Comorbid depressive symptoms and self‐esteem improve after either cognitive‐behavioural therapy or family‐based treatment for adolescent bulimia nervosa

This study examined the effect of family‐based treatment for bulimia nervosa (FBT‐BN) and cognitive behavioral therapy for adolescents (CBT‐A) on depressive symptoms and self‐esteem in adolescents with BN. Data were collected from 110 adolescents, ages 12–18, who met Diagnostic and Statistical Manual of Mental Disorders‐Fourth Edition, text revision criteria for BN or partial BN. Participants were randomly assigned to FBT‐BN or CBT‐A and completed measures of depressive symptoms and self‐esteem before and after treatment and at 6‐ and 12‐month follow‐up assessments. Depressive symptoms and self‐esteem significantly improved in both treatments, and neither treatment appeared superior on these clinical outcomes. Parents often worry whether FBT‐BN addresses comorbid depressive symptoms and low self‐esteem. Our findings address this concern, as they demonstrate that FBT‐BN does not differ from CBT‐A in improving depressive symptoms and self‐esteem, and both treatments result in symptom improvement. These findings can help clinicians guide families to choose a treatment that addresses BN and depressive symptoms and low self‐esteem.     

Assessment of self-reported self-esteem in healthy and diabetic children and adolescents in Greece

Background: The aim of the present study was to evaluate any possible negative effect of diabetes on the self‐esteem of children and adolescents with diabetes. Methods: Self‐esteem was evaluated using the Culture‐Free Self‐Esteem Inventory (CFSEI‐2) in 144 patients with Type 1 diabetes mellitus (T1DM; 7–18 years of age) treated in a diabetes center and compared against that of 136 healthy children and adolescents. Results: Self‐esteem was correlated with age (P = 0.017), but not with diabetes (P = 0.886). The median CFSEI‐2 score for both healthy and diabetic children was 22. There was no significant correlation between self‐esteem and sex, body mass index (BMI), physical exercise, HbA1c or parental educational level. According to Spearman’s rank correlation coefficient (r_s), there was a significant association between age and self‐esteem (r_s = ?0.15). Conversely, although BMI (r_s = ?0.09) and treatment duration (r_s = ?0.107) had a slight negative effect on self‐esteem and the duration of physical exercise (r_s = 0.11) and parental education (r_s = 0.07) seemed to have a positive effect, the associations did not reach statistical significance. Conclusions: Self‐esteem in diabetic children is mainly affected by their age, level of physical activity and level of family support. These findings emphasize the need to discriminate between glycemic control and diabetic adjustment.     

Locus of control and self‐esteem as correlates of body dissatisfaction in Croatian university students

The main aim of this research is to explore the relationship between locus of control, self‐esteem and body dissatisfaction in the sample of university students, as well as the sex differences among the measures. The Body Shape Questionnaire (BSQ), Rosenberg Self‐Esteem Scale and the Externality Scale have been used on the sample of 534 female and 183 male university students. The results suggest that body dissatisfaction plays a more significant role in self‐esteem for girls than it does for boys. However, even the girls still have significantly lower BSQ results in comparison with female university students in the UK, and especially in the USA. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐esteem and responsibility for change in recovery from bulimia nervosa

This study examined changes in self‐esteem before treatment of bulimia nervosa and 18 months later. In addition, the relationship between these changes and attribution of responsibility for the improvement or continuation of bulimic symptoms was also explored. One hundred and ten women with bulimia nervosa entered a treatment trial and completed measures of self‐esteem and bulimic symptoms. Fifty‐one of these women also completed the same measures 18 months later, at which point they also rated the degree to which they felt responsible for any change in levels of bulimic symptoms. Women who had recovered from bulimia nervosa reported an increase in their self‐esteem. Specifically, women who recovered increased their self‐like and social esteem and decreased their self‐dislike. There was no effect of type of treatment or attribution of responsibility for recovery/non‐recovery on changes in self‐esteem. Copyright © 2000 John Wiley & Sons, Ltd.     

