Risk factors for eating disorders
Appendix
Details of the variables used as potential predictors of eating disorder caseness, across the five risk factor domains
Variable / Ages assessed / Measure / ScoringObstetric & Birth Factors
Mother’s age at gestation / Pregnancy / Questionnaire item / Continuous
Mother’s BMI at 16 wks gestation / Pregnancy / Physical examination / Continuous
Father’s BMI at 16 wks gestation / Pregnancy / Questionnaire items / Continuous
Mother’s & father’s birth weights / Pregnancy / Questionnaire items / Continuous
Mother or father on a special diet / Pregnancy / Questionnaire item / Categorical
Family income in pregnancy / Pregnancy / Questionnaire item / Continuous
Family stress in pregnancy / Pregnancy / Life Events Scale / Continuous
Smoking, drug & alcohol use in pregnancy / Pregnancy / Questionnaire items / Continuous & categorical
Maternal health problems pre- & during pregnancy / Pregnancy / Questionnaire items & hospital records / Categorical
Concerns about pregnancy / Pregnancy / Questionnaire items / Categorical & continuous
Planned pregnancy / Pregnancy / Questionnaire items / Categorical
Mode of delivery / Birth / Hospital reported / Categorical
Duration of labour / Birth / Hospital reported / Continuous
Pre-term birth / Birth / Hospital reported / Categorical
Gestational age / Birth / Hospital reported / Continuous
Birth weight & length / Birth / Hospital reported / Continuous
Time to spontaneous respiration / Birth / Hospital reported / Continuous
Obstetric complications / Birth / Hospital reported / Categorical
Neonatal complications / Birth / Hospital reported / Categorical
Apgar scores (1, 5 & 10 minutes) / Birth / Hospital reported / Continuous
Poor sucking/ feeding / Post-birth / Hospital reported / Categorical
Age of onset of oral & self feeding / Post-birth / Questionnaire items / Continuous
Type of feeding (breast, bottle, tube) / Post-birth / Questionnaire items / Categorical
Maternal postnatal depression symptoms / Post-birth / Questionnaire items / Continuous
Child Personal & Emotional Functioning
Worries re. child emotional problems / 2 / Questionnaire item / Categorical
Worries re. child sleep / 2 / Questionnaire item / Categorical
Worries re. abuse (sexual or otherwise) / 2 / Questionnaire item / Categorical
Emotional & behavioural problems: CBCLa / 2, 5, 8, 10 / Parent-report CBCLa / Continuous & categoricala
Overly concerned with neatness/ cleanliness / 2, 5, 8, 10 / CBCL item / Categorical
Feels has to be perfect / 2, 5, 8, 10 / CBCL item / Categorical
Self-conscious/ easily embarrassed / 2, 5, 8, 10 / CBCL item / Categorical
Emotional & behavioural problems: SDQb / 10 / Parent-report SDQb / Continuousb
Self-efficacyc / 10 / Self-Efficacy Scalec / Continuousc
How easy/ difficult child is to manage / 5, 8, 10 / Questionnaire item / Continuous
Continued below
Continued
Seen psychologist/ psychiatrist in last yr / 8, 10 / Questionnaire item / Categorical
Diagnosed anxiety problems / 8, 10 / Questionnaire item / Categorical
Diagnosed depression / 8, 10 / Questionnaire item / Categorical
Academic performance / 8, 10 / Questionnaire item / Continuous
WISC Block Design / 8 / WISC Block Designd / Continuous
Limited by emotional problems / 8, 10 / Questionnaire item / Categorical
Social difficulties / 10 / Questionnaire item / Categorical
Child Health
Seen General Practitioner in last yr / 1, 2, 10 / Questionnaire item / Categorical
Seen Paediatrician in last yr / 1, 2, 5 / Questionnaire item / Categorical
Been to health clinic in last yr / 1, 2, 5 / Questionnaire item / Categorical
Hospital admissions in last yr / 2, 3, 5, 8, 10 / Questionnaire item / Continuous & categorical
Hospital emergency department in last yr / 5, 8, 10 / Questionnaire item / Categorical
Hospital outpatient department in last yr / 8, 10 / Questionnaire item / Categorical
Private medical specialist in last yr / 10 / Questionnaire item / Categorical
Worries re. child health problems / 1, 2, 10 / Questionnaire item / Categorical
Child limited by physical problems / 8, 10 / Questionnaire item / Categorical
Overall child health / 1, 2, 5, 8, 10 / Questionnaire item / Continuous
Child chronic medical condition / 5 / Questionnaire item / Categorical
Abdominal pain seen by doctor / 8, 10 / Questionnaire item / Categorical
Child blood glucose levels / 8 / Blood tests / Continuous
Child cholesterol (HDL, LDL, ratio) / 8 / Blood tests / Continuous
Parental and Family Functioning
Family stress / 1, 2, 5, 8, 10 / Life Events Scalee / Continuous
Father living with family / 2, 5, 8, 10 / Questionnaire item / Categorical
Family receives benefits / 2, 5, 8, 10 / Questionnaire item / Categorical
Family income / 2, 5, 8, 10 / Questionnaire item / Continuous
Mother employed / 2, 5, 8, 10 / Questionnaire item / Categorical
Father employed / 2, 5, 8, 10 / Questionnaire item / Categorical
