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Randomized trial of general hospital and residential alternative care for patients with severe and persistent mental illness.

OBJECTIVE: Severe and persistent mental illnesses are often lifelong and characterized by intermittent exacerbations requiring hospitalization. Providing needed care within budgetary constraints to this largely publicly subsidized population requires technologies that reduce costly inpatient episodes. The authors report a prospective randomized trial to test the clinical effectiveness of a model of acute residential alternative treatment for patients with persistent mental illness requiring hospital-level care. METHOD: Patients enrolled in the Montgomery County, Md., public mental health system who experienced an illness exacerbation and were willing to accept voluntary treatment were randomly assigned to the acute psychiatric ward of a general hospital or a community residential alternative. There were no psychopathology-based exclusion criteria. Treatment episode symptom improvement, satisfaction, discharge status, and 6-month pre- and postepisode acute care utilization, psychosocial functioning, and patient satisfaction were assessed. RESULTS: Of 185 patients, 119 (64%) were successfully placed at their assigned treatment site. Case mix data indicated that patients treated in the hospital (N = 50) and the alternative (N = 69) were comparably ill. Treatment episode symptom reduction and patient satisfaction were comparable for the two settings. Nine (13%) of 69 patients randomly assigned to the alternative required transfer to a hospital unit; two (4%) of 50 patients randomly assigned to the hospital could not be stabilized and required transfer to another facility. Psychosocial functioning, satisfaction, and acute care use in the 6 months following admission were comparable for patients treated in the two settings and did not differ significantly from functioning before the acute episode. CONCLUSIONS: Hospitalization is a frequent and high-cost consequence of severe mental illness. For patients who do not require intensive general medical intervention and are willing to accept voluntary treatment, the alternative program model studied provides outcomes comparable to those of hospital care.

Adult↗

Prospective study of neuropsychological and psychosocial outcome following surgical excision of intracerebral arteriovenous malformations.

In this prospective study the neuropsychological and psychosocial function of 64 patients undergoing surgical resection of cerebral arteriovenous malformations was examined prior to surgery (T1), one month post-surgery (T2) and one year post-surgery (T3). A mild but widespread cognitive decline was observed pre-operatively. There was a trend toward decreased neuropsychological function at T2. All neuropsychological tests showed a trend toward improvement at T3 compared with both pre-operative (generally not statistically significant) and early post-operative values (generally significant). Patients were assessed for change between testing times. At T2 patients were more likely to have deteriorated than improved, whereas at T3 the group which had altered from baseline were more likely to have improved than deteriorated. Deterioration in some verbal/language tasks was more common for left sided AVMs. Outcome did not differ significantly for patients presenting with haemorrhage. Psychosocial function was unchanged at late follow-up for the majority of patients.

Activities of Daily Living↗

Substance use and psychosocial outcomes following participation in residential laboratory studies of marijuana, methamphetamine and zolpidem.

RATIONALE: Non-therapeutic research with drugs of abuse in humans is important for a more comprehensive understanding of substance abuse and for the development of more effective treatments. However, the administration of substances from drug classes with abuse potential to human volunteers raises ethical questions regarding potential risk to study volunteers. OBJECTIVE: The purpose of this study was to assess the psychosocial functioning and reported drug-taking behavior of volunteers before and after participating in a residential laboratory study, during which either marijuana, methamphetamine or zolpidem was administered. METHODS: Twenty-two volunteers were administered Addiction Severity Index (ASI) interviews at intake and approximately six months following their study participation. RESULTS: No significant differences between intake and follow-up assessments were found on any ASI composite or drug/alcohol-taking variable. CONCLUSION: These preliminary data suggest that participation in residential laboratory studies involving the administration of drugs from classes with abuse potential does not alter subsequent psychosocial functioning or reported drug use.

Alcoholism↗

An empirical assessment of post-treatment alcohol consumption.

