Eating Behaviors 22 (2016) 222–224
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Eating Behaviors
Risky dieting amongst adolescent girls: Associations with family relationship problems and depressed mood Gemma L.M. Hinchliff a,b, Adrian B. Kelly a,⁎, Gary C.K. Chan a, George C. Patton d,e, Joanne Williams c a
Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia School of Psychology, The University of Queensland, Australia Deakin University, Melbourne, Australia d Murdoch Children's Research Institute, Melbourne, Australia e Department of Paediatrics, The University of Melbourne, Melbourne, Australia b c
a r t i c l e
i n f o
Article history: Received 17 March 2016 Accepted 1 June 2016 Available online 03 June 2016 Keywords: Adolescent Female Dieting Family Conflict Depressed mood
a b s t r a c t Objective: This study examined the association of risky dieting amongst adolescent girls with depressed mood, family conflict, and parent-child emotional closeness. Method: Grade 6 and 8 females (aged 11–14 years, N = 4031) were recruited from 231 schools in 30 communities, across three Australian States (Queensland, Victoria, and Western Australia). Key measures were based on the Adolescent Dieting Scale, Short Mood and Feelings Questionnaire, and widely used short measures of family relationship quality. Controls included age, early pubertal onset, and socioeconomic status. Results: Risky dieting was significantly related to family conflict and depressed mood, depressed mood mediated the association of family conflict and risky dieting, and these associations remained significant with controls in the model. Conclusion: Family conflict and adolescent depressed mood are associated with risky dieting. Implications: Prevention programs may benefit from a broadening of behavioural targets to include depressed mood and family problems. © 2016 Elsevier Ltd. All rights reserved.
1. Introduction Preoccupations with weight and weight control are prevalent amongst adolescent girls (Lawrence & Thelen, 1995), and dieting may carry heightened health risks regardless of overweightness (Crow, Eisenberg, Story, & Neumark-Sztainer, 2006). When dieting pre-occupations become excessive, there are increased risks of psychological distress, nutritional deficiencies, and subsequent eating disorders (Patton, Selzer, Coffey, Carlin, & Wolfe, 1999). In Australia, available data indicate that amongst 12–17 year olds, approximately 39% of girls compared to 13% of boys are classified as intermediate or extreme dieters (Patton et al., 1997). In this study we examined the association of depressed mood and family relationship problems with dieting in a large population of early adolescent girls (11–14 years of age). While some research indicates simple associations between dieting and depressed mood, family problems, and early pubertal onset, research is needed on the extent to which these factors predict dieting independent of each other. This is important because contextual factors are likely to be interrelated, and the identification of significant independent contextual factors ⁎ Corresponding author at: Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4072, Australia. E-mail address:
[email protected] (A.B. Kelly).
http://dx.doi.org/10.1016/j.eatbeh.2016.06.001 1471-0153/© 2016 Elsevier Ltd. All rights reserved.
should inform prevention policies and programs. The first hypothesis was that depressed mood and family relationship quality would be associated with dieting. Drawing on research showing that depressed mood mediates linkages between family distress and other adolescent health risk behaviours (Chan, Kelly, & Toumbourou, 2013), the second hypothesis was that depressed mood would mediate any family relationship–dieting association. 2. Method 2.1. Sample The sample consisted of 4058 girls in Grade 6 (modal age 11 years) and Grade 8 (modal age 13) from 231 schools located in 31 Australian communities (Victoria/Queensland/Western Australia). 2.2. Survey procedure Data was collected via a two-stage sampling strategy (community and school). The community sampling frame consisted of Statistical Local Areas (ABS, 2009). Within each community, primary (N = 164) and secondary schools (N = 82) were randomly selected. Of schools invited to participate, 83% (n = 443) responded, and of these, 52% agreed to participate. Adolescents only participated if signed parent consent
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Table 1 Regression models of dieting and depressed mood (N = 3704 females, 11–13 years old). Model 1 Dieting b Age Early puberty Socio-economic status (Ref: 1st quartile - least advantaged) 2nd quartile 3rd quartile 4th quartile - most advantaged Emotional closeness with mother Emotional closeness with father Family conflict Depressed mood
95% CI
Model 2 Depressed mood
Model 3 Dieting
b
95% CI
b
95% CI (−0.08, −0.03) (0.03, 0.14) (−0.14, −0.05) (−0.11, −0.02) (−0.13, −0.04) (0, 0.06) (−0.01, 0.05) (0.05, 0.09) (0.22, 0.3)
−0.06⁎⁎⁎ 0.11⁎⁎⁎
(−0.08, −0.04) (0.05, 0.16)
−0.02 0.08⁎⁎⁎
(−0.03, 0) (0.04, 0.12)
−0.05⁎⁎⁎ 0.09⁎⁎
−0.09⁎⁎⁎ −0.07⁎⁎ −0.10⁎⁎⁎
(−0.14, −0.04) (−0.12, −0.02) (−0.14, −0.05) (−0.03, 0.04) (−0.03, 0.03) (0.09, 0.14)
0.02 0.00 −0.05⁎⁎ −0.09⁎⁎⁎ −0.07⁎⁎⁎ 0.18⁎⁎⁎
(−0.02, 0.05) (−0.04, 0.04) (−0.09, −0.01) (−0.12, −0.07) (−0.09, −0.05) (0.17, 0.2)
−0.09⁎⁎⁎ −0.07⁎⁎ −0.08⁎⁎⁎
0.00 0.00 0.12⁎⁎⁎ R2 = 0.05
R2 = 0.20
0.03 0.02 0.07⁎⁎⁎ 0.26⁎⁎⁎ R2 = 0.09
Notes. Bold text indicates findings relating to the key research question. Model 1 tests whether family conflict predicts dieting without depressed mood in the model. Model 3 includes depressed mood in the model, and shows a significant drop in the effect for family conflict. Model 2 tests the association of family conflict with depressed mood. Early puberty was based on items relating to whether Menarche had occurred and the age at which Menarche occurred (see Measures). ⁎ p b 0.05. ⁎⁎ p b 0.01. ⁎⁎⁎ p b 0.001.
