Psychiatric Comorbidity and Emotional Eating in Veterans ... · in Veterans Seeking Weight Management Treatment Su Cho, PsyD SBM Presentation 3/31/16 . Background 2. The Prevalence

Emotional Overeating andPsychiatric Comorbidity

in Veterans Seeking Weight Management Treatment

Su Cho, PsyD

SBM Presentation

3/31/16

Background

2

The Prevalence Rates of Overweight/Obesity Are High Among VHA Population.

22

36

37

36

41

28

VHA

General Population

0% 20% 40% 60% 80% 100%

Underweight or Normal Overweight Obese

2013CDC; VA Corporate Data Warehouse

3

The Prevalence of Obesity Is Increasing Among VHA Users.

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23.7

31.3

37.6

39.3

23

42

37

21

2015

2010

2000

Underweight/Healthy Overweight Obese

VA Corporate Data Warehouse

4

5

Treatment

Referral

Annual Screening

MOVE! Participants Reverse the Weight Gain Pattern Compared to Non-Participants.

MOVE!® Weight Management Program For Veterans FY 13 Evaluation Report Narrative Summary 6

7

One of the Possible Contributing Factors: Psychiatric Comorbidities

• Depression <–> Obesity

• PTSD <–> Obesity

• Alcohol Abuse <-?-> Obesity

8

Veterans Have Higher Rates of Psychiatric Diagnoses Compared With the General Population.

DepressionPost-traumatic stress disorder (PTSD)

Alcohol use disorder

9

An Area of Overlap Between Psychiatric Dxsand Overweight/obesity May be Emotional Overeating.

• Stress-Eating-Obesity model

Stressors

Emotional

Eating

Weight

10

Psychiatric Dxs and Emotional Overeating

DepressionEmotional

Eating

Alcohol

Misuse

Emotional

Eating

PTSDEmotional

Eating

11

?

√ √

Aims

• Explore the relationships between emotional overeating and psychiatric diagnoses (depression, PTSD, and alcohol misuse) in veterans seeking treatment for weight management.

• Explore the relationship between emotional overeating and BMI in veterans seeking treatment for weight management.

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Hypotheses

• Emotional overeating will be positively related to depression, PTSD, and alcohol abuse in this population.

• Emotional overeating will be positively associated with BMI in this population.

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Methods

• Participants

– Veterans attending the MOVE! orientation

• Questionnaires from 15 orientation sessions

• EMR

– BMI

– Race

– Ethnicity

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Methods

• Measures

– Overeating

• Questionnaire on Eating and Weight Patterns (QEWP)– 1 item: During the past three months, did you often eat within

any two-hour period what most people would regard as an unusually large amount of food?

– Emotional overeating

• Yale Emotional Overeating Questionnaire (YEOQ)– 9 items

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Methods: YEOQ

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No

Days

1-5

Days

6-12

Days

13-15

Days

16-22

Days

23-27

Days

Every

Day

8. ANXIETY (worry, stress, nervousness)? 0 1 2 3 4 5 6

9. SADNESS (blue, down, depressed)? 0 1 2 3 4 5 6

10. LONELINESS (solitude, isolation, seclusion)? 0 1 2 3 4 5 6

11. TIREDNESS (worn-out, fatigued)? 0 1 2 3 4 5 6

12. ANGER (upset, frustrated, furious)? 0 1 2 3 4 5 6

13. HAPPINESS (good, joyous, excited)? 0 1 2 3 4 5 6

14. BOREDOM (apathy, disinterest, dullness)? 0 1 2 3 4 5 6

15. GUILT (regret, remorse, shame)? 0 1 2 3 4 5 6

16. physical PAIN? 0 1 2 3 4 5 6

ON HOW MANY DAYS OUT OF THE PAST 28 DAYS have you eaten an unusually large amount of food given the circumstances in response to feelings of…

Methods

• Measures

– Mental Health Screeners

• Depression: PHQ-2

• PTSD: PC-PTSD

• Alcohol misuse: AUDIT-C

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Results: Demographics

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Participants 126

Mean age 61.8 (SD= 8.6)

Gender Male (89.7%); n=113Female (10.3%); n=13

Race Caucasian (75.4 %)African American (19.8 %) Other (4 %)

Ethnicity Not Hispanic (93.7 %)Hispanic (6.3%)

Mean BMI 37.9 (SD= 7.5)Overweight (15.9%); n= 20Obesity class I (26.2%); n= 33Obesity class II (23.8%); n= 30Obesity class III (34.1%); n=43

Results: QEWP

Yes40%

No60%

During the past three months, did you often eat within any two-hour period

what most people would regard as an unusually large amount of food?