Substance abuse treatment programs have long contended that any post-treatment alcohol use is indicative of relapse. Recent studies, however, suggest more inclusive definitions. Zweben and Cisler (1996, 1999) consider both the drinking quantity and negative drinking consequences. Their proposed cutoffs integrate the 1995 NIAAA guidelines for sensible and high risk drinking levels with the objective assessment of drinking-related consequences into the definition of relapse. Our study applied this model to a group of detoxified alcoholics in a post-treatment followup project. We asked if: (1) Zweben and Cisler's drinking categories could be found in our sample; (2) whether subgroups defined by post-treatment drinking patterns differed with respect to their pre-treatment alcohol consumption levels, years of alcoholic drinking and drinking related problems; and (3) whether post-treatment drinking patterns were associated with differential psychosocial functioning at followup. Thirteen percent of the total sample (N=61) was found to meet Zweben and Cisler's moderate drinking category; 34% were abstinent, 27% heavy drinkers and 13 participants (26%) were unclassifiable. At treatment completion (T1), those who became moderate drinkers reported higher levels of self-confidence, but were otherwise similar to both abstainers and heavy drinkers. At followup (T2), approximately 1 year after initial testing (T1), groups differed on measures of emotional discharge, avoidance and logical coping skills and information seeking, suggesting a possible association between post-treatment drinking patterns and psychosocial functioning.

Adolescent↗

Specialist epilepsy nurses for treating epilepsy.

BACKGROUND: Epilepsy is the most common serious neurological condition after stroke, with a 0.5 per cent prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital based) care. OBJECTIVES: The aim of this review is to overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care. SEARCH STRATEGY: The following databases were searched: The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 1999), MEDLINE, GEARS, BIDS (EMBASE=Excepta Medica), ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register, Vignettes and expert panels from Standing Group on Health Technology Assessment, PsycLit database, World Wide Web sites and reference lists of articles. SELECTION CRITERIA: All randomized controlled and quasi-randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion and extracted the relevant data. The following outcomes were assessed: (a) seizure frequency (b) appropriateness of medication prescribed (c) social or psychological functioning scores (d) knowledge about epilepsy scores (e) objective measures of general health status/quality of life (f) patients' reports of information received (g) number of days spent on sick leave/missing school and employment status (h) costs of care (i) adverse effects. MAIN RESULTS: Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta-analysis. As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (e.g. seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement. There is some evidence that those patients who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention. REVIEWER'S CONCLUSIONS: It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made.

Epilepsy↗

The validity of Antonovsky's Sense of Coherence measure in a sample of schizophrenic patients living in the community.

AIM OF THE STUDY: To examine the construct and predictive validity of Antonovsky's Sense of Coherence (SOC) concept in a sample of schizophrenic persons living in the community. BACKGROUND: The salutogenic model of Antonovsky proposes that the individual's sense of coherence, which is a personal orientation towards life, determines the health experience. The salutogenic perspective might in several advantageous aspects contribute to the care and support for patients with a long and persistent mental illness like schizophrenia. DESIGN: The study is a 18-month follow-up study. Structured interviews were used to interview 120 patients with a diagnosis of schizophrenia or a schizoaffective disorder. Pearlin's mastery scale, Rosenberg's self-esteem scale, the Interview Schedule for Social Interactions (ISSI) and the Brief Psychiatric Rating Scale (BPRS) were used as construct validity measures of the SOC scale. Health related measures such as quality of life, global well-being, satisfaction with health assessed by the Lancashire Quality of Life Profile (LQOLP) and global psychosocial functioning (GAF) were used in calculations of the predictive validity of SOC. RESULTS: The SOC was positively related to mastery, self-esteem and social support but negatively associated to psychopathology. In total, mastery, self-esteem and adequacy of social integration explained 61.1% of the variance in SOC, and mastery contributed with the greatest part of the variance, 46.3% SOC was positively associated to all health related measures and changes in SOC during an 18-month follow-up was positively correlated to changes in overall subjective quality of life, general health, global well-being and global psychosocial functioning. CONCLUSION: The results gave support to the construct and predictive validity of the SOC measure in individuals suffering from a diagnosis of schizophrenia.

