Disordered eating behaviors and binge drinking in female high-school students: the role of impulsivity / Conductas alimentarias de riesgo y consumo escesivo de alcohol en mujeres estudiantes: el papel de la impulsividad

Introduction It is widely accepted that psychiatric comorbidity can increase the severity, chronicity, and treatment resistance of psychiatric disorders. In various studies worldwide, it has been estimated that the prevalence of alcohol use disorders in women with disordered eating behaviors (DEB) is situated at between 2.9 and 48.6%. It is worth noting that previous studies have not considered the analysis of the variables that could explain the comorbidity between DEB and alcohol use in adolescents, such as impulsivity, which is the key variable for explaining this comorbidity. On the other hand, most studies have addressed the adult population in psychiatric hospitals or people with eating disorders (ED) or alcohol use disorders. It is considered that those subjects have already developed psychiatric comorbid disorders. Impulsivity could be an unspecific trait that aggravates the psychiatric condition of a determined person and it is therefore more likely for that person to seek specialized care. According to the above, the role of impulsivity in the comorbidity of ED and alcohol use might not be similar to that of the general population, mostly among those who have not yet developed a whole clinical syndrome. Therefore, we consider that it is important to clarify the involvement of impulsivity in the comorbidity between disordered eating behaviors (DEB) and binge drinking (BD) in high school students. It is also crucial to analyze the association between impulsivity and the coexistence of DEB and binge drinking (BD) in female students aged between 15 and 19 years at public high schools in the State of Mexico. Methods Data for this study were drawn from the Project entitled "Prevalence and Factors Associated with Disordered Eating Behaviors in Adolescent Women with Different Levels of Urbanization and Migration Intensity" (CONACyT-SEP-2004-46560). The design for this study is cross-sectional and analytical. A sample of 2357 female students at 11 public high schools in the State of Mexico was randomly selected during the 2006-2007 school year. For data collection for this project, a questionnaire was used that included socio-demographic variables, the Plutchik Impulsivity Scale (PIS), the Brief Questionnaire to Measure Risky Eating Behaviors (BQREB), and the questions on alcohol use included in the Questionnaire of Surveys on Substance Use in Students in Mexico (2003 version). Data were analyzed with the STATA version 10 survey function. Results Impulsivity was associated with the coexistence of DEB and BD (U=224427; p<0.01). The 3.5% of female students with impulsivity presented DEB and BD together vs. 0.6% who did not; 19.6% of female students with impulsivity presented one of the two behaviors vs. 7.8% without this trait. Impulsivity was associated positively and significantly with the coexistence of DEB and BD (t=3.8; p<0.01), regardless of socioeconomic variables, such as the father's educational attainment, the mother's educational attainment, and the number of services in the household. Conclusion The results of this paper indicate a statistically significant association between impulsivity and the coexistence of DEB and BD. This means that there is a greater percentage of coexistence of DEB and BD in female high school students considered to be impulsive in comparison with adolescents without this trait. This occurs regardless of socioeconomic variables, such as the father's educational attainment, the mother's educational attainment, and the number of services in the household. Future research should establish the role of other variables such as depression and examine the association of impulsivity with socioeconomic variables.