Family functioning / 5, 8 / FADf / Continuousd
Parenting style / 10 / Parenting Scaleg / Continuouse
Mothers general health / 8, 10 / Questionnaire item / Continuous
Mother long-term health problems / 8, 10 / Questionnaire item / Categorical
Mother emotional problem - ever / 8, 10 / Questionnaire item / Categorical
Mother emotional problem - past 6 months / 8, 10 / Questionnaire item / Categorical
Mother hospitalised for emotional problem / 8, 10 / Questionnaire item / Categorical
Mother post-natal depression / 10 / Questionnaire item / Categorical
Maternal emotional distress / 10 / DASSh / Continuousf
Continued below
Continued
Father emotional problem - past 6 months / 8, 10 / Questionnaire item / Categorical
Father hospitalised for emotional problem / 8, 10 / Questionnaire item / Categorical
Mothers average weekly alcohol intake / 10 / Questionnaire item / Continuous
Fathers average weekly alcohol intake / 10 / Questionnaire item / Continuous
Child close relationship with mother / 10 / Questionnaire item / Categorical
Child close relationship with father / 10 / Questionnaire item / Categorical
Time mother spends with child each week / 10 / Questionnaire item / Continuous
Time father spends with child each week / 10 / Questionnaire item / Continuous
Eating, Weight and Shape
Mother breastfed baby / 1 / Questionnaire item / Categorical
Age stopped breastfeeding / 1, 2 / Questionnaire item / Continuous & categorical
Age first gave solids / 1, 2 / Questionnaire item / Continuous
Any feeding problems / 1 / Questionnaire item / Continuous
Any swallowing problems / 1, 2 / Questionnaire item / Continuous
Doctors visit re. vomiting / 1 / Questionnaire item / Categorical
Child vomits regularly / 8 / Questionnaire item / Categorical
Child’s diet restricted / 1, 2, 5 / Questionnaire item / Categorical
Child refuses to eat / 2 / Questionnaire item / Categorical
Worries re. child’s diet/ nutrition / 2, 5, 8 / Questionnaire item / Categorical
Dietician in last year / 8, 10 / Questionnaire item / Categorical
Parent-perceived child overeating / 2, 5, 8, 10 / CBCL item / Categorical
Parent-perceived child overweight / 2, 5, 8, 10 / CBCL item / Categorical
Time spent watching TV / 5, 8, 10 / Questionnaire item / Continuous
Involved in organised sport / 5, 8 / Questionnaire item / Continuous
Level of activity / 8, 10 / Questionnaire item / Continuous
Child skin fold thickness (abdomen) / 1, 5, 8, 10 / Physical examination / Continuous
Child BMI / 1, 5, 8, 10 / Physical examination / Continuous
Mother BMI / 8 / Physical examination / Continuous
Father BMI / 8 / Physical examination / Continuous
a Child Behavior Checklist (CBCL)1: Generates continuous and categorical scores on 8 subscales (Withdrawn, Somatic, Anxious-Depressed, Social, Thought, Attentional, Delinquent, and Aggressive Problems).
b Strengths and Difficulties Questionnaire (SDQ)2: Generates scores on 5 subscales (Emotional, Conduct, Hyperactivity, and Peer Problems, and Prosocial behaviour).
c Cowen’s Self-Efficacy scale3: Assesses self-efficacy in relation to Difficult Situations, New Experiences, & dealing with People and Social Situations
d Wechsler Intelligence Scale for Children (WISC)-III4, Block Design subtest: Assesses concept formation and visuo-spatial processing and evaluation.
e Life Events Scale5: Assesses stressful live events over the past 6 months
f Family Assessment Device6: Includes 2 items assessing how happy each parent is & 2 subscales regarding how well family members relate to each other and consider other family member’s feelings
g Parenting Scale7: Generates global scores and 3 subscale scores (Overreaction, Verbosity, Laxness)
h Depression Anxiety Stress Scales (DASS)8: Generates scores on 3 subscales (Depression, Anxiety, Stress).
References:
1. Achenbach TM. Manual for the Child Behavior Checlist/ 4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry; 1991.
2. Goodman R. The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psyc . 1997;38:581-586.
3. Cowen EL, Work WC, Hightower AD, Wyman PA, Parker GR, Lotyczewski BS. Toward the development of a measure of perceived self-efficacy in children. J Clin Child Psychol. 1991;20:169-178.
4. Wechsler D. Wechsler Intelligence Scale for Children - Third Edition (WISC-III). San Antonio TX: Pearson; 1991.
5. Brugha T, Cragg D. The List of Threatening Experiences: The reliability and validity of a brief life events questionnaire. Acta Psychiat Scand. 1990;82:77-81.
6. Epstein NB, Baldwin LM, Bishop DS. The McMaster Family Assessment Device. J Marital Fam Ther. 1983;9:171-180.
7. Arnold DS, O'Leary SG, Wolff LS, Acker MM. The Parenting Scale: A measure of dysfunctional parenting in discipline situations. Psychol Assessment. 1993;5:137-144.
8. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales (2nd Ed.). Sydney: Psychology Foundation; 1995.
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