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Assessing eating disorder symptoms in adolescence: Is there a role for multiple informants?

Authors

  • Sonja A. Swanson ScM,

    Corresponding author
    1. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
    • Correspondence to: Sonja A. Swanson, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Kresge 9th Floor, Boston, MA 02115. E-mail: sswanson@hsph.harvard.edu

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  • Kate M. Aloisio BA,

    1. Department of Mathematics, Smith College, Northampton, MA
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  • Nicholas J. Horton ScD,

    1. Department of Mathematics, Amherst College, Amherst, Massachusetts
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  • Kendrin R. Sonneville RD, ScD,

    1. Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Ross D. Crosby PhD,

    1. Department of Clinical Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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  • Kamryn T. Eddy PhD,

    1. Department of Psychiatry, Harris Center for Education and Advocacy in Eating Disorders, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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  • Alison E. Field ScD,

    1. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
    2. Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
    3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Nadia Micali MD, PhD

    1. Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, United Kingdom
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  • The UK Medical Research Council and the Wellcome Trust (Grant ref: 092731), and the University of Bristol provide core support for ALSPAC. This specific study further received funding from the National Institute of Health Research (NIHR)-clinician scientist award to Dr. N Micali (DHCS/08/08/012) and the NIH (Grant ref: MN087786-01).

ABSTRACT

Objectives

Studies of adolescent psychiatric disorders often collect information from adolescents and parents, yet most eating disorder epidemiologic studies only rely on adolescent report.

Method

We studied the eating disorder symptom reports, from questionnaires sent at participants' ages 14 and 16 years, provided by 7,968 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), and their parents. Adolescents and parents were asked questions about the adolescent's eating disorder symptoms (binge eating, vomiting, laxative use, fasting, and thinness). We assessed cross-sectional concordance and prevalence using kappa coefficients and generalized estimating equations. Generalized estimating equations were used to assess prospective associations between symptom reports and adolescent weight outcomes measured at a face-to-face assessment at 17.5 years.

Results

Parents and adolescents were largely discordant on symptom reports cross-sectionally (kappas < 0.3), with the parent generally less likely to report bulimic symptoms than the adolescent but more likely to report thinness. Female adolescents were more likely to report bulimic symptoms than males (e.g., two to four times more likely to report binge eating), while prevalence estimates according to parent reports of female vs. male adolescents were similar. Both informants' symptom reports were predictive of body mass and composition measures at 17.5 years; compared to adolescent report, parentally reported binge eating was more strongly predictive of body mass index.

Discussion

Parent report of eating disorder symptoms seemed to measure different, but potentially important, aspects of these symptoms during adolescence. Epidemiologic eating disorder studies should consider the potential value added from incorporating parental reports, particularly in studies of males. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:475–482)

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