The importance of thinking styles in predicting binge eating.

Impulsivity, Body Mass Index, negative emotions and irrational food beliefs are often reported as predictors of binge eating. In the current study we explored the role played by two thinking styles, namely food thought suppression and desire thinking, in predicting binge eating among young adults controlling for established predictors of this condition. A total of 338 university students (268 females) participated in this study by completing a battery of questionnaires measuring the study variables. Path analysis revealed that impulsivity was not associated with binge eating, that Body Mass Index and negative emotions predicted binge eating, and that irrational food beliefs only influenced binge eating via food thought suppression and desire thinking. In conclusion, thinking styles appear an important predictor of binge eating and they should be taken into consideration when developing clinical interventions for binge eating.

Investigation of the cause of miscarriage and its influence on women's psychological distress.

OBJECTIVE: To determine whether knowledge of the possible cause of miscarriage reduces women's long term psychological distress. DESIGN: Prospective longitudinal study. SETTING: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London. METHODS: In 143 women where a routine ultrasound scan at 10-14 weeks of gestation showed an anembryonic pregnancy or fetal death, investigations were carried out to help ascertain the cause of the pregnancy loss. The participants were divided into two groups according to whether the cause was identified or not, and the psychological conditions of the two groups were compared at four weeks and four months after the diagnosis of fetal loss. MAIN OUTCOME MEASURES: Anxiety, depression, grief, self-blame, worry. RESULTS: The scores for all outcome variables were significantly lower at the four-month compared with the four-week post-miscarriage assessment. A fetal chromosomal abnormality was the most commonly identified cause of miscarriage, and this group reported significantly less self-blame than women in whom no cause was identified. There were no significant differences between the groups on any other outcome variables. CONCLUSIONS: In women with a missed miscarriage, identification of the cause of fetal loss reduces the feelings of self-blame.

Some psychometric properties of the Texas Grief Inventory adjusted for miscarriage.

The psychometric properties of an adjusted version of the Texas Grief Inventory (Zisook, Devaul & Click, 1982) were evaluated in a sample of 207 women following an early pregnancy loss. Factor structure of the Inventory was examined, and the validity was assessed by comparing the level of grief in women who became pregnant following a miscarriage and those who did not. Factor analysis resulted in a three-factor solution that was theoretically interpretable. The identified subscales were: pure grief, grief-related emotions and perceived adjustment and functioning since miscarriage. Significantly lower levels of grief-related behaviours and feelings were reported in women who became pregnant, which was suggestive of the construct validity of the Inventory. The high reliability coefficient (Cronbach's alpha = .90) obtained with this 17-item version of the Grief Inventory suggests it to be a reliable instrument for the assessment of grief after early miscarriage.

Personal coping resources, responsibility, anxiety and depression after early pregnancy loss.

This cross-sectional study aimed at assessing the relationship of feeling of personal responsibility for miscarriage and personal coping resources (self-esteem and self-efficacy), with symptoms of anxiety and depression in 138 women at 19 to 400 days following the diagnosis of a missed abortion. Multiple regression analyses controlling for demographic and obstetric variables demonstrated that higher feelings of personal responsibility, and lower personal resources were significantly associated with anxiety and depression. Self-esteem had the most salient effect on women's level of affective psychopathology; higher levels of self-esteem were associated with lower anxiety and depression. Women with high levels of self-esteem also reported significantly lower feelings of personal responsibility for miscarriage than those with low levels of self-esteem. Interventions aimed at enhancing feelings of self-worth, and at altering exaggerated feelings of personal responsibility for miscarriage, could lessen the potential negative emotional impact of pregnancy loss on women.

Psychological outcomes following missed abortions and provision of follow-up care.

This cross-sectional study of 204 women who had experienced a missed abortion, diagnosed at 10-14 weeks of pregnancy, examined the availability and desirability of routine follow-up care, and whether such care is associated with reduced psychological morbidity in the aftermath of miscarriage. Clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively, and the mean score of grief was 2.52 which is similar to that observed in people who suffer death of a close relative. A follow-up appointment after the miscarriage was thought to have been desirable by 92% of women but was offered to only 30%. No significant association between such care and reduced psychological morbidity was identified. However, there were significantly more women with clinically elevated levels of anxiety among those who felt that they were not provided with an opportunity to discuss their feelings during the follow-up, suggesting that such a follow-up either had a deleterious effect on women's psychological state or the distress itself led to such a perception of care. One-third of women in our sample would have liked psychological counselling to help them deal with the emotional aspects of their loss.

PIP: The 10-14 week ultrasound scan has been introduced to routine prenatal care for early diagnosis of major defects and screening for chromosomal abnormalities. In about 3% of such scans, the diagnosis of missed abortion is made. Despite evidence of substantial emotional stress associated with early pregnancy loss, follow-up care is not routinely provided. The present study investigated the availability and effectiveness of such follow-up care in 204 women (median age, 36 years) from London, England, who received a diagnosis of missed abortion or anembryonic pregnancy at 10-14 weeks of gestation in 1995-96. At the time of the survey, 19-400 days after the ultrasound, clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively. The mean grief score was 2.52, which exceeded that reported in another study of persons who suffered the death of a close relative (2.23). 187 women (92%) expressed the belief a follow-up appointment after diagnosis would have been desirable; 73 (36%) thought they would have benefited from emotional counseling. However, a follow-up appointment was offered to only 61 women (30%). Even among women offered a follow-up visit, 22 (42%) indicated they were not provided an opportunity to discuss their feelings about the miscarriage. Women who attended the follow-up but felt they were not given an opportunity to express feelings had significantly higher mean anxiety and depression scores than women who did not have follow-up care or those who attended the follow-up and discussed their feelings. Overall, these findings indicate that miscarriage and the evacuation of retained products of conception are traumatic experiences that are too often dismissed as routine by medical staff.