Eating- and weight-related factors associated with depressive symptoms in emerging adulthood

Highlights

• Examined the link between eating- and weight-related disturbances and depression

• Used a sample of female and male emerging adults

• Eating- and weight-related disturbances are positively associated with depression.

• Body appreciation is negatively associated with depression.

Abstract

Research suggests that eating- and weight-related disturbances (EWRDs) are key factors associated with depressive symptoms. However, it is unclear how EWRDs, and to a greater extent body appreciation, are associated with depressive symptoms among emerging adults. This study investigated the association between EWRDs, body appreciation, and depressive symptoms among emerging adults. Female (n = 473) and male (n = 135) emerging adults completed measures of restrained eating, emotional eating, external eating, drive for muscularity, body appreciation, and depressive symptoms. Hierarchical multiple regression analyses, performed separately for women and men, found that restrained eating was significantly related to depressive symptoms among both genders, whereas emotional and external eating were significantly associated with depressive symptoms in women only. Body appreciation was negatively associated with depressive symptoms in both genders. The findings highlight the need for clinicians to assess for EWRDs and promote positive body appreciation among emerging adults.

Introduction

Depression is a significant issue that has been recognized as one of the leading causes of disability worldwide (World Health Organization, 2008). It has been estimated that approximately 16% of individuals will experience major depressive disorder (MDD) at some point during their lifetime (Kessler et al., 2003). Prevalence rates of depression have been found to vary widely based on age, with adolescence representing a period of vulnerability in which depression is most likely to first emerge (Hankin, 2006, Jacobs et al., 2008). Numerous trajectory studies have found that depressive symptoms peak in adolescence and then decline during the transition into emerging adulthood (Ge et al., 2006, Natsuaki et al., 2009). However, other studies have documented elevated rates of depressive symptoms among emerging adults (i.e., broadly individuals between the ages of 18–29; Kessler and Walters, 1998, Wang et al., 2010). Moreover, a study conducted by Tanner et al. (2007) found that lifetime depression prevalence rates increased from 8.8% to 31% during emerging adulthood, representing a greater increase than other psychiatric disorders. Thus, depression is a concerning issue in emerging adulthood, although it is unclear how depressive symptoms and their associated risk and protective factors may change from adolescence to emerging adulthood.

Depression rates have also been found to vary by gender, with women being much more likely to experience depression compared to men (Hankin & Abramson, 1999). This gender difference emerges in early adolescence and continues into adulthood, where twice as many women are depressed in comparison to men (Hankin, 2006). A variety of theories have been put forth to account for the consistent gender difference in risk for depression, with some researchers suggesting that women face more pressures to achieve an idealized body type than men, which may make them vulnerable to depressed mood when dealing with negative life events (Bearman and Stice, 2008, Fredrickson and Roberts, 1997).

Although genetic predisposition, cognitive vulnerabilities, lack of social support, and stressful life events are all general factors that have repeatedly been demonstrated in the literature to be associated with depression (Hankin, 2006, Jacobs et al., 2008), eating- and weight-related disturbances (EWRDs) are novel risk factors and are receiving increasing attention in the research literature on depression, and may contribute to the observed gender difference in rates of depression. EWRDs can be conceptualized as maladaptive beliefs and behaviors related to eating and physical appearance (Rawana, Morgan, Nguyen, & Craig, 2010). While the link between EWRDs and depression during adolescence has been demonstrated in the literature (Rawana, 2013, Rawana et al., 2010), a paucity of research has examined this relationship in the next stage of development, namely emerging adulthood (Norwood, Rawana, & Brown, 2013). Therefore, the present study sought to examine the relationship between EWRDs and depressive symptoms during emerging adulthood. Further, in addition to clarifying the role of negative constructs (i.e., EWRDs) and their association with depressive symptoms, the present study also examined the role of positive body image, namely an appreciation for one's body.

Emerging adulthood refers to the period of development taking place from the late adolescent years to the mid-to-late twenties (i.e., 18–29), with a focus on the 18–25 age range (Arnett, 2000). This time frame presents unique challenges that are vastly different from both adolescence and adulthood. Emerging adulthood is thought to be unique to today's industrialized societies, owing mainly to the delaying of marriage and parenting, as well as the high rates of post-secondary education enrolment (Arnett, 2000). This period is demographically diverse, and marked by personal exploration and growth (Arnett, 2000), and often results in attaining self-sufficiency (i.e., taking responsibility for oneself, independent decision making, etc.) (Arnett, 1997, Arnett, 1998, Arnett, 2000). Although emerging adulthood is filled with numerous opportunities for personal growth, individuals' experiences are not always fulfilling or positive. The high rates of depression during emerging adulthood may be reflective of the expanding roles and unique challenges characteristic of this developmental period.