Adaptation, Psychological↗

Longitudinal study of maternal depressive symptoms and child well-being.

OBJECTIVE: To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children. METHOD: As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989-1990 in Tampere, Finland. Of the 270 mother-child pairs at the latest stage of the study in 1997-1998, 188 mother-child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of children's psychosocial functioning and problems reported on the Child Behavior Checklist and Teacher's Report Form were examined. RESULTS: Children's low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of child's high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1-8.9 and odds ratio 8.5, 95% confidence interval 2.7-26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome. CONCLUSIONS: Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the child's well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.

Adaptation, Psychological↗

Psychosocial characteristics of adolescents with a past history of dysthymic disorder: comparison with adolescents with past histories of major depressive and non-affective disorders, and never mentally ill controls.

Little is known about the psychosocial functioning of persons who have recovered from dysthymic disorder. Such information might be useful in identifying trait markers for dysthymia, and for guiding continuation and maintenance treatment. We explored this issue using data from the Oregon Adolescent Depression Project, a large community-based study of the epidemiology of psychiatric disorders in a high school population. Four groups of adolescents were identified: 38 with a past history of dysthymic disorder; 217 with a past history of major depressive disorder; 142 with a past history of non-affective disorders; and 1079 with no lifetime history of psychopathology. The groups were compared on an extensive battery of psychosocial variables. The most consistent and diagnostically specific finding was that adolescents with a past history of dysthymic disorder reported having a significantly lower level of social support from friends than each of the other three groups of adolescents. Adolescents with a past history of dysthymic disorder also reported significantly higher levels of depressive, internalizing and externalizing symptoms and daily hassles than adolescents with no lifetime history of psychopathology. In addition, they reported higher levels of depressive symptoms and self-consciousness, but fewer externalizing symptoms than adolescents with a past history of non-affective disorders. These data suggest that adolescents with dysthymic disorder continue to experience significant difficulties in psychosocial functioning even after recovery.

Adolescent↗

Quality of life of patients treated by home mechanical ventilation due to restrictive ventilatory disorders.

The quality of life of patients with hypoventilation and home mechanical ventilation (HMV) has not been well described. Modern quality of life assessment techniques were therefore introduced in a cross-sectional study of patients treated with HMV. The aim was to study various aspects of the patient's quality of life and relate them to the underlying diseases, blood gases and the type of ventilatory connection. The study comprised 39 patients, most of them ventilated only during the night (n = 35). Nasal ventilation predominated (n = 29). Patients treated with HMV reported satisfactory levels of both psychosocial functioning and mental well-being that compared well with a general population group. Their quality of sleep was generally good. The quality of life measures were mainly influenced by the patients' underlying disease. Patients with scoliosis expressed in almost all instances the best quality of life. The quality of life of patients with ventilation by tracheostomy was reported to be at least as good as that of patients with nasal ventilation. The global quality of life estimation was mainly determined by the mental state of the patients and their sleep quality and only to a minor extent by physical handicaps. In conclusion, the patients treated with HMV reported good psychosocial functioning and mental well-being, in spite of severe physical limitations and dependence on regular nocturnal ventilation.

Adolescent↗

[Psychosocial screening and selection of candidates for liver transplantation].

281 consecutive candidates for liver transplantation were referred to our consultation-liaison service for psychiatric evaluation over a 4-year period. For these candidates a semistructured psychiatric interview according to the codes listed in the DSM-III-R and the Transplant Evaluation Rating Scale (TERS) classifying patients' level of adjustment in psychosocial functioning were completed. Our study showed a prevalence rate of psychiatric disorders of 65.8 % among candidates. The categories of alcohol abuse (27.8 %) and alcohol dependence (11.7 %) were the most frequent psychiatric diagnoses. The mean TERS summary score of the whole sample was 33.38 +/- 7,31. 68.4 % of the sample were considered good candidates, 18.1 % of the candidates were identified borderline, but acceptable under some conditions, and 13.5 % of the referrals were rated poor liver transplant candidates. The TERS summary scores discriminated well between the three rating categories of candidate quality. Apart from a careful assessment of psychiatric morbidity including substance abuse disorders, the C-L psychiatrist should always rate psychosocial functioning referring to coping, compliance, social support and lifestyle factors among liver transplant candidates. The TERS therefore may be used routinely.