Reliability and validity of a novel Haemophilia‐specific Self‐Efficacy Scale

Higher self‐efficacy in chronic disease patients is associated with higher development of self‐management skills and increased quality‐of‐life. Quantification and monitoring of self‐efficacy is therefore of importance. Self‐efficacy in haemophilia patients has received little attention due to lack of standardized scales. To validate the novel Haemophilia‐specific Self‐Efficacy Scale (HSES) in haemophilia patients on prophylactic home treatment, haemophilia patients aged 1–18 years on prophylactic treatment ≥1 year were included from three Dutch Haemophilia Treatment Centres. The HSES consists of 12 items, relating to perceptions of the ability to function on a day‐to‐day basis with regard to patient's disease. Retest was performed in a subsample. Validity was proven by the General Self‐Efficacy Scale and by the health‐related quality‐of‐life assessment tool Haemo‐QoL. Data were analysed from 53 children (response 75%), with a mean age of 9.8 years (SD 4.0). Mean total scale score of HSES was 55.5 (SD 4.7; range 38–60), with a ceiling effect of 17%. The HSES showed adequate internal consistency (Cronbach's alpha 0.72) and good test–retest reliability (Intra‐Class‐Correlation coefficient 0.75; P < 0.01; n = 37). The convergent validity was adequate as haemophilia‐specific self‐efficacy correlated significantly with general self‐efficacy (r = 0.38; P < 0.01). High HSES scores correlated significantly with quality‐of‐life as measured by the Haemo‐QoL (r = ?0.42; P ≤ 0.01). The novel HSES is a reliable and valid tool to assess self‐efficacy in paediatric haemophilia patients on prophylactic home treatment. High self‐efficacy correlated with higher quality‐of‐life, further underlining the importance to standardly assess, monitor and improve self‐efficacy.     

Does Self‐Esteem Mediate the Relationship between Interpersonal Problems and Symptoms of Disordered Eating?

It has been proposed that interpersonal problems play a role in the maintenance of disordered eating because of an adverse effect on self‐esteem, which in turn encourages the pursuit of achievement in the valued domain of weight and shape. This study aimed to identify the types of interpersonal problems that are associated with disordered eating and to determine whether self‐esteem mediates the relationship between interpersonal problems and eating disorder symptoms. Female university students (n = 227) completed the Inventory of Interpersonal Problems‐32, Eating Disorder Examination Questionnaire and Rosenberg Self‐Esteem Scale. Regression analysis identified two forms of interpersonal problems that were associated with disordered eating: difficulties being sociable and being too dependent on the opinion of others. Self‐esteem mediated the relationship between interpersonal problems and overevaluation of weight and shape but did not mediate the relationship between interpersonal problems and dietary restraint. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

French adaptation of the eating disorder recovery self‐efficacy questionnaire (EDRSQ): Psychometric properties and conceptual overview

High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessment of EDs. Self‐efficacy is a key motivational factor in the recovery from EDs. A self‐report measure, the Eating Disorder Recovery Self‐Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthy eating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the EDRSQ to French (EDRSQ‐F), (b) assess the psychometric properties of this French version, and (c) establish normative data for a non‐clinical sample. Participants were 203 undergraduate women. They completed the EDRSQ‐F and measures of ED symptoms, depression and self‐esteem. A confirmatory factor analysis (CFA) revealed a bi‐factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence of construct validity. Findings support the validity of the EDRSQ‐F and suggest it is a useful instrument for the assessment of EDs. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐esteem and cognitive development in the era of the childhood obesity epidemic

Consequences of obesity for mental health and cognitive development are not established to the same degree as those for chronic diseases. This study aims to document the interrelationships between body weight, self‐esteem and school performance in childhood. Height and weight measurements and self‐report of self‐esteem, diet quality and physical activity of 4945 grade 5 students were linked with standardized literacy test results. Structural equation models were applied to confirm hypothesized relationships between body weight, self‐esteem and school performance, and revealed that body weight affected self‐esteem negatively and that school performance affected self‐esteem positively. Body weight did not affect school performance, and self‐esteem did affect neither body weight nor school performance. Subsequent multi‐level logistic regression showed that obese students, relative to normal weight students, were more likely (1.44; 95% CI: 1.12–1.84), and students with good school performance, relative to those performing poor, were less likely (0.39; 95% CI: 0.26–0.58), to have low self‐esteem. Diet quality and active living had positive effects on both school performance and self‐esteem. The study findings further establish obesity as a risk factor for low self‐esteem and add to the rationale to promote healthy eating and active living among children and youth as this will prevent chronic diseases and improve mental health and cognitive development.     