Eating- and weight-related disturbances (EWRDs) can be defined as dysfunctional and maladaptive attitudes, behaviors, and cognitions related to physical appearance and eating, that are less severe than symptoms of clinical eating disorders (Rawana et al., 2010). Adolescence and young adulthood represent a time period in which physical appearance and perceived attractiveness take on increasing importance, especially among women (Pesa, Syre, & Jones, 2000). Problems with weight or eating during adolescence have been shown to be related to an increased risk for a variety of mental and physical consequences during emerging adulthood (Johnson et al., 2002, Ohring et al., 2002). Recent research has also documented a specific link between EWRDs and depression (Rawana, 2013, Rawana and Morgan, 2011, Stice and Bearman, 2001). In a longitudinal study involving a large sample of adolescent boys and girls, Paxton, Neumark-Sztainer, Hannan, and Eisenberg (2006) found that body dissatisfaction was a prospective risk factor for depression and low self-esteem over a five-year period. The link between negative body image and adverse psychosocial consequences, particularly in girls, has been found in several other studies (Bearman and Stice, 2008, Stice et al., 2002).

There are three common types of EWRDs that are well-documented and clinically meaningful in the literature that will be examined in the current study. These EWRDs are emotional eating (i.e., eating based on one's emotions), external eating (i.e., eating based on external cues such as smell), and restrained eating (i.e., restricting caloric intake). There have been mixed findings as to which of these EWRDs are specifically related to depressed mood. Ouwens, Van Strien, and Van Leeuwe (2009) found that a direct, positive association existed between emotional eating and depression among women; however, no such relationship was found between external eating and depression. This link between emotional eating and depressive symptoms has also been demonstrated in other studies, including those that used a sample with men (e.g., Elfhag & Morey, 2008). Past findings for restrained eating meanwhile are conflicting. On the one hand, Elfhag and Morey (2008) found no relation between restrained eating and depressive symptoms. However, a study by Harrell and Jackson (2008) found restrained eating to be linked with depressive symptoms among female college students, with rumination mediating the relationship between the two variables. Therefore, eating disturbances, particularly emotional eating, appear to put one at significant risk for depressive symptoms. While these findings have repeatedly been demonstrated in samples of adolescents and adults, additional research is needed using emerging adult samples, especially given the unclear prevalence and nature of depressive symptoms among this age group.

A review of the existing literature on EWRDs and depression suggests that there is also a need to focus on elucidating positive constructs pertaining to eating- and weight-related behaviors that may be associated with lower levels of depression (Rawana et al., 2010). One such construct is body appreciation, which is the focus on positive aspects of one's body image or appearance. Body appreciation is characterized by positive regard and acceptance of one's body regardless of actual size and appearance, attending to the body's needs, living a healthy lifestyle, and generally disregarding media pressures (Avalos, Tylka, & Wood-Barcalow, 2005). In validation studies of the Body Appreciation Scale (BAS), findings indicated that, among college women, body appreciation was positively associated with self-esteem, proactive coping, and optimism above and beyond body dissatisfaction, supporting the notion that body appreciation is distinct from body dissatisfaction (Avalos et al., 2005). To date, the BAS is the only known measure that assesses multiple characteristics of positive body image. Subsequent researchers using the BAS have found that female undergraduates with higher body appreciation are less likely to consider undergoing cosmetic surgery (Swami, 2009), and that body appreciation positively predicts intuitive eating but not depressive symptoms among college women (Iannantuono & Tylka, 2012). In order to contribute to the growing research on the association between body appreciation and mental health issues, and with the BAS measure in particular, it is important to examine the role of body appreciation in the relation between unhealthy eating- and weight-related behaviors and depressive symptoms. As such, the current study will examine the association between EWRDs and depressive symptoms in emerging adulthood, while considering the contribution of body appreciation to this relationship.