Adaptation, Psychological↗

[18-month follow-up of patients with schizophrenia].

This article presents the latest results of a 18 months follow-up study with schizophrenic patients, with the purpose to assess psychosocial functioning in the community after being discharged from a psychiatric hospital. The patients reported a satisfactory level of psychosocial and global functioning: mean = 2.4 at discharge; mean = 2.8 at six months (p < 0.05) and mean = 2.7 at 18 months follow-up. The use of medication was reduced from 62 per cent at six months to 59 per cent at 18 months by the patients, and the level of rehospitalization increased from 10 per cent at six months to 40 per cent at 18 months. Patients with no medication (t-test = p .001) and also rehospitalized patients (t-test = p .05) reported lower levels of satisfactory psychosocial functioning in comparison with patients under medication and also without rehospitalization. These results might contribute to a better psychosocial handling of schizophrenic patients in the community. The need for longitudinal follow-up research in Mexican schizophrenic patients is noted.

Adolescent↗

Prospective study of selective peripheral denervation for botulinum-toxin resistant patients with cervical dystonia.

We have carried out a prospective study of selective peripheral denervation (SPD) in cervical dystonia (CD) patients with primary or secondary botulinum toxin (BT) treatment failure using independent standardized assessment. Patients referred for surgery had a standardized clinical examination, neck muscle EMG, videofluoroscopic swallow and CT of the cervical spine, and were selected for surgery on the basis of the results of these investigations. CD severity, disability and pain were assessed preoperatively and at 3, 6, 9, 12 and 18 months postoperatively using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Severity of head tremor and dysphagia were scored using established rating scales. Additionally, psychosocial function was assessed in a representative subsample of patients (n = 12) using several established questionnaires. Of the 62 patients who were assessed, 22 (35.5%) were not offered surgery, most commonly because of widespread dystonia. Of the remaining 40 patients, 37 have so far had surgery, 31 of whom have been followed up for at least 1 year, and 15 for 18 months after surgery (mean follow-up duration 16.7 months). Using the TWSTRS global outcome score, 68% of patients derived functionally relevant improvement at 12 months after surgery. In the entire operated group, total TWSTRS scores were reduced by 30% at 6 and 12 months after surgery (P < 0.0001). The subscores for severity, disability and pain were reduced by 20, 30 and 40%, respectively, at 6 months (P < or = 0.01) and 20, 40 and 30%, respectively, at 12 months (P < 0.01). Pain increased over time, which appeared to result from muscle reinnervation. TWSTRS scores were not significantly improved in the six patients with primary BT treatment failure. Head tremor did not change. There was a significant improvement of body concept, perceived disfigurement, stigma, and quality of life in the 12 patients whose psychosocial function was assessed. Preoperative disability and restriction of head movement were negatively correlated and the initial response to BT treatment positively correlated with global outcome score. Spread or deterioration of dystonia elsewhere in the body occurred in three patients, with unpleasant sensory symptoms in denervated posterior cervical segments occurring in 14. Ten patients developed mild to moderate dysphagia, and two developed severe dysphagia. We conclude that SPD is an effective treatment for patients with secondary, but probably not for those with primary, BT treatment failure. Reinnervation is not infrequent and can compromise outcome. Postoperative morbidity is low, but there is a risk of dysphagia.

Botulinum Toxins↗

Prospective 10-year follow-up in adolescent anorexia nervosa--course, outcome, psychiatric comorbidity, and psychosocial adaptation.