was obtained (67% response rate). The survey was approved by the University of Melbourne Human Research Ethics Committee. Further details of the survey methods are described elsewhere (Hemphill et al., 2010). Of the analysis sample, 684 girls had missing data on one or more variables, of which 8, 115, and 27 participants had missing data on depressed mood, family conflict, and dieting respectively. Missing data were multiply imputed with chained equations using STATA 13 (5 datasets). Twenty-seven girls were excluded because responses were unreliable (e.g., reported Menarche under 6 years of age). 2.3. Measures Participants completed a modified version of the Communities That Care (CtC) Youth Survey (Arthur, Hawkins, Pollard, Catalano, & Baglioni, 2002). Dieting was assessed using the 8-item Adolescent Dieting Scale (ADS) (Patton et al., 1997). The ADS assesses calorie counting, reducing food quantities at meals, and skipping meals (e.g., “Do you try to eat less than a certain number of calories as a means of controlling weight?”; 4point Likert scales from 0 “Seldom/never” to 3 “almost always”; α = 0.87). Depressed mood was measured using the 13-item Short Mood and Feelings Questionnaire (SMFQ) (Angold, Costello, Messer, & Pickles, 1995) (α = 0.91). Family conflict was assessed using three items (e.g., “People in my family often insult and yell at each other”) (4-point Likert scale 1 ‘YES!’ to 4 ‘NO!’; α = 0.80) (Salom, Kelly, Alati, Williams, & Williams, 2015). Parent-child emotional closeness was measured using three items for each parent (e.g., “Do you feel close to your mother/father?”) (Kelly et al., 2011) (4-point scale, α = 0.82–83). Pubertal timing was assessed with the items “Have you begun to menstruate (had your first period)” (yes/no) (Petersen, Crockett, Richards, & Boxer, 1988), and “How old were you when you started to menstruate (had your first period)?” (Tanner, 1962). Participants who responded ‘yes’ to the first question were coded as having early pubertal onset if they reported an age of menarche of 11 years or younger. Socioeconomic status (SES) was determined using standard Australian census measures based on income and type of occupation. 2.4. Analysis Analyses were performed using STATA 13. In Model 1, dieting was regressed on family conflict, allowing for the estimation of the total effect of family conflict on dieting. In Model 2, depressed mood was regressed on family conflict, to estimate the statistical effect of family conflict on depressed mood. In Model 3, dieting was regressed on family conflict and depressed mood. This allowed the estimation of the direct
and indirect effects of family conflict on dieting (via depressed mood). Control variables were adjusted in each model. The product of the coefficient of family conflict in Model 2 and the coefficient of depressed mood in Model 3 was calculated, and its 95% confidence interval was computed using 5000 bootstrap replicates. A 95% confident interval that does not include zero indicates significant mediation. 3. Results For Model 1 there was a significant total effect of family conflict on dieting after adjusting for controls (Table 1). There were significant yet small associations between dieting and age (p b 0.001), early pubertal onset (p b 0.001), and socioeconomic advantage (p b 0.001). The association of dieting and mother/father emotional closeness was nonsignificant. For Model 2 there was a significant effect of family conflict on depressed mood (p b 0.001). Depressed mood was also positively associated with early pubertal onset (p b 0.001), and negatively associated with high socioeconomic advantage (p b 0.05) and emotional closeness to either parent (p b 0.001). For Model 3 there was a significant direct effect of family conflict on dieting (p b 0.001). The effect of depressed mood was also significant (p b 0.001). The product of the relevant coefficient was 0.05 (95% CIs = 0.04,0.06), indicating a significant indirect effect of family conflict on dieting through depressed mood. Comparison of family conflict coefficients across Models 1–3 indicated that 44% of the total effect was mediated by depressed mood. 4. Discussion The key findings of this study were that dieting behaviour was negatively associated with family conflict, positively associated with depressed mood, and that depressed mood mediated family conflict and dieting behaviour. Dieting behaviour was also associated with socioeconomic disadvantage and early pubertal onset. Emotional closeness to parents showed weak and consistent associations with depressed mood. While this study is based on a large sample and