behavior and ED itself between early teenage and young adulthood, prior researches failed to prove such continuity in most participants. Most researches revealed that ongoing ED behavior was combined with obesity occurrence and a broad array of psychopathology (Herpertz-Dahlmann, Dempfle, Konrad, Klasen, & Ravens-Sieberer, 2015).
iii. Women and Migraine
MDD, ED and migraine show predominance in female patients. Whether or not migraine has greater prevalence in ED-diagnosed females as compared to healthy females is yet to be determined. Mustelin and coworkers (2014) cite references to several literature sources which fail to provide decisive evidence, owing to inadequate sample data. Researchers discovered that the reason for migraine’s prevalence in ED-afflicted females is: comorbid MDD linked closely to migraine. High prevalence of migraine in comorbid MDD and ED-afflicted females may occur due to an interaction between the two; the researchers, however, weren’t adequately equipped to carry out a formal examination.
This section evaluates the methodology adopted in the aforementioned literature sources.
Allen and colleagues (2012) forwarded questionnaire packages to teen participants to complete at home prior to attending direct assessment, aiming at:
1. Examining ED-afflicted teens’ nutritional intake in relation to control cluster — micro and macro-nutrient consumption comparison was carried out across non-ED and ED clusters
1. Comparing fatty acid consumption across ED-afflicted teens without and with depression — the ED group was segregated into low and high depression clustered based on Beck Depression Inventory for Youth (BDI-Y) scores, through the use of fixed cut-offs,
1. Exploring links between depression, ED and fatty acid consumption — correlations were studied between BDI-Y scores, fat consumption and global ED symptom scores and
1. Testing a meditational theory where fat consumption is a partial mediating factor in the depression-ED linkage — regression analyses were performed for ascertaining whether fat consumption mediated the depression-ED linkage.
Herpertz-Dahlmann and colleagues (2015) used specially-prepared interviewers for performing a computer-aided child/teenager and parent interview. Respondents were also mailed questionnaires, to be returned by post. The SCOFF questionnaire evaluated reference point and follow-up ED behavior. SCOFF is an abbreviation for the first alphabet of focus words in the following five questions evaluating various ED elements.
1. Do you get sick due to an uncomfortable feeling of fullness? (purposeful vomiting)
1. Are you worried that you no longer have control over the quantity you consume? (lack of intake control)
1. Of late, have you lost over one stone of wright within 3 months? (weight loss)
1. Do you consider yourself fat despite others calling you overly thin? (distortion of body image) and
1. Do you think food is dominating your living? (Foods’ disproportionate effect on life).
Christina and colleagues (2015) employed a national population survey of 211 T1D-diagosed individuals between 18 and 21 years of age, who were administered the aforementioned SCOFF questionnaire and other standardized questionnaires. Allen and coworkers’ 2012 study applied self-reported information derived from the seventeen-year Raine Study. Respondents included 429 teenage girls who were administered exhaustive questionnaires dealing with ED, depression and food consumption. Reference point and follow-up data was collected via a phone interview. Self-reporting questionnaires were posted to the respondents of Herpertz-Dahlmann and colleagues’ (2015) study. At both the measurement points, ED, anxiety and depression symptoms, in addition to body mass index (BMI), were gauged for 771 subjects (351 males, 420 females). Reference point ages ranged between 11 and 17 years, while that at the follow-up stage was between 17 and 23 years.
Mustelin and coworkers (2014) isolated female lifetime diagnosed BN (bulimia nervosa; N5 60) and AN (anorexia nervosa; N5 55) patients and their twins out of the FinnTwin16 group born between 1975 and 1979 (N5 2,825 women). MDD and ED diagnoses were garnered from migraine information included in self-reporting questionnaires and clinical interviews. Costa and colleagues (2016) conducted cross-sectional research to ascertain whether mediation was present for diverse conditional perfectionistic self-exhibition values. 121 ED-diagnosed females (diagnosis based on ED Examination 16.0D) were administered a set of self-reporting questionnaires for gauging self-criticism, depression, perfectionistic presentation of self and external shame, followed by mediated-moderation examination.
Eating Problems and Depression
Data revealed female dominance as compared to males, in case of ED symptoms as well as positive ED-symptom screening. But no gender-based variance was noted in distribution of positive PHQ-9 item frequency; nevertheless, average PHQ-9 scores for females were somewhat higher as compared to males (Christina, et al., 2015). Furthermore, no appreciable variances were noted in reported micro- or macro-nutrient consumption across partial and complete ED cases, or ED diagnostic subdivisions (Allen, et al., 2012).
