Body-Image and Eating Disturbances Predict Onset of Depression Among Female Adolescents: A Longitudinal Study
Original article authored by:
Eric Stice, Chris Hayward, Rebecca P. Cameron, Joel D. Killen, and Barr C. Taylor
Approximately 20% of adolescents meet the criteria of having experienced major depression. Depression is associated with numerous health risks such as suicide attempts and substance use. It also predicts future adjustment problems such as school failure, delinquency, marital difficulties, and unemployment. The rate of depression is higher among girls than boys. Indeed, by late adolescence, the rate of depression among girls is twice that of boys.
Past research is somewhat limited regarding what factors contribute to this difference among boys and girls during adolescence. The authors of this study hypothesized that body image and eating-related risk factors could account for some of the depression seen in girls. As a result, this study explores the link between body image, eating disturbances, and major depression in girls, and examines the extent to which body image and eating-related risk factors can predict the onset of major depression among females.
The data for this study were drawn from a longitudinal survey of 1,124 females from three schools in northern California. These girls had parent permission to take part in the study. Participation included completing a survey, taking part in height and weight measurements, and having a clinical interview four times over a four-year period. The girls were an average of 14.7 years old at the beginning of the study. Their ethnic/racial background was mixed: 25% Asian, 4% Black, 42% White, 15% Hispanic, 7% Native American, 6% "mixed" racial heritage, and 1% "other."
The study included the following measures, which are established scales that have also been used in other research:
- Body mass index (BMI=kg/M2)
- Body dissatisfaction (e.g., I think my thighs are too large)
- Dietary restraint (e.g., How often do you diet?)
- Bulimic symptoms (e.g., I have gone on eating binges where I felt I could not stop)
- Depressive symptoms (e.g., I have been feeling pretty down and unhappy this week)
- Major depression diagnosis (from DSM--III—R)
The study focuses only on those girls who did NOT have a diagnosis of ever having experienced major depression at the baseline assessment (n=1,024). The data were analyzed using a special regression analysis (called survival analysis) to see how the outcomes of interest (e.g., body dissatisfaction, dietary restraint) were related to each other and to the onset of major depression.
- The authors found that three factors were important in predicting the onset of major depression:
- body dissatisfaction,
- dietary restraint, and
- bulimic symptoms
- Elevated body mass did NOT predict the onset of major depression.
The authors conclude that body image and eating-related risk factors that emerge with adolescence can contribute to higher rates of depression among girls. The authors note that body dissatisfaction is thought to contribute to depression because of its emphasis for females in Western societies.
Body image is also thought to contribute to dietary restraint, which in turn leads to depression because of the failures often associated with dieting. Bulimic symptoms are thought to lead to depression because of the shame and guilt often associated with bingeing and purging.
Of interest, the cognitive aspects of body image appeared to be more important in predicting major depression than was actual body size.
Implications for Practice
This study yields implications for practitioners as well as researchers.
- Practitioners working with adolescents could help reduce major depression and related problems by designing ways to reduce body dissatisfaction, dieting, and bulimic symptoms.
- Practitioners are likely to get more impact by focusing on the cognitive aspects of body image (how youth think or feel about how their bodies look) than on actual body dimensions.
- Because girls in Western societies are often judged based on their appearance, practitioners should address the cultural norms that influence body image and eating-related risk factors.
- More research is needed to study how body image and eating-related risk factors differ for boys and girls. Further, additional research is needed to look at other general risk factors for major depression (e.g. negative life events or deficits in social support).
Though not discussed in this article, depression among adolescents also has been found to be linked to sexual risk-taking behavior such as sexual initiation and use of contraception (Kowaleski & Jones, 1998). The impact of body image on adolescents' sexual risk-taking behaviors is not well studied.
Kowaleski-Jones, L. & Mott, F. (1998). Sex, contraception and childbearing among high-risk youth: Do different factors influence males and females? Family Planning Perspectives, 30(4), 163-169.
Stice, E., Hayward, C., Cameron, R., Killen, J., Taylor, B. (2000) Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study. Journal of Abnormal Psychology, 109(3), 438-444.