Introducción En términos generales, se acepta que la comorbilidad psiquiátrica puede incrementar la gravedad, la cronicidad y la resistencia al tratamiento de los trastornos psiquiátricos. En diversos estudios en todo el mundo se ha estimado que la prevalencia de trastornos por consumo de alcohol en mujeres con conductas alimentarias de riesgo (CAR) se sitúa entre el 2.9 y el 48.6%. Es importante señalar que los estudios anteriores no han considerado el análisis de las variables que podrían explicar la comorbilidad entre las CAR y el consumo de alcohol en los adolescentes, tales como la impulsividad, que es la variable considerada como la más importante para explicar dicha comorbilidad. Por otro lado, la mayor parte de la literatura ha estudiado a población adulta en hospitales psiquiátricos o a sujetos que ya han cumplido con los criterios diagnósticos de los trastornos de la conducta alimentaria (TCA) y de los trastornos por uso de alcohol. Se ha considerado que dichas poblaciones ya han desarrollado trastornos psiquiátricos comórbidos y que la impulsividad puede ser un rasgo inespecífico que agrava la situación psiquiátrica de una persona y que de esa forma sea más probable que acuda a una institución hospitalaria. Por lo tanto, es posible que la participación de la impulsividad en la comorbilidad entre los TCA y el consumo de alcohol no sea similar en la población general, sobre todo en la que no ha desarrollado los trastornos aún. Por lo tanto, consideramos importante aclarar la participación de la impulsividad en la comorbilidad entre las conductas alimentarias de riesgo (CAR) y el consumo excesivo de alcohol (CEA) en la población general y especialmente en aquellos sujetos en riesgo de presentar estos trastornos. Para ello se consideró importante analizar la asociación entre la impulsividad y la coexistencia de las conductas alimentarias de riesgo y el consumo excesivo de alcohol en estudiantes de sexo femenino de entre 15 y 19 años en escuelas públicas del Estado de México. Método Los datos para este estudio fueron obtenidos del Proyecto "Preva-lencia y Factores Asociados a Conductas Alimentarias de Riesgo en Mujeres Adolescentes en Localidades con diferente Nivel de Urbanización e Intensidad de Migración" (CONACyT-SEP-2004-46560). El diseño del estudio es transversal-analítico. La unidad de análisis fueron las estudiantes de sexo femenino entre 15 y 19 años de edad en instituciones educativas públicas de nivel medio superior en el Estado de México. Para la selección de las estudiantes, se utilizó un muestreo aleatorio estratificado. La muestra consistió en 2357 estudiantes de 11 escuelas públicas en el Estado de México durante el año escolar 2006-2007. Para la recolección de datos se empleó un cuestionario que incluía variables sociodemográficas, la Escala de Impulsividad Plutchik, el Cuestionario Breve de Conductas Alimentarias de Riesgo, y las preguntas sobre el consumo de alcohol, incluidas en el cuestionario de estudiantes (versión 2003) de las encuestas sobre consumo de sustancias en estudiantes de México. Los datos fueron analizados con la función survey del programa estadístico STATA versión 10 con una ponderación de la muestra que correspondió a la probabilidad de selección debido al nivel de marginación y estatus migratorio. Para determinar la asociación entre la impulsividad y la coexistencia entre las CAR y el CEA, se realizó un análisis de regresión ordinal. Resultados La impulsividad se asoció con la coexistencia entre las conductas alimentarias de riesgo y el consumo excesivo de alcohol (U=224427, p<0.01). El 3.5% de las estudiantes con impulsividad presentaron CAR y CEA de manera conjunta vs. el 0.6% que no cumplieron con dicha definición, mientras que el 19.6% de las estudiantes con impulsividad presentaron una de las dos conductas vs. 7.8% sin dicho rasgo. La impulsividad se asoció de manera positiva y significativa con la coexistencia CAR & CEA (t=3.83; p<0.01), de manera independiente a las variables socioeconómicas como la escolaridad del padre, la escolaridad de la madre y el número de servicios en la vivienda. Conclusión Los resultados de este trabajo indican una asociación estadísticamente significativa entre la impulsividad y la coexistencia de CAR y CEA. Lo anterior significa que hay un porcentaje mayor de la coexistencia de CAR y CEA en las estudiantes que cumplieron la definición operacional de impulsividad en comparación con las estudiantes sin dicho rasgo, de manera independiente a las variables socioeconómicas como la escolaridad del padre, la escolaridad de la madre y el número de servicios en la vivienda. Los resultados del presente estudio muestran que la impulsividad está asociada con una serie de conductas que pueden incrementar el desarrollo de un TCA comórbido con un trastorno por consumo de alcohol, y por lo tanto, sugieren un peor pronóstico para las adolescentes incluidas en el estudio. Lo anterior plantea la necesidad de detectar a los sujetos en riesgo de desarrollar ambos trastornos y su canalización a los servicios de salud especializados. Queda pendiente establecer el papel de otras variables como la depresión, y estudiar la asociación entre la impulsividad con las variables socioeconómicas mencionadas.

