Early Psychopathology of Obesity

Transcription

1 Early Psychopathology of Obesity Anna Ek 1, Josefin Hedman 2, Claude Marcus 1, & Paulina Nowicka 1, 3 1 Division of Pediatrics, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden 2 Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden 3 Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK 23 rd ECOG Congress th November 2013 Liverpool, UK

2 Background Increased levels of depression, symptoms of ADHD and other psychological problems have been reported in older children with obesity (for review: Puder & Munsch, 2010; Harringer & Thompson, 2012; Kalarchian & Marcus, 2012). Not much is known on the prevalence of early psychopathology in obese children as young as four. 21 november 2013

3 The More and Less Study different treatment approaches to early obesity RCT in Stockholm County, Sweden Referral from 68 child health care centres and 7 paediatric clinics 120 children 4-6 years with obesity A). Standard treatment in paediatric clinic (n=60) B). Parent training program in group (n=60) Data collected at baseline and after 3, 6 and 12 months: weight, height, waist circumference, blood pressure, blood samples, sociodemographics, lifestyle habits, parenting practices, family function, as well as child and parental psychosocial health Anna Ek ECOG

4 Method All parents of children included Jan-Apr 2013 (n=28) filled out: the Child Behaviour Checklist for ages (CBCL 1.5-5) the Beck Depression Inventory Second Edition (BDI-II), measuring parents degree of depression. Children s levels of problematic behaviour symptoms were compared to the Swedish and Danish reference populations. Anna Ek ECOG

5 Child Behaviour Checklist Standardized and validated in 23 countries Parents ratings of children's behavioural, emotional and social function problems 99 items Achenbach, Rescorla, 2000 Anna Ek ECOG

6 CBCL scales DSM Scale Affective problems Anxiety problems Pervasive Developmental Problems Attention deficit/hyperactivity Problems Oppositional defiant Problems. Syndrome Scale Emotionally Reactive Anxious/Depressed Somatic Complaints Withdrawn Sleep Problems (CBCL only) Attention Problems Aggressive Behavior Anna Ek ECOG

7 CBCL scales cont. Emotionally reactive Anxious/Depressed Somatic complaints Withdrawn 21.Disturbed 46.Twitching 82.MoodChang 83.Sulks 92.UpsetByNew 97.Whining 99.Worries 10.Dependent 33.FeelingsHurt 37.UpsetBySep 43.LookUnhapp 47.Nervous 68.SelfConsc 87.Fearful 90.Sad 1. AchesPains 7. ThingsOut 39. Headaches 45. Nausea 78. Stomachache 86. TooNeat 93. Vomiting 2.ActsYoung 4.AvoidsEye 23.NoAnswer 62.RefusesActiv 67.UnRespAffec 70.LittleAffect 71.LittleIntrest 98.Withdrawn Attention problems Aggressive behavior Sleep problems 5.Concentrate 6.Can'tSitStill 56.Clumsy 59.ShiftsQuickly 95.Wanders 8.Can'tWait 1 15.Defiant 16.Demanding 18.DestroyOther 20.Disobedient 27.NoGuilt 29.Frustrated 35.Fights 40.HitsOthers 42.HurtsAcciden 44.AngryMoods 53.Attacks 58.Punishment 66.Screams 69.Selfish 81.Stubborn 85.Temper 88.Uncooperativ 96.WantAttentio 22.NotSleepAlo 38.SleepProb 48.Nightmares 64.ResistsBed 74.SleepLess 84.TalkInSleep 94.WakesOften Anna Ek ECOG

8 CBCL scales ratings Emotionally reactive Anxious/Depressed Somatic complaints Withdrawn 21.Disturbed 46.Twitching 82.MoodChang 83.Sulks 92.UpsetByNew 97.Whining 99.Worries 10.Dependent 33.FeelingsHurt 37.UpsetBySep 43.LookUnhapp 47.Nervous 68.SelfConsc External behaviors 87.Fearful 90.Sad 1. AchesPains 7. ThingsOut 39. Headaches 45. Nausea 78. Stomachache 86. TooNeat 93. Vomiting Internal behaviors 2.ActsYoung 4.AvoidsEye 23.NoAnswer 62.RefusesActiv 67.UnRespAffec 70.LittleAffect 71.LittleIntrest 98.Withdrawn Attention problems Aggressive behavior Sleep problems 5.Concentrate 6.Can'tSitStill 56.Clumsy 59.ShiftsQuickly 95.Wanders 8.Can'tWait 1 15.Defiant 16.Demanding 18.DestroyOther 20.Disobedient 27.NoGuilt 29.Frustrated 35.Fights 40.HitsOthers 42.HurtsAcciden 44.AngryMoods 53.Attacks 58.Punishment 66.Screams 69.Selfish 81.Stubborn 85.Temper 88.Uncooperativ 96.WantAttentio 22.NotSleepAlo 38.SleepProb 48.Nightmares 64.ResistsBed 74.SleepLess 84.TalkInSleep 94.WakesOften Anna Ek ECOG