Fear of falling and falls self‐efficacy and their relationship to higher‐level competence among community‐dwelling senior men and women in Japan

Aim: This cross‐sectional study examined the relationships of fear of falling and falls self‐efficacy with higher‐level competence among community‐dwelling senior citizens in Japan. Methods: Of the 822 registered senior citizens, 731 (89%) community dwellers were requested to participate in the survey using a mailed self‐accomplished questionnaire. Data from 648 respondents with duly accomplished questionnaires were analyzed using R², the coefficient of determination, based on a multivariate regression analysis. Results: Fear of falling, low falls self‐efficacy and higher‐level functional disability were observed among respondents. Of the hypothesized relationships examined by sex, fear of falling was significantly associated with disability among male respondents and low falls self‐efficacy among both sexes. Several confounding variables were strongly associated with competence. Conclusion: While the data underscore the strategic importance of promoting higher‐level competence among the senior citizens, there is much to suggest that their competence is likely to be maintained if their fear of falling and falls self‐efficacy were modified. Programs must also consider a wide array of intervening factors. Geriatr Gerontol Int 2011; 11: 282–289.     

Psychosocial Characteristics in Relation to Disordered Eating Attitudes in Greek Adolescents

The study explores possible links between eating attitudes in Greek adolescents and certain psychosocial characteristics such as self‐esteem, empathy and anxiety. A total of 202 students (109 boys and 93 girls), 15–18 years old, have been recruited. The following questionnaires were used: the Eating Attitudes Test (EAT‐26), the State‐Trait Anxiety Inventory, the Self‐Perception Profile for Adolescents, the Multidimensional Body‐Self‐Questionnaire‐Overweight Preoccupation and the Index of Empathy of Children and Adolescents. The EAT‐26 revealed that 18.3% of the total sample of students (12.8% of boys and 24.7% of girls) reported having disordered eating attitudes. Adolescents with disordered eating attitudes had significantly higher levels of anxiety and scored less in self‐reported physical appearance and romantic appeal. Empathy and global self‐esteem did not differ significantly between the two groups. Adolescents with disordered eating attitudes have certain psychosocial characteristics which differentiate them from the students with healthier eating attitudes. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Exploring Self‐Neglect in Older Adults: Preliminary Findings of the Self‐Neglect Severity Scale and Next Steps

Despite the public health implications of self‐neglect, no tool exists for characterizing this condition. Self‐neglecters often have no caregivers or surrogates to interview regarding the neglect and are often too cognitively impaired to provide valid self‐reports. In response to this need, researchers from the Consortium for Research in Elder Self‐neglect of Texas (CREST) collaborated with other experts in the field of elder self‐neglect to design the Self‐neglect Severity Scale (SSS). The SSS assesses three domains of self‐neglect (hygiene, functioning, and environment) and relies on observational ratings assigned by trained observers. After pilot testing and revision, the SSS was field tested in the homes of subjects who had been reported to and substantiated by Texas Adult Protective Services (APS) as self‐neglecting and compared with results of subjects recruited from a local geriatric clinic who were reported to APS but had no history of self‐neglect. The first field test demonstrated that the SSS could distinguish elderly self‐neglecters from community dwellers who do not self‐neglect. The SSS exhibited adequate scale reliability (Cronbach alpha) and correlation with case status. Interrater reliability also appeared adequate, although sensitivity and specificity fell below the conventional acceptable range. Future methods are proposed for refining the SSS to improve its use as the benchmark for identifying elder self‐neglect.     

Home self‐dilatation for esophageal strictures

Esophageal strictures secondary to caustic ingestion, head and neck radiation and at the anastomosis post‐esophagectomy tend to be refractory to one or several dilatations. One option for these strictures is home self‐dilatation. The aim of this study was to assess the efficacy and safety of home self‐dilatation for a refractory esophageal stricture. A retrospective chart review was performed of all patients from 1997 to 2009 that performed home self‐dilatation for an esophageal stricture. Patients with proximal strictures without tortuosity or a shelf proximal to the stricture were selected for self‐dilatation. The patients were taught self‐dilatation by the surgeon and an experienced nurse, and an appropriate sized Maloney dilator was provided to the patient and returned when no longer needed. There were 16 patients (11 male and 5 female) with a median age of 60 years (range 38–78). The stricture was related to the anastomosis after esophagectomy in 12 patients, caustic injury in 3 patients and cervical chemoradiotherapy in 1 patient. Prior to initiation of self‐dilatation patients had a median of four endoscopic dilatations. Self‐dilatation was done with a Maloney dilator ranging in size from 45 to 60 French. The median duration of self‐dilatation was 16 weeks. No patient had a perforation or complication related to self‐dilatation. No patient required stenting or repetitive endoscopic dilatations because of failure of self‐dilatation. Strictures recurred in two patients after cessation of self‐dilatation and both responded to endoscopic dilatation followed by additional self‐dilatation. Self‐dilatation effectively resolves refractory esophageal strictures. It was well tolerated, and there were no complications in this series. Home self‐dilatation should be considered the treatment of choice in appropriate patients with refractory esophageal strictures in the cervical esophagus.     