The aim of the present study was to follow up the long-term course of adolescent-onset anorexia nervosa by repeated assessment, to analyze the association between the course of the eating disorder and psychiatric comorbidity, and to evaluate psychosocial outcome. The sample consisted of 39 inpatients who were reinvestigated 3, 7, and 10 years after discharge. The patients and 39 controls matched for age, gender, and occupational status were assessed with structured interviews on DSM-III-R eating disorders, additional axis I and axis II psychiatric disorders, and psychosocial functioning. Results showed that 69 % of the original subjects met the criteria for full recovery at the 10-year follow-up. One patient (3%) still exhibited the full syndrome of restrictive anorexia nervosa, two patients (5%) the full syndrome of bulimia nervosa. None of the patients had died. Of the subjects, 51% currently had an axis I psychiatric disorder and 23% met the full criteria for a personality disorder. Apart from the eating disorder, anxiety disorders and avoidant-dependent and obsessive-compulsive personality disorders were the most common psychiatric diagnoses. There was a significant association between psychiatric comorbidity and the outcome of the eating disorder and between outcome and psychosocial adaptation. With regard to psychiatric morbidity and psychosocial functioning, long-term recovered patients did not differ significantly from normal controls. It is concluded that in most patients adolescent anorexia nervosa takes a prolonged course, although it seems to be more favorable than in adult-onset forms. Those who achieve complete recovery from the eating disorder have a good chance of overcoming other psychiatric disorders and to adapt to social requirements.

Adaptation, Psychological↗

Postremission predictors of relapse in women with eating disorders.

OBJECTIVE: The authors sought to evaluate patterns and predictors of relapse among women with eating disorders. METHOD: Interviews were conducted biannually to annually to assess symptoms of eating disorders, axis I disorders, treatment, and psychosocial function on a weekly basis for women diagnosed with anorexia nervosa (N=136) or bulimia nervosa (N=110) and prospectively followed for 9 years. At the last follow-up, 229 (93%) of the subjects had been retained in the study group. RESULTS: Relapse occurred in 36% of the women with anorexia nervosa and 35% of the women with bulimia nervosa. Women with intake diagnoses of anorexia nervosa, restricting subtype, tended to develop bulimic symptoms during relapse, whereas women with intake diagnoses of anorexia nervosa, binge-purge subtype, or bulimia nervosa tended to return to bulimic patterns during relapse. Greater body image disturbance contributed to a risk of relapse in both eating disorders, and worse psychosocial function increased the risk of relapse in bulimia nervosa. CONCLUSIONS: These results may explain the long-term efficacy of interpersonal therapy for bulimia nervosa and suggest that focused body image work during relapse prevention may enhance long-term recovery from eating disorders.

Adaptation, Psychological↗

Community reinforcement therapy for cocaine-dependent outpatients.

OBJECTIVE: To examine the contributions of community reinforcement therapy to outcome in the community reinforcement approach (CRA) + vouchers outpatient treatment for cocaine dependence. METHODS: One hundred cocaine-dependent outpatients were randomly assigned to one of 2 treatment conditions: CRA + vouchers or vouchers only. All patients earned incentives in the form of vouchers exchangeable for retail items contingent on cocaine-free urinalysis results during treatment weeks 1 to 12. Incentives were combined with a 24-week course of CRA therapy designed to promote healthy lifestyle changes in the CRA + vouchers condition, while incentives represented the primary treatment in the vouchers-only condition. Patient drug use and psychosocial functioning were assessed at intake and at least every 3 months for 2 years after treatment entry. RESULTS: Patients treated with CRA + vouchers were retained better in treatment, used cocaine at a lower frequency during treatment but not follow-up, and reported a lower frequency of drinking to intoxication during treatment and follow-up compared with patients treated with vouchers only. Patients treated with CRA + vouchers also reported a higher frequency of days of paid employment during treatment and the initial 6 months of follow-up, decreased depressive symptoms during treatment only, and fewer hospitalizations and legal problems during follow-up. CONCLUSIONS: Combining CRA with vouchers had therapeutic effects on substance abuse and psychosocial functioning during treatment and posttreatment follow-up in cocaine-dependent outpatients, although effects on cocaine use appear to be limited to the treatment period.