9 CBCL scales ratings Emotionally reactive Anxious/Depressed Somatic complaints Withdrawn 21.Disturbed 10.Dependent 1. AchesPains 2.ActsYoung 46.Twitching 33.FeelingsHurt 7. ThingsOut 4.AvoidsEye 82.MoodChang Affective problems 37.UpsetBySep 83.Sulks Internal behaviors 39. Headaches Emotionally 23.NoAnswer Reactive 43.LookUnhapp 45. Nausea 62.RefusesActiv 92.UpsetByNew Anxiety problems 97.Whining 47.Nervous 78. Stomachache Anxious/Depressed 67.UnRespAffec 99.Worries 68.SelfConsc 86. TooNeat 70.LittleAffect External Pervasive Total behaviors Developmental Problem Scale Somatic Score Complaints 87.Fearful 93. Vomiting 71.LittleIntrest Problems 90.Sad 98.Withdrawn Attention Attention deficit/hyperactivity Aggressive behavior Sleep Problems (CBCL Sleep problems only) problems 5.Concentrate 6.Can'tSitStill 56.Clumsy 59.ShiftsQuickly 95.Wanders DSM Scale Problems Oppositional defiant Problems. 8.Can'tWait 1 15.Defiant 16.Demanding 18.DestroyOther 20.Disobedient 27.NoGuilt 29.Frustrated 35.Fights 40.HitsOthers 42.HurtsAcciden 44.AngryMoods 53.Attacks 58.Punishment Syndrome Scale Attention Problems Aggressive Behavior 66.Screams 69.Selfish 81.Stubborn 85.Temper 88.Uncooperativ 96.WantAttentio 22.NotSleepAlo 38.SleepProb 48.Nightmares 64.ResistsBed 74.SleepLess 84.TalkInSleep 94.WakesOften Anna Ek ECOG

10 Results 1 (3) 28 children, mean age 4.9 years, 50% boys, mean BMI SDS 3.0 The total score of problem behaviours in this clinical sample was 30.6 (SD 20.3), compared to 22.3 (15.4) in a Swedish reference population, and to 16.1 (15) in a Danish population. Obese children also had higher scores on the subscales Anna Ek ECOG

11 Results 2 (3) CBCL/1.5-5 More and Less Clinical Sample (n=28) Swedish Reference Population (n=1439) Scales Mean (SD) Mean (SD) Total Problem (20.37) (15.45) Externalizing (7.50) 9.46 (6.68) Internalizing 7.43 (6.75) 4.82 (4.63) Emotionally Reactive 3.39 (2.60) 1.42 (1.60) Anxious/Depressed 1.50 (1.43) 0.89 (1.38) Somatic Complaints 1.82 (2.54) 1.65 (1.83) Withdrawn 1.64 (1.79) 0.86 (1.40) Sleep Problems 3.61 (2.70) 2.35 (2.20) Attention Problems 2.29 (2.09) 1.49 (1.53) Aggressive Behavior 7.50 (5.84) 7.97 (5.63) Anna Ek ECOG

12 Results 3 (3) N=28, mean age 4.9 years, 50% boys, mean BMI SDS 3.0 The total score of problem behaviours in this clinical sample was 30.6 (SD 20.3), compared to 22.3 (15.4) in a Swedish reference population, and to 16.1 (15) in a Danish population. Obese children also had higher scores on the subscales. No significant gender associations. Mothers scores, but not father s scores, on BDI-II were positively correlated with the children s scores on the total problem scale (p=0.038) and on the externalizing problem subscale (p=0.041). Anna Ek ECOG

13 Conclusions Higher total problem score was reported in children with obesity as young as four compared to reference data These findings need to be investigated in a larger sample The link to mother s reported degree of depression needs to be confirmed in a larger sample. Anna Ek ECOG

14 Contact information Anna Ek Paulina Nowicka Visit our webpage Anna Ek ECOG

15 Thank you! Anna Ek ECOG