Ageing, anxiety and appearance: Exploring the body image of women in midlife

The majority of body image research has focussed primarily on young adult women, a group within which appearance dissatisfaction has been repeatedly reported. These appearance worries have been found to adversely predict psychological and physical health outcomes, including unhealthy weight control behaviours, low levels of exercise, substance misuse and depression (Neumark-Sztainer et al., 2006). Recently however, greater attention has been given to women in midlife: commonly defined as the period between 35 and 55 years of age (Hockey & James, 2003). Similarly, appearance concerns have been identified amongst many women in midlife and older adulthood (Pruis & Janowsky, 2010; Tiggemann, 2004). Studies have found both that women aged 54 reported more dissatisfaction with their bodies compared with retrospective reports of their 20s, 30s, and 40s (McLaren & Kuh, 2004) and that levels of body dissatisfaction were similar in a middle-aged group (50-65 years) and group of women of 66 years and older (Lewis & Cachelin, 2001).This article reviews research exploring the body image of women in midlife, a group who have been previously overlooked within this research area

Body image in midlife: Developing a psychosocial intervention for women who have received treatment for breast cancer

Survival rates for breast cancer have improved over the recent decades, and increasing numbers of women in midlife are coming to terms with the consequences of the disease and its treatment. Among the various side-effects associated with treatment are appearance and bodily alterations, which can elicit body image concerns and subsequently impose long-lasting adverse impacts upon psychological and physical health. Governments, health services, and support organisations have stressed the importance of the development, evaluation, and dissemination of psychosocial interventions that provide support for women adjusting to the residual consequences of the diagnosis and treatment of cancer, including body image distress. The overall aim of this thesis was to develop and assess the acceptability of an evidence-informed psychosocial intervention targeting body image among women in midlife who have undergone treatment for breast cancer. The thesis adopted a mixed-method pragmatic approach, and followed the Medical Research Council’s framework for the development and evaluation of complex interventions (Craig et al., 2008). First, a systematic review of existing body image interventions for women in midlife, including those treated for breast cancer, was conducted to assess the current status of the literature and identify existing effective interventions. Interventions targeting women in midlife (n=11) were found to have longer-lasting and larger effects on body image at post-test and were evaluated in studies of greater methodological rigour, compared with interventions targeting women who had undergone treatment for breast cancer (n=22). Second, an online survey tested and compared an established sociocultural model of body image (Tripartite Influence Model; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999) between women in midlife who were treated (n=169), and not treated (n=323), for breast cancer, in order to assess potential targets for body image interventions and the applicability of research and interventions among women in midlife for use with women treated for breast cancer. This study revealed a similar pattern of risk factors among both groups, whereby sociocultural and psychological factors proposed within the model influenced body image. Next, an integration of findings from the systematic review and online survey informed the adaptation of an existing evidence-based and rigorously evaluated body image intervention for women in midlife (McLean, Paxton, & Wertheim, 2011) for use among women treated for breast cancer. Finally, the adapted intervention was evaluated for its acceptability through focus groups and interviews with women who had undergone treatment for breast cancer (n=22) and health professionals involved in their psychosocial care (n=5). The adapted intervention was found to be acceptable to both participant groups, pending some further amendments. In addition to informing the adaptation of an existing body image intervention for use with women who have undergone treatment for breast cancer, the findings also provide important implications for practice, theory, and research. The present research has identified previously unexplored sociocultural and psychological influences on the body image of women who have undergone treatment for breast cancer and reveals the value of a theoretical model developed within the wider body image field for a group with an altered appearance

Consumer opinion on social policy approaches to promoting positive body image: Airbrushed media images and disclaimer labels

© The Author(s) 2015. Disclaimer labels on airbrushed media images have generated political attention and advocacy as a social policy approach to promoting positive body image. Experimental research suggests that labelling is ineffective and consumers' viewpoints have been overlooked. A mixed-method study explored British consumers' (N = 1555, aged 11-78 years) opinions on body image and social policy approaches. Thematic analysis indicated scepticism about the effectiveness of labelling images. Quantitatively, adults, although not adolescents, reported that labelling was unlikely to improve body image. Appearance diversity in media and reorienting social norms from appearance to function and health were perceived as effective strategies. Social policy and research implications are discussed

Assessing the effectiveness of interventions to support patient decision making about breast reconstruction: A systematic review

© 2018 Elsevier Ltd Background: Decision making about breast reconstruction (BR) following a diagnosis of breast cancer, Ductal Carcinoma in Situ (DCIS), or to reduce future breast cancer risk, is difficult and complex. This paper systematically reviews interventions aiming to support patients facing the option of BR, and assesses their effectiveness in improving a range of patient outcomes. Methods: Ten databases were searched for articles published up to October 2017 that evaluated interventions to support patient decision making about BR within controlled trials. All included studies were assessed for methodological quality. Descriptive analyses of patient outcomes within included studies were performed. Results: The search yielded 3291 articles. Eight studies met the inclusion criteria resulting in the evaluation of seven distinct interventions (n = 1212). Six studies were assessed to be of weak methodological quality, with one of moderate and one of strong quality. Three out of five interventions demonstrated a reduction in decisional conflict (ds = 0.26–0.69) and two out of three interventions resulted in reductions in decisional regret (ds = 0.27–3.69) at various time points. Treatment choice was altered in two of five studies. There were no changes in patient-reported anxiety levels, whilst the impact on depression was mixed. In all studies which reported on it, improvements in patient satisfaction and involvement in decision making were found. Conclusions: Few interventions are currently available. Whilst some findings are encouraging, improvements on patient outcomes are mixed. Further research should focus on the development and evaluation of effective interventions

