Journal Article Annotations
2022, 1st Quarter

Hispanoamerican Psychiatry

Annotations by Katiuska Ramirez, MD, Carlos Fernandez-Robles, MD and Isabella Campusano, MD
January, 2022

Ethnic/racial and gender differences in disordered eating behavior prevalence trajectories among women and men from adolescence into adulthood.
Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path.

PUBLICATION #1 — Hispanoamerican Psychiatry

Ethnic/racial and gender differences in disordered eating behavior prevalence trajectories among women and men from adolescence into adulthood.

Melissa Simone, Susan Telke, Lisa M Anderson, Marla Eisenberg, Dianne Neumark-Sztainer

Abstract: Soc Sci Med. 2022 Feb;294:114720. doi: 10.1016/j.socscimed.2022.114720. Epub 2022 Jan 11.

Background:
Disordered eating behaviors (DEB) are highly prevalent and are associated with nega-tive long-term health outcomes. Extant research on DEB prevalence trajectories has predominantly focused on white women, thereby lacking both gender and ethnic/racial diversity, which may lead to preventive interventions that are not optimally timed for socially minoritized groups. The pur-pose of this study was to identify patterns in DEB trajectories from adolescence to adulthood across intersecting gender and ethnic/racial identities.

Methods:
Participants (n = 1314) were from Project EAT (Eating and Activity in Teens and Young Adults), a population-based sample in the United States. Unhealthy weight control behaviors and binge eating were assessed across four waves at 5-year intervals. Gender-stratified generalized es-timating equations (GEE) analyses were applied to examine ethnic/racial and gender differences in the prevalence trajectories of two forms of DEB (unhealthy weight control behaviors and binge eat-ing).

Results:
Hispanic/Latina young women reported heightened prevalence of unhealthy weight con-trol behaviors and binge eating during adolescence (82.4% and 31.1%) relative to women with other ethnic/racial identities (44-70.2% and 8.8-18.2%) at any other developmental time point. Black/African American women reported linear increases in unhealthy weight control behaviors from adolescence (46.6%) to adulthood (65.5%), with nearly 20% greater prevalence relative to white women (44.6%) during adulthood. Among men, prevalence of unhealthy weight control be-haviors was higher among Hispanic/Latinos (60.7-68.0%) and Asian Americans (41.9-56.7%) relative to Black/African American (24.6-36.9%) and white men (25.7-34.9%). Similarly, Hispanic/Latino young men reported up to ten or more times higher prevalence of binge eating during adoles-cence (22.8%) and adulthood (26.8%) relative to men from other ethnic/racial identities at any other time point (1.7-12.3%).

Conclusions:
Ethnic/racial disparities in DEB prevalence vary across development, DEB subtype, and by gender. Targeted preventive interventions, or interventions that address these different trajec-tories, that are optimally timed may reduce these disparities.

Keywords:
Adolescence; Adulthood; Developmental trajectories; Disordered eating behaviors; Eth-nic/racial minority health; Prevalence trajectories.

Annotation

The finding:
This study assessed the prevalence of disordered eating behaviors (DEBs) using a longitudinal population-based study. The results demonstrate significant variability among prevalence rates for unhealthy weight control behaviors (UWCBs) and binge eating based on patient gender, ethnicity/race, and developmental period. Women were found to have higher rates of UCWBs and binge eating compared to men in all age groups studied. Among all women in the study, the prevalence of UWCBs and binge eating were highest in late adolescence and adulthood respectively. Rates of both UWCBs and binge eating were highest among men during adulthood.

There was an increased prevalence of DEBs among Hispanic/Latina adolescent girls, Black/African American women, and Hispanic/Latino men in the study. The prevalence of binge eating was found to be three times higher in Hispanic/Latina women compared to women in other ethnic/racial groups and developmental time periods. UWCB prevalence was twice as high among Asian American men and Hispanic/Latino men across each developmental period relative to Black/African American and white men. Binge eating prevalence among Hispanic/Latino men during adolescence and adulthood were found to be up to 10 times higher compared to men with any other ethnic/racial identity at any other time point.

Strength and weaknesses:
Strengths of the study include its longitudinal nature with four waves of data obtained over a 15-year period. The data examined multiple intersecting gender and ethnic/racial identities, allowing for comparison among different groups. Limitations of the study include relatively low sample sizes in specific groups. Data from Native American or Native Hawaiian or Pacific Islanders were collected but not analyzed due to small sample sizes in these groups resulting in low statistical power. Similarly, the sample size of adolescent Black/African American men who responded to binge eating assessments resulted in insufficient statistical power. The survey used in the study asked participants to identify as either male or female without providing additional gender identity response options. The study was not able to evaluate specific subtypes of UWCBs (e.g., fasting or use of laxatives or diuretics), again due to limited numbers of responses for individual behaviors.