controls for several potential confounds, it is cross-sectional nature so it cannot address etiological pathways. The results are consistent with earlier research that family conflict leads to depressed mood, particularly in girls, and this may contribute to weight gain and weight control behaviours, including excessive dieting. The present study points to the need for further research on the longitudinal role of family distress and depressed mood in driving excessive dieting. If family conflict and depressed mood are drivers of early and excessive dieting, parents may benefit from education on effective conflict management, and school-based programs might increase their focus on depressed mood. The study is
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limited by its reliance on adolescent self-report and the positive parental consent mechanism may have biased the sample towards those with fewer problems (Kelly & Halford, 2007). Role of funding sources This research was funded by an NHMRC Project Grant to J. Williams, J. Toumbourou, R. Homel, and G. Patton. Data analysis and preparation of this manuscript was supported by ARC DP130102015 to A. B. Kelly (first investigator). Study sponsors were not directly involved in the production of this manuscript or decision to submit the manuscript for publication. Contributors Hinchliff completed this project as part of her honours dissertation under the supervision of the second author. Chan assisted in the data analysis. Hinchliff and Kelly wrote the first draft of the manuscript. Patton and Williams provided conceptual input on the study and reviewed the final manuscript. All authors contributed to and have approved the final manuscript. We thank Professor John Toumbourou for his assistance and guidance with respect to this manuscript. Conflict of interest All authors declare that they have no conflicts of interest.
References ABS (2009). Socio-economic indices for areas. Canberra: Australian Bureau of Statistics. Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249. Arthur, M. W., Hawkins, J. D., Pollard, J. A., Catalano, R. F., & Baglioni, A. J., Jr. (2002). Measuring risk and protective factors for substance use, delinquency, and other adolescent problem behaviors. The Communities That Care Youth Survey. Evaluation Review, 26(6), 575–601.
Chan, G. C. K., Kelly, A. B., & Toumbourou, J. W. (2013). Accounting for the association of family conflict and very young adolescent female alcohol use: The role of depressed mood. Journal of Studies on Alcohol and Drugs, 74(3), 396–505. Crow, S., Eisenberg, M. E., Story, M., & Neumark-Sztainer, D. (2006). Psychosocial and behavioral correlates of dieting among overweight and non-overweight adolescents. The Journal of Adolescent Health, 38(5), 569–574. Hemphill, S., Toumbourou, J. W., Smith, R., Kendall, G. E., Rowland, B., Freiberg, K., et al. (2010). Are rates of school suspension higher in socially disadvantaged neighbourhoods? An Australian study. Health Promotion Journal of Australia, 21, 12–18. Kelly, A. B., & Halford, W. K. (2007). Responses to ethical challenges in conducting research with Australian adolescents. Australian Journal of Psychology, 59(1), 24–33. Kelly, A. B., O'Flaherty, M., Toumbourou, J. W., Connor, J. P., Hemphill, S. A., & Catalano, R. F. (2011). Gender differences in the impact of families on alcohol use: A lagged longitudinal study of early adolescents. Addiction, 106(8), 1427–1436. Lawrence, C. M., & Thelen, M. H. (1995). Body image, dieting, and self-concept: Their relation in African-American and Caucasian children. Journal of Clinical Child Psychology, 24(1), 41–48. Patton, G. C., Carlin, J. B., Shao, Q., Hibbert, M. E., Rosier, M., Selzer, R., et al. (1997). Adolescent dieting: Healthy weight control or borderline eating disorder? Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38(3), 299–306. Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B., & Wolfe, R. (1999). Onset of adolescent eating disorders: Population based cohort study over 3 years. British Medical Journal (Clinical Research Ed.), 318(7186), 765–768. Petersen, A., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: Reliability, validity, and initial norms. Journal of Youth and Adolescence, 17(2), 117–133. Salom, C., Kelly, A. B., Alati, R., Williams, G., & Williams, J. W. (2015). School and family factors influence the development of depressive symptoms and alcohol use in young adolescents. Drug and Alcohol Review. Tanner, J. M. (1962). Growth at adolescence; with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity. Oxford: Blackwell Scientific Publications.