Prospective pathways to depressive symptoms and disordered eating in adolescence: A 7-year longitudinal cohort study

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8,915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls

Exploring the experiences and psychosocial support needs of informal carers of men with breast cancer: A qualitative study

Purpose: The provision of practical and emotional support for men who have been diagnosed with breast cancer in the UK falls primarily on their partners, close family members or friends. However, informal carers’ experiences are omitted from the research literature. Therefore, the present study aimed to explore the care-giving experiences of informal carers (ICs) of men with breast cancer in the UK and identify psychosocial support needs and preferences. Methods: Semi-structured interviews, conducted on the telephone or via online video calls, explored ICs’ experiences of providing support, the psychosocial issues they faced and the impact of the illness on themselves and their relationship with the patient. They were also asked about any support previously offered to them, in addition to their support preferences. Twelve ICs participated (11 females, 1 male), and 9 were spouses. Interview transcripts were analysed with reflexive thematic analysis using NVIVO software. Results: Four key themes were identified: “The impact of caring”, “Lack of awareness”, “Isolated and alone” and “Making a difference”. Conclusions: The physical, emotional, financial and social impact of providing emotional and practical care and support for a man diagnosed with breast cancer can be considerable. ICs may experience significant levels of distress and often feel isolated. Greater awareness and more research is needed to better understand the psychosocial impact and support needs for ICs of men with breast cancer. There is an evident necessity to address their information needs and offer sources of support throughout the cancer journey

Game on! A randomised controlled trial evaluation of playable technology in improving body satisfaction and negative affect among adolescents

Playables are mini-games used in digital advertising and may offer a novel and engaging avenue to improve young people’s well-being at scale. This randomised controlled trial evaluated the immediate impact and protective properties of a psychoeducational playable on adolescents’ body satisfaction and negative affect, and engagement in prosocial behaviours, relative to two active control conditions. Girls and boys aged 13–14 years (N = 6575) were randomised into one of three conditions: body image playable, body image social networking posts (i.e. static images of the body image playable messages; control 1) or an ocean conservation playable (control 2). Both body image micro-interventions significantly improved state body satisfaction and negative affect, relative to the oceanic playable. No condition buffered against the negative effects associated with viewing idealised media images. Developing playables to counteract the potentially harmful effects associated with surrounding digital environments is a promising avenue for mental health

Aerobiology over Antarctica – a new initiative for atmospheric ecology

The role of aerial dispersal in shaping patterns of biodiversity remains poorly understood, mainly due to a lack of coordinated efforts in gathering data at appropriate temporal and spatial scales. It has been long known that the rate of dispersal to an ecosystem can significantly influence ecosystem dynamics, and that aerial transport has been identified as an important source of biological input to remote locations. With the considerable effort devoted in recent decades to understanding atmospheric circulation in the south-polar region, a unique opportunity has emerged to investigate the atmospheric ecology of Antarctica, from regional to continental scales. This concept note identifies key questions in Antarctic microbial biogeography and the need for standardized sampling and analysis protocols to address such questions. A consortium of polar aerobiologists is established to bring together researchers with a common interest in the airborne dispersion of microbes and other propagules in the Antarctic, with opportunities for comparative studies in the Arctic

Adaptation and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) for use in English among adolescents in urban India

Body image concerns are a global issue among adolescents, including in India. These concerns can prevent adolescents from engaging in everyday life activities, impeding social and academic development. However, at present, there are no psychometrically valid measures to assess such impact in the Indian context. This study culturally adapted and validated the Body Image Life Disengagement Questionnaire (BILD-Q) for use in English among adolescents in urban India. A total of 1427 adolescents completed an adapted version of the BILD-Q along with additional measures pertaining to body image. Exploratory factor analysis identified one dimension of body image life disengagement, which provided the best fit. The 9-item one-factor model was further supported by confirmatory factor analysis. The scale demonstrated good internal consistency and test re-test reliability. Further analysis demonstrated that the scale can be used to compare scores between boys and girls without measurement bias. This study presents a culturally adapted version of the BILD-Q, which can be used as a valid and reliable measure to assess the impact of body image concerns on life disengagement among English-speaking adolescents in urban India

Adaptation and validation of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) for use in English among adolescents in Urban India

Eating pathology is increasingly common among Indian adolescents. However, brief validated measures of disordered eating in Indian contexts are scarce. This study adapted and validated a culturally appropriate English language version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) among 385 adolescents (mean age = 13.42 years; 47.3% girls) in urban India. Confirmatory factor analysis indicated that a two-factor eight-item solution had an acceptable fit to the data across gender: an ‘Eating Concerns and Restraint’ subscale and a ‘Weight and Shape Concerns’ subscale. Further, the questionnaire can be utilised as both a unidimensional and multidimensional tool. This allows for the computation of a total score on the primary factor of ‘Child Eating Pathology’, as well as the two subscales. Internal consistency of the ‘Weight and Shape Concerns’ subscale (α = 0.825) and ‘Eating Concerns and Restraint’ subscale (α = 0.649) was satisfactory. Concurrent validity was established through medium significant correlations with measures of body image and broader mental health. The results support the use of the ChEDE-Q for assessing disordered eating among urban Indian adolescents, thus providing the research community and practitioners with a measure to investigate the nature and scale of disordered eating among adolescents in India