Conductas alimentarias de riesgo en población estudiantil del Distrito Federal: tendencias 1997-2003 / Risky eating behaviors in student population in México City: trends 1997-2003

Objective. The main purpose of this study was to identify the trends of risky eating behaviors among student population in Mexico City in the period 1997-2003 and its relationship with sex age and family head educational level. Methods. Data from the 1997 (N = 9,755), 2000 (N = 3,286) and 2003 (N = 3,062) Drug and Alcohol Prevalence in Student Population of Mexico City Survey's were analyzed. These are representative data of students of junior high, high school and technical schools in Mexico City, with a mean age of 14.5 years (SD - 1.9). Eating behaviors were assessed with a brief questionnaire developed following DSM-FV diagnostic criteria. Risky eating behaviors and the number of risk indicators were compared by sex, age and family head educational level. Results. The results showed an overall increase in the percentage of males (from 1.3% in 1997 to 3.8% in 2003), and females (3.4% in 1997 to 9.6% in 2003) who showed 3 or more risky eating behaviors. The analysis by age groups showed an increase in all but 16-17 year old males, and in all females, being 12-13 year old males and 18-19 year old females the most affected. Regarding the type of risk indicators in both sexes and across all age groups, an increase in preoccupation towards gaining weight and the use of purging and restrictive methods to loose weight was observed. Body weight over estimation decreased in males, while in females showed an increase along with binges in the 2000 survey but showed a decrease after that (2003 survey). The relationship between the family head educational level and risky eating behaviors did not show a regular pattern among males, while a positive relationship between both variables was found among females. Conclusions. A first overall view of the situation of risky eating behaviors among adolescent students in Mexico City and the changes observed in the period studied. An increase of these behaviors was observed along the period of study, being younger males and older females the most affected, as well as women whose family head showed higher educational level.

Objetivo. Identificar las tendencias de las conductas alimentarias de riesgo en estudiantes del Distrito Federal en el periodo 1997-2003 y su relación con el sexo, la edad y el nivel de escolaridad del jefe de familia. Material y métodos. Se analizaron los datos de las encuestas sobre la Prevalencia del Consumo de Drogas y Alcohol en la Población Estudiantil del Distrito Federal 1997 (N = 9,755), 2000 (N = 3,286) y 2003 (N = 3,062). Se trata de muestras representativas de estudiantes de nivel secundaria, preparatoria y técnico en la ciudad de México, con una edad promedio de 14.5 años (DE = 1.9). La información acerca de conductas alimentarias de riesgo se obtuvo mediante un cuestionario breve desarrollado con base en los criterios diagnósticos del DSM-IV. Se hicieron comparaciones por sexo, edad y escolaridad del jefe de familia acerca del tipo, cantidad y frecuencia de conductas alimentarias de riesgo. Resultados. Los resultados mostraron un incremento general en la proporción de estudiantes que reportaron tres o más conductas alimentarias de riesgo (hombres, 1.3% en 1997 a 3.8% en 2003; mujeres 3.4% en 1997 a 9.6% en 2003). Por grupos de edad, se observó incremento en la frecuencia de estas conductas en varones de todas las edades excepto los de 16 y 17 años, y en las mujeres de todas las edades, siendo los más importantes en los varones de 12-13 años y en las mujeres de 18-19 años. En cuanto a los tipos de conducta, se incrementaron la preocupación por engordar y el uso de métodos purgativos y restrictivos para bajar de peso, la sobrestimación del peso corporal disminuyó de forma general en los varones, mientras que en las mujeres se incrementó junto con la práctica de atracones en la medición 2000, pero disminuyó en la medición 2003. La relación con la escolaridad del jefe de familia no mostró un patrón regular en los varones, pero en las mujeres se encontró una relación positiva entre estas variables. Conclusiones. Se muestra un primer panorama acerca de la situación que guardan las conductas alimentarias de riesgo en los adolescentes escolarizados de la ciudad de México y los cambios observados en el periodo estudiado. Se observa un incremento de dichas conductas a lo largo del periodo de estudio, siendo los varones más jóvenes y las mujeres de mayor edad los má-s afectados, así como las mujeres cuyo jefe de familia refirió mayor nivel de escolaridad.

Panorama del trabajo de investigación en epidemiología psiquiátrica en México: últimos 30 años