Relevance:
Historically, studies investigating DEB prevalence over time have used samples which disproportionately include white women. This study demonstrates significant variability among prevalence rates for both UWCBs and binge eating based on patient gender, ethnicity/race, and developmental period. Gaining a better understanding of the trajectory of DEBs over time and the impact of ethnicity/race on this trajectory will help identify patients at elevated risk of these behaviors, inform when to screen for DEBs, and when to time preventative measures to decrease DEB prevalence.

PUBLICATION #2 — Hispanoamerican Psychiatry

Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path.

Guillermo A Guaracha-Basáñez, Irazú Contreras-Yáñez, Gabriela Hernández-Molina, Viviana A Estrada-González, Lexli D Pacheco-Santiago, Salvador S Valverde-Hernández, José Roberto Galindo-Donaire, Ingris Peláez-Ballestas, Virginia Pascual-Ramos

Abstract: PLoS One. 2022 Jan 18;17(1):e0262756. doi: 10.1371/journal.pone.0262756. eCollection 2022..

Background:
Previous models that assess quality-of-Life (QoL) in patients with rheumatic diseases have a strong biomedical focus. We evaluated the impact of COVID-19 related-health care interruption (HCI) on the physical, psychological, social relationships and envi-ronment QoL-dimensions, and explored factors associated with QoL when patients were re-incorporated to the outpatient clinic, and after six-month follow-up.

Patients and methods: Study phase-1 consisted of a COVID-19 survey administered from June 24th-October 31st 2020, to outpatients with rheumatic diseases who had face-to-face consultation at outpatient clinic reopening. Study phase-2 consisted of 3 consecutive assess-ments of patient´s QoL (WHOQOL-BREF), disease activity/severity (RAPID-3), and psycho-logical comorbidity/trauma (DASS-21 and IES-R) to patients from phase-1 randomly selected. Sociodemographic, disease and treatment-related information, and comorbidities were ob-tained. Multiple linear regression analysis identified factors associated with the score assigned to each WHOQOL-BREF dimension.

Results:
Patients included (670 for phase-1 and 276 for phase-2), had primarily SLE and RA (44.2% and 34.1%, respectively), and all the dimensions of their WHOQOL-BREF were af-fected. There were 145 patients (52.5%) who referred HCI, and they had significantly lower dimensions scores (but the environment dimension score). Psycho-emotional factors (pri-marily feeling confused, depression and anxiety), sociodemographic factors (age, COVID-19 negative economic impact, years of scholarship, HCI and having a job), and biomedical factors (RAPID-3 score and corticosteroid use) were associated with baseline QoL dimensions scores. Psycho-emotional factors showed the strongest magnitude on dimensions scores. Most con-sistent predictor of six-month follow-up QoL dimensions scores was each corresponding baseline dimension score, while social determinants (years of scholarship and having a job), emotional factors (feeling bored), and biomedical aspects (RAPID 3) had an additional impact.

Conclusions:
HCI impacted the majority of patient´s QoL dimensions. Psycho-emotional, sociodemographic and biomedical factors were consistently associated with QoL dimensions scores, and these consistently predicted the QoL trajectory.

Conflict of interest statement:
The authors have declared that no competing interests exist.

Annotation

The finding:
During the early part of the COVID-19 pandemic-related interruptions in healthcare resulted in lower physical and psychological health scores, social relationships, and overall reduced quality of life for rheumatological patients in Mexico. These findings persisted six months later, despite re-establishing healthcare visits. Affected patients were most likely to be young, unemployed, have a diagnosis different from rheumatoid arthritis, be treated with corticosteroids, and have high pain scores and lower physical function. Also, they had more frequent comorbidities, higher anxiety, depression, distress related to traumatic events, and referred more frequently negative emotions.

Strength and weaknesses:
This well-designed study benefits from having a large number of participants and a low attrition rate. Using Spanish-validated versions of several tools improves reliability, validity, and breadth of nuance. However, while the study describes many variables, there are some notable absences among factors well known to impact QoL, such as exercise, nutritional state, coping skills, and relevant to the setting, COVID-19 vaccination status.

Relevance:
Healthcare interruptions were common during the early part of the COVID-19 pandemic due to lock downs and hospitals’ forced operational adjustments. This study shows the extent and impact of healthcare interruptions, even in tertiary care centers, for patients with rheumatological diseases. These patients experienced detrimental effects on their physical, psychological, and social well-being and their overall quality of life. Patients in less-resourced countries with more gaps in telemedicine access may experience even more pronounced negative outcomes from care interruptions. C-L psychiatrists can draw from these findings to consider the effect of healthcare interruptions on medically ill patients.