Mental health and body image among SGM youth engaged with a digital eating disorder intervention

Abstract

Sexual and gender minority (SGM) teens may experience body image concerns and eating disorders (EDs) at higher rates than their non-SGM peers. The current investigation examined differences in baseline survey responses by SGM and non-SGM youth who participated in a pilot randomized controlled trial of a digital intervention for EDs. Eligible teens (N = 147) aged 14–17 years old who screened positive or at high risk for an ED completed a baseline survey to assess current ED symptoms, mental health comorbidities, and ED treatment history. The majority of participants (mean age 16.021 years) screened positive for symptoms of a clinical/subclinical ED (n = 98, 66.7%), 123 endorsed severe anxiety (83.7%), and 81 endorsed severe depression (55.1%). A total of 72.1% (n = 106) identified as SGM and were more likely to report severe symptoms of depression (p = 0.01), any symptoms of anxiety (p = 0.03), social anxiety disorder (p = 0.02), and lifetime suicide attempts (p<.001), compared with non-SGM peers. Qualitative feedback on the intersection of SGM identities and body image concerns were also reported among SGM teens. Future eating disorder interventions provided to SGM youth should include content on comorbidities like depression and anxiety, which may be barriers to ED recovery among SGM teens.

Keywords:

• SGM
• LGBTQ+
• youth
• eating disorders
• social media
• mHealth

Disclosure statement

Ellen Fitzsimmons-Craft receives royalties from UpToDate and is on the Clinical Advisory Board for Beanbag Health.

Craig Barr Taylor is a paid consultant for Google Mental Health and is an unpaid member of the SilverCloud, HelloBetter Scientific Advisory Boards and the Koko.Ai Community Advisory Board.

Hannah S. Szlyk is a paid consultant for Google Health.

Additional information

Funding

This study was funded by the National Institutes on Drug Abuse, award number K12 DA041449, and the National Institute of Mental Health, grant numbers R34 MH119170 and K08 MH120341.

Notes on contributors

Erin Kasson

Erin Kasson, MS, MSW- Ms. Kasson is a Senior Clinical Research Coordinator in the Department of Psychiatry at Washington University School of Medicine. She is a board certified behavior analyst and has worked with a variety of clinical populations in both outpatient and research settings, including youth and young adults. Ms. Kasson’s research interests include co-occurring mental health disorders, and the impact of anxiety and depression on the development and maintenance of other risk behaviors (e.g. disordered eating, substance misuse).

Hannah S. Szlyk

Hannah S. Szlyk, PhD, LCSW- Dr. Hannah S. Szlyk, PhD is an Assistant Professor in the Department of Psychiatry at Washington University School of Medicine and a doctoral-level licensed clinical social worker (LCSW) with training in suicidology among underserved and minoritized populations and in qualitative and mixed methods study design and analyses. Her current work extends this research program to include mHealth interventions for SUD (e.g. opioid use disorder (OUD), alcohol, cannabis, and vaping) among adolescents and adults, and special populations, like pregnant and postpartum women and people. She is especially interested in understanding how mHealth tools can be used to amplify health equity. She holds graduate degrees in social work from Columbia University (MSSW) and the University of Texas at Austin (PhD) and received additional training at The Menninger Clinic and the Brown School (as a NIMH T32 postdoctoral fellow).

Xiao Li

Xiao Li, MS- Ms. Li is a Senior Statistical Data Analyst in the Department of Psychiatry at Washington University School of Medicine. She completed her Master’s degree in Health Data Science and is pursuing her PhD in epidemiology at St. Louis University. She has experience with data mining of national databases and integrating machine learning algorithms into applications. Ms. Li has extensive experience with performing survival analysis, longitudinal analysis, and modeling of large population-based studies.

Georgi Sirko

Georgi Sirko, MSW- Ms. Sirko completed her BA in Psychological Sciences from University of Connecticut and her Master of Social Work degree from Washington University in Saint Louis. She has training in conducting psychosocial assessment, crisis intervention, strengths-based intervention and trauma-informed care. She has worked with a variety of populations within nonprofit organizations. Her research interests include intimate partner violence, PTSD, and how stigma influences help-seeking.

Isabel Rehg

Isabel Rehg- Ms. Rehg worked as a high school student volunteer and aided researchers with drafting and editing portions for this paper. She is interested in mental health research and equity within healthcare.

Melissa M. Vázquez

Melissa M. Vázquez, BA – Ms. Vázquez is a NIMH Diversity Supplement Scholar and medical student at Washington University School of Medicine in St. Louis. She graduated with her BA from Washington University in St. Louis with a major in Women Gender and Sexuality Studies and a minor in Sociology. Her research and clinical interests include mental health, psychiatry, socio-structural determinants of health, culturally competent care, and promoting mental health equity.

Denise E. Wilfley

Denise E. Wilfley, PhD- Dr. Denise Wilfley, Ph.D. is the Scott Rudolph University Professor of Psychiatry, Medicine, Pediatrics, and Psychological & Brain Sciences, and Director of the Center for Healthy Weight and Wellness at Washington University School of Medicine. She is recognized internationally as an expert in evidence-based approaches for the treatment of obesity and weight-related disorders as well as interventions to promote healthy lifestyle behaviors. She has authored over 200 publications and has held prominent roles on national boards for both obesity and eating disorders.

C. Barr Taylor

C. Barr Taylor, MD- Dr. C. Barr Taylor is a Research Professor at Palo Alto University and Director of the Center for m2Health, which focuses on developing, evaluating, and disseminating digital health interventions for preventing and treating common mental health problems. He is also a Professor of Psychiatry (emeritus) at Stanford University. Dr. Taylor did his undergraduate training at Columbia University, his medical training at the University of Utah Medical Center, and his residency in psychiatry at Stanford Medical Center. He has published nearly 400 papers and written or co-written 11 books. He is currently one of the Principal Investigators on a large, long-term NIMH-funded study designed to evaluate the effects of digital interventions to prevent and treat anxiety, depression, and eating disorders in college students.

Ellen E. Fitzsimmons-Craft

Ellen Fitzsimmons-Craft PhD, FAED, LP- Ellen Fitzsimmons-Craft, PhD is an Associate Professor of Psychiatry at Washington University School of Medicine, St. Louis, Missouri, USA and a licensed clinical psychologist. She has established programmatic lines of research centering on the use of technology for eating disorder prevention and treatment, eating disorder screening, sociocultural etiological and maintenance factors for eating disorders, eating disorder recovery, and college mental health. Ultimately Dr. Fitzsimmons-Craft’s work aims to disseminate evidence-based interventions from research to practice as well as extend treatments in ways that will reach the large number of people in need of care for mental health problems but who are not receiving services. She is a Fellow in the Academy for Eating Disorders, is a current recipient of a National Institute of Mental Health K08 Career Development Award, and has authored more than 120 peer-reviewed publications. Dr. Fitzsimmons-Craft is passionate about increasing access to scalable, evidence-based mental health services, collaborating with numerous industry partners, nonprofit organizations, including the National Eating Disorders Association (NEDA) and the National Association of Anorexia Nervosa and Associated Disorders (ANAD), and statewide groups in the U.S. in order to do so. Her work has been featured in high-profile media outlets including Wired, Forbes, Scientific American, Slate, and The Verge.