In addition to focusing on adolescents and adults, initial research on the topic of EWRDs and depression has almost exclusively included female populations. To date, this issue still persists with studies being unproportionately conducted with female samples (e.g., Ohring et al., 2002, Presnell et al., 2009). However, in recent years, it has been demonstrated that men are also affected by issues of body image (Ata et al., 2007, Furham and Calnan, 1998). In particular, it appears that while beauty and attractiveness in women is linked to a thin body type (Stice, Hayward, Cameron, Killen, & Taylor, 2000), men have the opposite concern, in that there is increasing societal pressure and depiction in the media of an ideal muscular body type for men (Ata et al., 2007). This increase in muscularity portrayals is not limited to standard modes of media such as television; there has been a documented increase in the size of modern action figures (Pope, Olivardia, Gruber, & Borowiecki, 1999), as well as Playgirl centerfolds (Leit, Pope, & Gray, 2001).

The unrealistic depictions in the media have contributed to a “drive for muscularity” in young men; a preoccupation with achieving the big, muscular body type that is often portrayed (McCreary & Sasse, 2000). It is believed that mass media and societal standards have both a direct impact on body image dissatisfaction, as well as an indirect impact via appearance comparison, and the internalization of the muscular standard (Lawler & Nixon, 2011). Some researchers have reported that men appear to be particularly concerned with areas above the waist, such as the arms and chest (McCabe & Ricciardelli, 2004). Others however, point out that caution must be taken in order to avoid oversimplification. Ridgeway and Tylka (2005) conducted a study with thirty undergraduate college men in which leanness and height, in addition to muscularity, emerged as key characteristics of the ideal body shape. Part of the reason for this pursuit of the ideal body type is the message men receive: appearance is important, and attractiveness leads to success (Gillen & Lefkowitz, 2009). These messages and the drive for muscularity may be well-founded in terms of potential gains, as individuals who are taller and non-obese in comparison to their peers have been found to have an advantage in terms of adolescent dating (Cawley, Joyner, & Sobal, 2006).

Body image has undoubtedly become an important predictor of psychological well-being in men (Tager, Good, & Morrison, 2006). Research has shown that men who are exposed to the muscular ideal are more likely to experience decreased body satisfaction (Agliata & Tantleff-Dunn, 2004). Two recent meta-analyses conducted by Barlett, Vowels, and Saucier (2008), which reviewed both correlational and experimental research in the area, found that pressure from the mass media was associated with lower body-esteem and self-esteem, higher body dissatisfaction, as well as a greater likelihood of negative psychological and behavioral outcomes such as depression and steroid use.

While previous research has shown a clear association between specific EWRDs (e.g., emotional eating) and depressive symptoms in women, far less is known about other body image concerns, such as the drive for muscularity among men. Although it is now generally acknowledged that men exert a drive for muscularity, there remains a lack of research focusing specifically on male populations during emerging adulthood. Furthermore, past research has found that the drive for muscularity is relevant in women as well; however, its effect is not as strong as it is in men, and it appears to be associated with negative outcomes only in men (McCreary & Saucier, 2009). Thus, in addition to examining the role of the previously mentioned EWRDs in the emergence of depressive symptoms, the aim of the current study was also to determine the relationship between the drive for muscularity and depressive symptoms among a sample of female and male emerging adults.

This study had two objectives. Given the high rates of depression during emerging adulthood and the dearth of research on EWRDs during this period, Objective 1 of this study was to determine whether the presence of EWRDs was associated with higher levels of depressive symptoms among female and male emerging adults. Based on previous research demonstrating that EWRDs prospectively predict higher levels of depression (Rawana, 2013, Rawana et al., 2010), it was hypothesized that higher levels of EWRDs would be associated with more severe depressive symptoms in both women and men. Specifically, it was hypothesized that emotional eating would be positively associated with depressive symptoms in both men and women, restrained eating would be positively associated with depressive symptoms in women only, and that there would be no association between external eating and depressive symptoms in either gender. In terms of the desire to gain muscle mass, the authors hypothesized that there would be a positive association between the drive for muscularity and depressive symptoms among men only. Therefore, in order to distinguish EWRDs between the genders, and allow for comparison to be made, the results of the current study are presented separately for women and men.

Objective 2 aimed to determine whether body appreciation was negatively associated with depression after accounting for EWRDs. It was hypothesized that body appreciation would be negatively associated with depressive symptoms among both women and men. No additional gender-specific predictions were made due to the limited research on body appreciation. Related to the protective role of body appreciation, an exploratory analysis was undertaken to examine the potential of body appreciation to influence or moderate the relationship between EWRDs and depressive symptoms. Based on the limited research involving body appreciation, no hypotheses related to this were made.