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Abstract: Mental health frames and policies to enforce them cannot be excluded from the social context, neither the population's health conditions or the international tendencies. Their strategic place depends on the role they play in the global milieu, and on the benefits derived from what is done in terms of prevention and attention within the field. Psychiatric epidemiology serves as a tool for knowing mental disorders distribution, the risk factors implied in their etiology and evolution, as well as the elements influencing their detection and treatment. But psychiatric epidemiology has remained behind other branches of epidemiology given the problems for conceptualizing and measuring mental disorders. Thus, most of the work has been basically descriptive. Nevertheless it has been possible to move forward through historical series, analyses of community diagnosis, health services evaluation, risk measurement, description of clinical frames, identification of new syndromes and its related causes, and in carrying out national and international representative surveys in general population. This paper has four objectives: 1. to present an overview of the work done in epidemiologic psychiatry in Mexico for the last 30 years; 2. to analyze the main areas explored; 3. to identify the most used designs; and 4. to enumerate the populations studied. Method. Articles about different aspects related to study and analysis of psychiatric epidemiology in Mexico were collected, including those reporting empirical results. The search was performed in a bibliographic database consulted in the Centro de Información en Salud Mental y Adicciones (CISMAD), located at the Instituto Nacional de Psiquiatría Ramón de la Fuente. Approximately 158 papers published in national and international journals were reviewed. Results. In the 1970's, work was aimed towards historical analysis seeking to provide an epidemiologic view of psychiatric disorders in Mexico. Interest was set on aspects related to attention of mental patients, the teaching of psychiatry, and in the advance of psychiatric knowledge. Some studies were done to have a look at the frequency and characteristics ofcertain diseases in unexplored populations. During the 1980's there was a renewed interest in dissecting the status of epidemiologic psychiatry and mental health, together with an intention to state its role in the future. Cross sectional studies were performed to know the prevalence ofdifferent mental illnesses in medical care. Validity and reliability of several detection and diagnosis instruments were evaluated, and some essays about the importance of having a clear view of attention needs and demands were carried out. At the beginning of the 1990's there were descriptive studies in rural and urban populations to describe the main elements determining the use of health services and the quest patterns for different attention options. New diagnosis instruments were used in subjects attending the first and second levels of care. Research on schizophrenia began with reviews and dissertations about its status in Mexico and other countries. Results of the Mental Health National Survey showing prevalence in general population were made public. Home base surveys made possible to know the scope of mental illness in children, adolescents, and adults. The use of epidemiology in child psychiatry allowed the inclusion of developmental psychopathology in the analysis of the interaction and interdependence of biological, psychological, and social variables. The 21st century set the emergence of the first longitudinal reports on suicide. Work continues on the prevalence of mental illness and new approaches on risk factors are added. Research on the frequency of disorders from well-defined diagnosis criteria is signed. Use and abuse of substances, and violence against women are studied to know their effects on mental health. The Survey on Psychiatric Morbidity was planned and conducted with great methodological rigor, and thus it was included in the first generation of ICPE studies, which has enabled data comparison on an international basis. Results have shown that depressive disorders are the most recurrent, whereas disorders related to substance abuse and dependence affect basically men, and that anxiety disorders are the most chronic. In 2000, the World Health Organization launched an initiative to make national epidemiologic studies in different countries, and Mexico was the first Latin American country to participate. The National Psychiatric Epidemiology Survey initial results have confirmed that the prevalence of disorders along life is 28.6%, and that annual prevalence is 14%. Discussion. It is important to underline the need to pay attention to mental health problems from a preventive approach. In this respect, Mexico is a little behind and it is urgent to grow according to the advances, instruments, and techniques used in other countries. It is also important to acknowledge the work done so far; in this sense, the development of national surveys accounts for it. General population studies allow for the generation of an overview of the needs and the basic issues to create preventive interventions. Mexican epidemiologic psychiatry is in a developmental stage, stressed by the use of standardized diagnosis criteria to get comparable data (both from Mexico and other countries in the world). However, the study designs employed until now do not allow for the exploration of the temporary evolution of disorders and related factors to be more exhaustive. Besides, there are limitations in evaluating health services, which could be overcome through cost-effectiveness analyses. In the national context it is notorious the lack of inquiring about the diagnosis boundaries, which should be one of the main directions of psychiatric epidemiology in the next years. This would be highly relevant taking into account that Mexico is a transition country that accepts and uses both European and American criteria. It should be mentioned also that, although Mexico has the same kind of problems than other countries, research has shown they are smaller, which makes studies on protective and risk factors a priority for the future. There are still certain aspects of epidemiology which remain practically untouched in research. For instance, it is important to focus on rural areas, on migrant populations, and on native groups to overcome the existing backwardness. Another important topic in the prevention area is the work to do carried out with mental problems during childhood and adolescence. Longitudinal studies would mark the path to evaluate different types of factors: genetic, biologic, familiar, psychodyna-mic, social, and economic. It is also important to analyze the interaction among them to know its impact on etiology and on the development of psychopathology during life.