Adult↗

Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients.

Abdominoplasty is an increasingly common aesthetic surgery procedure that has yet to be evaluated using the most recently developed and psychometrically sophisticated measures of body image and quality-of-life outcomes. This study prospectively evaluated 30 consecutive female abdominoplasty patients, preoperatively and postoperatively, using measures of body image, psychological investment in appearance, and general psychosocial functioning. One-way repeated-measures (pretest versus posttest) analyses of variance revealed significant positive postsurgical changes on the Appearance Evaluation subscale of the Multidimensional Body-Self Relations Questionnaire. Mean scores for the questionnaire's Body Areas Satisfaction Scale improved postoperatively (p < 0.001). Scores for the Body Exposure and Sexual Relations Questionnaire also improved significantly (p < 0.001) postoperatively. These findings indicate significant improvements in body image outcome, including positive changes in patients' evaluations of their overall appearance, their average body image dissatisfaction, and their experiences of self-consciousness and avoidance of body exposure during sexual activities. As predicted, no changes were seen on any measure of psychological investment in appearance or on patients' reports of general psychosocial functioning (self-esteem, satisfaction with life, or social anxiety).

Abdominal Wall↗

Quality of life during chemotherapy for small cell lung cancer. I. An evaluation with generic health measures.

The Sickness Impact Profile (SIP) and the Hospital Anxiety and Depression scale (HAD) were used for assessment of physical and psychosocial functioning and emotional distress in patients with small cell lung cancer (SCLC) receiving chemotherapy. Treatment schedules extended over 12 months. Before treatment sixty-two patients, 36-80 years of age, completed the questionnaires and a selection of lung cancer symptom items. Approximately 50% of the patients reported clinically significant physical dysfunction, while emotional distress was reported by 25% and social restraints by 40%. Self-reported overall dysfunction, as assessed by SIP total index, was clinically significant in 60% of the patients. SIP physical and total indices were strongly related to WHO performance status (grade 0-4). The assessment was subsequently repeated every third month during the treatment period. Overall tumour response rate was 82%. The changes of physical and psychosocial functioning, as assessed by SIP, were significantly related to tumour response, although a persistent substantial overall dysfunction was shown among 50% of the responders after 3 months and among c. 40% after 6 months. In addition to tumour response, pain and appetite changes correlated with the change of overall SIP in multivariate analysis, implying the importance of pain control and appetite stimulating measures for patients with advanced cancer. Anxiety and depression, as measured by HAD, were reduced in 21 patients who completed 12 months chemotherapy, but only anxiety co-varied with tumour response. The results lend support to the use of the generic SIP and HAD as outcome measures in clinical research with SCLC patients receiving chemotherapy.

Adult↗

Gender, ethnicity, psychosocial factors, and quality of life among severely overweight, treatment-seeking adolescents.

OBJECTIVE: To examine gender and ethnic differences in psychosocial functioning among 100 (78% African American and 59% girls) treatment-seeking overweight 11- to 18-year-old adolescents. Self-esteem was examined as a potential mediator of the association between weight-related teasing and quality of life (QOL). METHODS: Adolescents completed measures evaluating self-esteem, dietary habits, teasing, and QOL. RESULTS: Few racial or gender differences were found. Mean QOL was similar to that reported in another study examining treatment-seeking overweight adolescents and substantially lower than what has been reported for non-treatment-seeking overweight adolescents. Self-esteem partially mediated the association between teasing and QOL. CONCLUSIONS: Severely overweight adolescents of both genders and diverse ethnicities face significant stigmatization and manifest poor overall psychosocial functioning, which is negatively associated with QOL. Furthermore, self-esteem appears to partially mediate the negative relationship between teasing and QOL.

Adolescent↗