Pre‐attentive exposure to the thin female beauty ideal does not affect women's mood,self‐esteem and eating behaviour

Exposure to the thin beauty ideal has been found to decrease women's mood and self‐esteem as well as to increase self‐reported eating pathology. In the present study, it was tested whether the changes in mood, self‐esteem and eating behaviour could be activated outside of conscious attention by ultrashort exposure to either slides of thin media models, obese models or neutral slides. The subliminal exposure did not affect women's mood and self‐esteem in the expected way and the eating behaviour of restrained and unrestrained subjects was unaffected by the manipulation. It is concluded that pre‐attentive exposure to the thin beauty ideal had no devastating effect on the well‐being of women. Note that data from supraliminal studies may be seriously confounded by demand characteristics like answering in a socially desirable way. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.     

An intensive family‐based treatment guided intervention for medically hospitalized youth with anorexia nervosa: Parental self‐efficacy and weight‐related outcomes

Recent studies suggest the efficacy of family‐based treatment (FBT) among youth with anorexia nervosa (AN) in intensive treatment settings. This study aimed to assess weight outcomes in youth who received an FBT intervention while hospitalized for medical complications of AN. Parental self‐efficacy among participating caregivers was also measured. Post‐discharge weights of 49 participants were compared with weights of 44 youth who were hospitalized prior to the provision of the FBT intervention. Youth who received the FBT intervention gained significantly more weight than youth in the retrospective treatment as usual group at 3 and 6 months following discharge. FBT youth were 2.84 times more likely than retrospective treatment as usual youth to achieve at least 95% of treatment goal weight at 6 months post‐discharge. Finally, parental self‐efficacy significantly increased in caregivers who participated in the FBT intervention. Findings provided preliminary support for the provision of FBT to medically hospitalized youth with AN.     

The impact of cognitive impairment in dementia on self‐care domains in diabetes: A systematic search and narrative review

Self‐management is integral to effective chronic disease management. Cognitive impairments (CogImp) associated with dementia have not previously been reviewed in diabetes mellitus (DM) self‐care. The aims of this study are to know (1) whether CogImp associated with dementia impact self‐care and (2) whether specific CogImp affects key DM self‐care processes. A systematic literature search with a narrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. This review examined studies published from January, 2000 to February, 2016 describing the relationship between cognition and DM self‐care domains in community dwelling older adults with dementia/CogImp. Eight studies met inclusion criteria. Decrements in all self‐care domains were associated with CogImp. Problem solving was related to reduced disease knowledge (OR 0.87, 95% CI = 0.49‐1.55), resulting in poorer glycemic control. Decision‐making impairments manifested as difficulties in adjusting insulin doses, leading to more hospital admissions. People without CogImp were better able to find/utilize resources by adhering to recommended management (OR 1.03, 95% CI = 1.02‐1.05). A lack of interaction with health care providers was demonstrated through reduced receipt of important routine investigation including eye examinations (ARR = 0.85, 95% CI = 0.85‐0.86), HbA1c testing (ARR = 0.96, 95% CI = 0.96‐0.97), and LDL‐C testing (ARR = 0.91, 95% CI = 0.901‐0.914). People without CogImp had better clinic attendance (OR 2.17, 95% CI = 1.30‐3.70). Action taking deficits were apparent through less self‐testing of blood sugar levels (20.2% vs 24.4%, P = 0.1) resulting in poorer glycemic control, self‐care, and more frequent micro/macrovascular complications. Persons with diabetes and CogImp, particularly in domains of learning, memory and executive function, were significantly impaired in all self‐care tasks.     

Self‐Discrepancy and Eating Disorder Symptoms Across Eating Disorder Diagnostic Groups

This study examined self‐discrepancy, a construct of theoretical relevance to eating disorder (ED) psychopathology, across different types of EDs. Individuals with anorexia nervosa (AN; n = 112), bulimia nervosa (BN; n = 72), and binge eating disorder (BED; n = 199) completed semi‐structured interviews assessing specific types of self‐discrepancies. Results revealed that actual:ideal (A:I) discrepancy was positively associated with AN, actual:ought (A:O) discrepancy was positively associated with BN and BED, and self‐discrepancies did not differentiate BN from BED. Across diagnoses, A:O discrepancy was positively associated with severity of purging, binge eating, and global ED psychopathology. Further, there were significant interactions between diagnosis and A:O discrepancy for global ED psychopathology and between diagnosis and A:I discrepancy for binge eating and driven exercise. These results support the importance of self‐discrepancy as a potential causal and maintenance variable in EDs that differentiates among different types of EDs and symptom severity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Development and initial evaluation of a measure of self‐management for adults with antineutrophil cytoplasmic antibody–associated small‐vessel vasculitis

Objective

To develop a measure of illness self‐management for adults living with antineutrophil cytoplasmic antibody (ANCA)–associated small‐vessel vasculitis (ANCA‐SVV) and to gather evidence of its reliability and validity.