19n= 119

Results: YEOQ

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Emotion Average Frequency (SD)

Anxiety 1.26 (1.79)

Sadness 1.20 (1.67)

Loneliness 1.08 (1.74)

Tiredness 1.45 (1.92)

Anger 1.02 (1.60)

Happiness 1.07 (1.49)

Boredom 1.66 (1.90)

Guilt 1.04 (1.71)

Physical pain 1.49 (2.20)

Average 1.25 (1.50)

No

Days

1-5

Days

6-12

Days

13-15

Days

16-22

Days

23-27

Days

Every

Day

0 1 2 3 4 5 6

Results: YEOQ con’d

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Emotional

Overeating

Questionnaire

Age Gender Race

Anxiety . . .

Sadness . . .

Loneliness -.23 (p<.05) . .

Tiredness -.20 (p<.05) . .

Anger . . .

Happiness -.20 (p<.05) . .

Boredom -.28 (p<.01) . .

Guilt -.21 (p<.05) . .

Pain . . .

Total Score -.24 (p<.01) . .

Results: Mental Health Screeners

Age Gender Race BMI

PHQ-2 + n=41

32.5%

. . Non-Caucasian .

- n=84 . . Caucasian .

PC-PTSD + n= 29

23.0%

. Female Non-Caucasian .

- n=96 . Male Caucasian .

AUDIT-C + n=19

16.7%

. . . .

- n=104 . . . .

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Results: Emotional Overeating and Depression

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Depression Screen

EOQ Positive Negative

M (SD) M (SD) F p

Anxiety* 2.39 .26 .65 .00 15.28 <.01

Sadness* 2.53 .23 .52 .16 25.17 <.01

Loneliness* 2.02 .26 .60 .19 12.42 <.01

Tiredness* 2.55 .29 .85 .21 12.86 <.01

Anger* 1.20 .24 .55 .17 11.80 <.01

Happiness* 1.60 .23 .72 .16 5.25 <.01

Boredom* 2.66 .29 1.10 .21 10.74 <.01

Guilt* 2.33 .24 .39 .17 22.73 <.01

Pain* 2.58 .34 .89 .24 10.01 <.01

Total Score 2.29 .21 .70 .15 19.74 <.01

Results: Emotional Overeating and PTSD

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PTSD Screen

EOQ Positive Negative

M (SD) M (SD) F p

Anxiety* 3.00 .31 .74 .17 14.59 <.01

Sadness* 2.47 .31 .81 .17 7.48 <.01

Loneliness* 2.56 .31 .63 .17 11.72 <.01

Tiredness* 2.61 .37 1.08 .20 5.72 <.01

Anger* 2.18 .30 .68 .16 6.51 <.01

Happiness* 1.95 .28 .77 .15 4.73 <.01

Boredom* 2.73 .36 1.30 .20 5.10 <.01

Guilt* .58 .16 2.59 .30 12.45 <.01

Pain* 2.93 .42 1.06 .23 6.22 <.01

Total Score* 2.56 .27 .85 .14 11.50 <.01

Results: Emotional Overeating and Alcohol Misuse

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Alcohol Misuse Screen

EOQPositive Negative

M (SD) M (SD) F p

Anxiety 1.25 .45 1.27 .19 .00 .97

Sadness .81 .42 1.28 .17 1.05 .31

Loneliness .75 .44 1.14 .18 .67 .42

Tiredness .63 .48 1.90 .20 3.53 .06

Anger .56 .40 1.10 .17 1.52 .22

Happiness 1.81 .19 1.07 .16 .02 .90

Boredom .81 . 47 1.81 .19 3.85 .05

Guilt .56 .43 1.10 .18 1.34 .25

Pain .88 .56 1.63 .23 1.57 .21

Total Score .82 .38 1.33 .16 1.60 .21

Results: Emotional Overeatingand BMI

BMI

Emotional

Overeating

Questionnaire

Males and

FemalesMales only

Anxiety

Sadness r=.21, p<.05

Loneliness

Tiredness r=.19, p<.05

Anger r=.21, p<.05 r=.22, p<.05

Happiness

Boredom r=.26, p<.01

Guilt r=.20, p<.05

Pain r=.24, p<.01 r=.20, r<.05

Total Score r=.20, p<.05

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Limitations

• Cross-sectional self-report survey

• YEOQ validation

• BMI measurement

• Inclusion of treatment seeking veterans

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Conclusion

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DepressionEmotional

Eating

Alcohol

Misuse

Emotional

Eating

PTSDEmotional

Eating

28

X

√ √

Conclusion Con’d

BMI

Angry

Pain

Sad

Tired

Bored

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Implications

• Veterans screening positive for depression, PTSD, and obesity may benefit from additional evaluation for emotional overeating.

• For veterans endorsing emotional overeating, comprehensive intervention may be beneficial.

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Acknowledgements

• Robin Masheb, PhD

• Lindsey Dorflinger, PhD

• Chris Ruser, MD

• Dominica Hernandez, MA

• Kathryn Min, MA

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