Eating Disorder and BMI
ED-diagnosed subjects at study outset showed high likelihood of developing obesity/being overweight after six years, independent of parental or baseline BMIs. In contrast, after parental and baseline BMI adjustment, no link was discovered between underweight-ness and high baseline SCOFF values (Herpertz-Dahlmann, et. al. 2015). Researchers accounted for family income and BMI and found that ED scores no longer remained significantly linked to total n-3/6 FA or polyunsaturated fat. Very few ED sample individuals reported thiamine, phosphate, zinc and vitamin B6 consumption exceeding two-thirds less than the Australian Reference Daily Intake. Owing to the healthy weights of most ED cluster members and the endurance of between-group variances after controlling for BMI, these variances may not be ascribed to ‘underweight’ status. This emphasizes the significance of tackling the potential physiological effects of ED even among normally-weighing teens (Allen, et al., 2012).
Self-Criticism and Depression
Costa and colleagues (2016) looked into whether self-deprecation’s potential mediating impact on the depression-shame relationship exists in case of different conditional perfectionistic self-exhibition values. The model revealed that self-deprecation greatly mediates this link, constituting 45% of the overall depression variance. Thus, shame nevertheless directly impacts depression, but the application of self-deprecation apparently contributes greatly to this relationship, to some extent.
1. The country-wide evaluation of a distinct youngster sample was one forte of the research. Additionally, while respondent ages and diabetes commencement showed homogeneity, they were administered different kinds of diabetes treatment at different healthcare centers (Christina, et al., 2015).
1. The population-based study sample and acquisition of detailed dietary information are strengths as well. This was the first research to observe dietary consumption among ED-afflicted teens (Allen, et al., 2012).
1. The SCOFF questionnaire’s validation in case of diabetics wasn’t totally complete. Moreover, the question on cut-off value choice for general diabetes care screening tools is debatable (Christina, et al., 2015).
1. The support of self-reported nutritional intake, and integrating food frequency questionnaire information with fat status and biochemical nutrition consumption markers (for instance blood samples) may prove ideal for dealing with this problem (Allen, et al., 2012).
1. Mustelin and coworkers (2014) supported migraine self-reporting by only one item evaluating doctor-diagnosed migraine, which may result in underreporting. However, migraine prevalence in the general sample (12%) was in line with prior population estimations.
This research reveals that female ED patients demonstrate experiences in line with the shame phenomenology. In other words, such females believe other people view them negatively (i.e., ugly, worthless, imperfect, etc.). Thus, the understanding of potential exposure to sensed failures and imperfections is an external driver fueling fear of being judged negatively (Costa, et. al., 2016). The study established a link between lack of eating control, body distortion, intentional vomiting, and other such distinct phenomena at a young age with subsequent depression, irrespective of baseline depression and previous body weight. ED behavior potentially suggests exceeding dissatisfaction with self and unjustifiable impact of body shape and weight on a person’s self-image, which can cause depression (Herpertz-Dahlmann, et. al., 2015).
Allen and colleagues (2012) revealed that depressed and ED-diagnosed teens reported considerably lower polyunsaturated fat consumption compared to ED-diagnosed teens without obvious depression. This result pattern has consequences for depression evaluation and management among ED-afflicted persons. For example, fat supplementation might improve moods, even during preliminary ED treatment phases when individuals are disinclined to drastically change their eating habits. Additional research is necessary for assessing this probability, and ascertaining if fat consumption changes predict depression changes. T1D youngster-targeted educational initiatives can help them take on complete independent disease management responsibility, thereby avoiding unsatisfying metabolic results and bettering their diabetes self-management. For ensuring their mental health issues, premature complication onset and poorer diabetic patient outcomes don’t persist, ongoing diabetes care is suggested, which includes routine screening for psychological issues when transitioning to diabetes care in adulthood (Christina, et al., 2015).
Allen, K., Mori, T., Beilin, L., Byrne, S., Hickling, S., & Oddy, W. (2012). Dietary intake in population-based adolescents: support for a relationship between eating disorder symptoms, low fatty acid intake and depressive symptoms. Journal of Human Nutrition and Dietetics, 459 – 469.
Christina, B., Lange, K., Stahl-Pehe, A., Castillo, K., Scheuing, N., Holl, R., . . . Rosenbaeur, J. (2015). Symptoms of Eating Disorders and Depression in Emerging Adults with Early – Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control. PLoS ONE.
Costa, J., Maroco, J., Pinto Gouveia, J., & Ferreira, C. (2016). Shame, Self-Criticism, Perfectionistic Self-Presentation and Depression in Eating Disorders. International Journal of Psychology and Psychological Therapy, 315 – 328.
Herpertz-Dahlmann, B., Dempfle, A., Konrad, K., Klasen, F., & Ravens-Sieberer, U. (2015). Eating disorder symptoms do not just disappear: the implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood. Eur Child Adolesc Psychiatry, 675 – 684.
Lyoo, I., Yoon, S., Jacobson, A., Hwang, J., Musen, G., & Neil, H. (2012). Prefrontal cortical deficits in type 1 diabetes mellitus: brain correlates of comorbid depression. Arch Gen Psychiatry, 1267 – 1276.
Mustelin, L., Raevuori,, A., Kaprio, J., & Keski-Rahkonen, A. (2014). Association Between Eating Disorders and Migraine May be Explained by Major Depression. International Journal of Eating Disorders, 884 – 887.
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