Methods

Development of the Vasculitis Self‐Management Scale (VSMS) was guided by previous research on self‐management in other chronically ill populations, a review of the current treatment literature for ANCA‐SVV, interviews with patients, and consultation with experts. A total of 205 patients living with ANCA‐SVV or a closely related condition then completed the VSMS, along with measures of sociodemographic and clinical variables, social desirability bias, and general adherence to medical recommendations, using a self‐administered mailed questionnaire. A principal components analysis was conducted on the VSMS items. Internal consistency reliability and construct validity of the resulting subscales were assessed. Forty‐four patients completed the VSMS a second time, for the purpose of assessing test–retest reliability.

Results

Analyses suggested an 8‐factor solution. The final VSMS consisted of 43 items representing these 8 behavioral domains. Correlations among the 8 domains were null to modest in magnitude. The internal consistency reliability of the 8 subscales ranged from minimally acceptable (α = 0.67) to excellent (α = 0.94), and correlations between subscale scores at time 1 and time 2 suggested good temporal stability. Preliminary evidence for validity was mixed.

Conclusion

These findings suggest that the VSMS is a promising method for assessing illness self‐management in adults with ANCA‐SVV. More research exploring the validity of the measure is warranted.     

Self‐efficacy in rheumatoid arthritis: translation and test of validity,reliability and sensitivity of the Danish version of the Rheumatoid Arthritis Self‐Efficacy Questionnaire (RASE)

Objectives: To describe the translation and test of the Danish version of the original British ‘Rheumatoid Arthritis Self‐Efficacy Questionnaire’ (RASE). Methods: The questionnaire was forward and back translated by individuals with Danish and English as their respective primary languages. The questionnaire was tested by five lay‐people and in the field by 10 + five persons with rheumatoid arthritis (RA). A test‐retest was performed on 62 outpatients with RA. The sensitivity of the adapted Danish version of RASE (RASE‐DK) was finally tested on 106 outpatients with RA – before, immediately after and three months after they had participated in a short self‐management course performed by a multidisciplinary team. Results: RASE‐DK showed good face validity, but ‘relaxation’ was interpreted in various ways. Internal consistency evaluated by Cronbach's alpha was 0.91. Reliability evaluated by the intra‐class correlation coefficient (ICC) was 0.88. A Bland–Altman plot showed good agreement. RASE‐DK, like the original English version of RASE, was not associated with disease activity (Disease Activity Score, DAS‐28) or disability (Health Assessment Questionnaire, HAQ), and correlated significantly with the Arthritis Self‐Efficacy Scale (ASES) subscales ‘other’ and ‘pain’, and total ASES. RASE‐DK showed a highly significant change, from baseline to immediately after participation in the short course (p < 0.001). The effect faded during the following three months. Conclusion: RASE‐DK met the appropriate standards for validity, reliability and sensitivity, and is appropriate for use in Denmark. However, the concept of self‐efficacy may be too abstract for a few individuals, and relaxation is interpreted in various ways by the Danish patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Personality traits and self‐injurious behaviour in patients with eating disorders

The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self‐injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N = 38) and age‐matched controls (N = 67) were examined concerning self‐reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety‐related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self‐injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating Disorders,Normative Eating Self‐Efficacy and Body Image Self‐Efficacy: Women in Recovery Homes

Although eating disorders (EDs) and ED symptoms are common among individuals in recovery for substance abuse (SA), long‐term SA treatment programmes rarely address these problems. The present study examined the prevalence of EDs among women residing in Oxford Houses—low‐cost, self‐governed recovery homes for SA. Further, among women both with and without an ED diagnosis, the association between duration of Oxford House residency and eating‐related self‐efficacy scores was examined as an indicator of potential treatment effects on ED symptoms. During a telephone assessment, participants were administered the Structured Clinical Interview for DSM‐IV‐TR Axis I Disorders and the Eating Disorder Recovery Self‐Efficacy Questionnaire. Results indicated that 12 of the 31 women analysed met criteria for an ED (bulimia nervosa, 2; ED not otherwise specified, 10). Differential findings were evident for eating‐related self‐efficacy measures depending on ED diagnostic status and duration of residency. Potential interpretations, limitations and implications are discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.