title: Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models.
abstract: Diagnostic criteria for eating disorders (ED) remain largely based on clinical presentations, but do not capture the full range of behaviours in the population. We aimed to derive an empirically based ED behaviour classification using behavioural and body mass index (BMI) indicators at three time-points in adolescence, and to validate classes investigating prospective associations with adverse outcomes. Adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) provided data on ED at age 14 (n = 6615), 16 (n = 5888), and 18 years (n = 5100), and had weight and height measured. Psychological and behavioural outcomes were assessed at 15.5/16 and 17.5/18 years. We fit gender- and age-stratified latent class models, and employed logistic regression to investigate associations between classes and later outcomes. One asymptomatic and two symptomatic (largely representing higher and lower frequency ED behaviours) classes were observed at each time-point, although their relative prevalence varied by age and gender. The majority of girls in symptomatic classes remained symptomatic at subsequent assessments. Girls in symptomatic classes had higher odds of subsequent anxiety and depressive disorders, binge drinking, drug use, and deliberate self-harm. Data analyses were underpowered amongst boys. The presence of two symptomatic classes (characterised by different ED behaviour frequency) and their prospective association with adverse outcomes suggest a need to refine diagnostic thresholds based on empirical data. Despite some instability of classes, particularly in mid-adolescence, evidence that half of girls in symptomatic classes remained symptomatic suggests persistence of ED behaviours in adolescence, and highlights a need for early identification to reduce chronicity.
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. n.micali@ucl.ac.uk.|Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. n.micali@ucl.ac.uk.|Institute of Child Health, University College London, London, UK. n.micali@ucl.ac.uk.
authors.forename: Nadia
authors.initials: N
authors.lastname: Micali
authors.affiliation: Department of Mathematics and Statistics, Amherst College, Amherst, MA, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Horton
authors.affiliation: Department of Biomedical Statistics, Neuropsychiatric Research Institute, Fargo, ND, USA.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Epidemiology, Harvard T. H. ChanSchool of Public Health, Boston, USA.|Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Swanson
authors.affiliation: Human Nutrition Program, Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
authors.forename: K R
authors.initials: KR
authors.lastname: Sonneville
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Solmi
authors.affiliation: Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Calzo
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA.|Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Department of Epidemiology, Brown University School of Public Heath, Providence, RI, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Field
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D001068:Feeding and Eating Disorders / Q000145:classification / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D010290:Parents; D011446:Prospective Studies; D016728:Self-Injurious Behavior / Q000523:psychology; D019966:Substance-Related Disorders / Q000523:psychology
keywords: ALSPAC; Adolescent; Eating disorders; Latent class