A systematic review of mental health interventions to reduce self-stigma in medical students and doctors.

Background: A growing body of literature has revealed that many medical students and doctors do not seek professional help for their mental health due to fear of stigma (both public- and self-stigma) and questioning of their clinical competency. The aim of this systematic review was to identify and evaluate direct and indirect interventions that address mental health stigma in medical students and/or doctors. We focused explicitly on studies that measured the impact on self-stigma outcomes. Method: A systematic search of the following electronic databases was undertaken from inception to 13 July 2022: PubMed, Embase, PsycINFO, and CINAHL, together with manual searching of reference lists. Screening of titles, abstracts, and full texts of eligible studies, plus quality appraisal using the Mixed Methods Appraisal Tool, were independently conducted by multiple reviewers with disagreements resolved via discussion. Results: From 4,018 citations, five publications met the inclusion criteria. None of the studies explicitly aimed to reduce self-stigmatisation, with the majority focusing on medical students. Most of the identified interventions focused on reducing professional stigma (i.e., stigma toward patients with mental illness) and measurement of self-stigma was incidentally collected via a subscale of the general stigma measure selected. Three studies found significant reductions in self-stigma following the delivered intervention. These studies were of moderate quality, had medical student samples, employed combined education and contact interventions, and used the same outcome measure. Discussion: Intentional development and evaluation of interventions specifically designed to decrease self-stigma among doctors and medical students are needed, with further research required on the optimal components, format, length, and delivery of such interventions. Researchers delivering public/professional stigma reduction interventions should strongly consider measuring the impact of such interventions on self-stigma outcomes, using fit-for-purpose, psychometrically sound instruments.

Disordered eating measures validated in pregnancy samples: a systematic review.

Although disordered eating in pregnancy has been linked to numerous negative consequences, there is currently no published instrument specifically devised to identify or measure such symptoms in pregnancy. As such, this study systematically reviewed the literature to evaluate the performance of general measures of disordered eating in pregnancy samples. A systematic search of the following electronic databases was undertaken from inception to April 2019: Scopus, Medline, PsycINFO, Embase, ProQuest Dissertations and Theses, and the Cumulative Index to Nursing and Allied Health Literature. From 1724 citations, eight publications met the inclusion criteria and were included in the review. Most of the included studies (6/8) were of reasonable quality. Overall, three self-report inventories (EDE-Q, EDI-2, and DEBS) and one semi-structured clinical interview (EDE) had some form of psychometric information available. Most studies reported reliability, with only two reporting validity. No studies assessed screening accuracy. Other than the EDE-Q, which had preliminary evidence to suggest possible utility in pregnancy, the findings of this review revealed little to no evidence to support the use of general measures of disordered eating in pregnancy. A strong need for research exploring the validity of existing measures in pregnancy samples, including the EDE-Q, was also evident.

Signs and symptoms of disordered eating in pregnancy: a Delphi consensus study.

BACKGROUND: This study aimed to establish consensus on the expression and distinction of disordered eating in pregnancy to improve awareness across various health professions and inform the development of a pregnancy-specific assessment instrument. METHODS: A three-round modified Delphi method was used with two independent panels. International clinicians and researchers with extensive knowledge on and/or clinical experience with eating disorders formed the first panel and were recruited using structured selection criteria. Women who identified with a lived experience of disordered eating in pregnancy formed the second panel and were recruited via expressions of interest from study advertising on pregnancy forums and social media platforms. A systematic search of academic and grey literature produced 200 sources which were used to pre-populate the Round I questionnaire. Additional items were included in Round II based on panel feedback in Round I. Consensus was defined as 75% agreement on an item. RESULTS: Of the 102 items presented to the 26 professional panel members and 15 consumer panel members, 75 reached consensus across both panels. Both panels clearly identified signs and symptoms of disordered eating in pregnancy and endorsed a number of clinical features practitioners should consider when delineating disordered eating symptomatically from normative pregnancy experiences. CONCLUSION: A list of signs and symptoms in consensus was identified. The areas of collective agreement may be used to guide clinicians in clinical practice, aid the development of psychometric tools to detect/assess pregnancy-specific disordered eating, in addition to serving as starting point for the development of a core outcome set to measure disordered eating in pregnancy.

Consensus on the assessment of disordered eating in pregnancy: an international Delphi study.

This study aimed to assess and develop consensus on the assessment of disordered eating in pregnancy. A three-round modified Delphi approach was used. Participants were international clinicians and researchers (N = 26) with extensive knowledge on and/or clinical experience with eating disorders, particularly in relation to pregnancy and/or women's health. Clear consensus among the panel, defined as 75% agreement, was reached regarding the assessment of disordered eating in pregnancy, in addition to potential assessment methods. Antenatal assessment of disordered eating was perceived to be crucial and ideally occur in a routine manner. Despite agreement that various assessment methods would be relevant in assessing disordered eating in pregnancy, psychometrically sound brief screening instruments were perceived to be most feasible for practitioners and women accessing antenatal care; however, these instruments must be pregnancy-specific and delivered in an authentic and caring manner to be beneficial.

Attitudes towards anorexia nervosa: volitional stigma differences in a sample of pre-clinical medicine and psychology students.

BACKGROUND: Anorexia nervosa (AN) is a highly stigmatised condition, with treatment often involving multidisciplinary care. As such, understanding and comparing the attitudes of emerging mental health and medical professionals towards AN, within the content of sex-based differences, is pertinent to facilitate the development of targeted stigma interventions. AIMS: Examine the volitional stigmatisation of AN in emerging medical and mental health professionals. METHOD: Participants (N = 126) were medical (n = 41) and psychology students (n = 85) who completed a range of attitudinal outcome measures (e.g. Causal Attributions Scale, Eating Disorder Stigma Scale, Opinions Scale, Characteristics Scale and Affective Reaction Scale). RESULTS: Across both disciplines, men were found to exhibit significantly higher eating disorder (ED) stigma, considered AN to be a more trivial and weak illness, and attributed greater levels of blame and responsibility to AN sufferers. Men also had significantly lower biogenetic causal attributions. Compared with psychology students, medicine students exhibited slightly greater anticipation of negative reactions in response to AN, obtained higher selfish/vain scores and considered sociocultural factors to contribute "a lot" in the development and maintenance of AN. CONCLUSIONS: Overall, results indicate interventions aimed at improving ED mental health literacy are needed, specifically targeting males and potentially medical students.

Food for Thought: A Randomised Controlled Trial of Emotional Freedom Techniques and Cognitive Behavioural Therapy in the Treatment of Food Cravings.

Addressing the internal determinants of dysfunctional eating behaviours (e.g. food cravings) in the prevention and treatment of obesity has been increasingly recognised. This study compared Emotional Freedom Techniques (EFT) to Cognitive Behavioural Therapy (CBT) for food cravings in adults who were overweight or obese (N = 83) in an 8-week intervention. Outcome data were collected at baseline, post-intervention, and at 6- and 12-months follow-up. Overall, EFT and CBT demonstrated comparable efficacy in reducing food cravings, one's responsiveness to food in the environment (power of food), and dietary restraint, with Cohen's effect size values suggesting moderate to high practical significance for both interventions. Results also revealed that both EFT and CBT are capable of producing treatment effects that are clinically meaningful, with reductions in food cravings, the power of food, and dietary restraint normalising to the scores of a non-clinical community sample. While reductions in BMI were not observed, the current study supports the suggestion that psychological interventions are beneficial for food cravings and both CBT and EFT could serve as vital adjunct tools in a multidisciplinary approach to managing obesity.