The Prevalence of Exercise Addiction Symptoms in a Sample of National Level Elite Athletes

Exaggerated exercise volumes, lack of control, withdrawal symptoms and conflicts with family and friends are core symptoms of exercise addiction. The condition can lead to health problems and social isolation because exercise is given the highest priority in any situation. The prevalence of the risk of exercise addiction has mostly been assessed in leisure time exercisers such as runners, fitness attendees and cyclists. The prevalence proportion ranges from 3 to 42% depending on the type of sport and the assessment tool. The proportion is greater among elite athletes, and increases with the level of competition. This study's primary aim was to assess the prevalence of exercise addiction among elite athletes competing at national level and its secondary aim was to evaluate the psychometric properties of the Exercise Addition Inventory (EAI) in elite sports. Participants (n = 417) from 15 sports disciplines and with 51% women completed an online survey. Results showed that 7.6% were at risk of exercise addiction. This group was younger, exhibited tendency to exercise despite pain and injury, felt guilty if not exercising enough, and reported substantial eating disorder symptoms. The reliability and validity of the EAI was good suggesting that the scale is appropriate for measuring the risk of exercise addiction in elite athletes

Depressive Symptoms in Danish Elite Athletes Using the Major Depressive Inventory (MDI) and the Center for Epidemiological Studies Depression Scale (CES-D)

Background: The prevalence of depressive symptoms among athletes is an ongoing debate in the scientific literature. Aims: The aim of the current study was to assess the prevalence of depressive symptoms in Danish elite athletes and to evaluate the psychometric properties of the Major Depressive Inventory (MDI) and the Center for Epidemiological Studies Depression Scale (CES-D) in athletes. Methods: The total sample comprised 996 athletes from two cross-sectional studies using the MDI (n = 409) and the CES-D (n = 587). Results: Using the original cut-off points, the MDI found 8.6% and the CES-D found 22.0% at risk of depression. Using alternative cut-off points recommended in the literature, both instruments detected 10-11% of athletes at risk of depression. No statistically significant differences were found related to age, injury, and type of sport between high risk and low risk groups, whereas female gender was identified as a risk factor for higher depressive symptoms. Principal component analyses confirmed a single factor structure in both instruments with sufficient item loadings on the first component and Cronbach α values of .89 and .88. Discussion: We recommend regular screening of depressive symptoms in elite athletes, with MDI and CES-D as reliable instrument for that purpose

Economic evaluation alongside a randomized controlled trial of blended cognitive-behavioral therapy for patients suffering from major depressive disorder

OBJECTIVE: This study aimed to investigate the cost-effectiveness of blended cognitive-behavioral therapy (CBT) compared to standard CBT for adult patients suffering from major depressive disorder (MDD). DESIGN: A cost-utility analysis alongside the randomized controlled ENTER trial. SETTING: Center for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark. PARTICIPANTS: The study included 76 patients suffering from MDD. INTERVENTIONS: The patients in the intervention group received blended CBT treatment comprising a combination of online modules and face-to-face consultations with a psychologist. The patients in the control group received standard CBT treatment, that is, solely face-to-face consultations with a psychologist. The treatment period was 12 weeks. OUTCOME MEASURES: Cost-effectiveness was reported as incremental cost-effectiveness ratio. A micro-costing approach was applied to evaluate the savings derived. Changes in quality-adjusted life-years (QALYs) were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at the baseline and the six-month follow-up. RESULTS: Data for 74 patients were included in the primary analysis. The adjusted QALY difference between blended CBT and standard CBT was −0.0291 (95% CI: −0.0535 to −0.0047), and the adjusted difference in costs was -£226.32 (95% CI: −300.86 to −151.77). Blended CBT was estimated to have a 6.6% and 3.1% probability of being cost-effective based on thresholds of £20,000 and £30,000. CONCLUSION: Compared to standard CBT, blended CBT represents a cost-saving but also a loss in QALYs for patients suffering from MDD. However, results should be carefully interpreted, given the small sample size. Future research involving larger replication studies focusing on other aspects of blended CBT with more patient involvement is advised. TRIAL REGISTRATION NUMBER: ClinicalTrial.gov: S-20150150

Mobile Diary App Versus Paper-Based Diary Cards for Patients With Borderline Personality Disorder:Economic Evaluation

BACKGROUND: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown. OBJECTIVE: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility. METHODS: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app. RESULTS: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US$322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5; general practice −1.32; SE 3.68 and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worried about potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction of the new technology but pointed at innovation potential from digital database registrations. CONCLUSIONS: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT03191565; http://clinicaltrials.gov/ct2/show/NCT03191565 INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/1773

Workplace Sexual Harassment Increases the Risk of PTSD Symptoms with Higher Frequency and Harassment Coming from a Colleague or Leader as Risk Factors

This study examined the effect of workplace sexual harassment on posttraumatic stress (PTSD) symptoms while also examining the effect of harassment frequency, harassment source, and workplace social capital. The sample consisted of 3153 Danish social educators (females 79.3%) responding to the International Trauma Questionnaire (ITQ) and the Copenhagen Psychosocial Questionnaire II item on sexual harassment (COPSOQ). The prevalence of sexual harassment was 22% exposed within the recent year. We found a significant positive relationship between exposure to workplace sexual harassment and PTSD symptoms. Harassment frequency was associated with significantly higher levels of PTSD symptoms. Harassment from a colleague/leader compared to a client was associated with higher levels of PTSD symptoms although the difference was not statistically significant. Workplace social capital had an inverted association with PTSD symptoms, but there was no moderation effect on the relationship between sexual harassment and PTSD. These findings suggest that higher harassment frequency and harassment from a colleague/leader is associated with an increased severity of PTSD symptoms following exposure to workplace sexual harassment. Workplace social capital seems to alleviate level of PTSD symptoms, but did not moderate the association between exposure to workplace sexual harassment and PTSD symptoms. Possibly, feelings of shame and guilt may discourage some employees from disclosing their experiences with colleagues or leaders and thereby seek available support at the workplace. Future studies need to uncover the barriers that prevent victims of sexual harassment from seeking and benefitting from social support available at the workplace

A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries.

Research into the detrimental effects of excessive exercise has been conceptualized in a number of similar ways,including ‘exercise addiction’,‘exercise dependence’,‘obligatory exercising’,‘exercise abuse’,and‘compulsive exercise. Among the most currently used (and psychometrically valid and reliable) instruments is the Exercise Addiction Inventory (EAI). The present study aimed to further explore the psychometric properties of the EAI by combining the datasets of a number of surveys carried out in five different countries (Denmark, Hungary, Spain, UK, and US) that have used the EAI with a total sample size of 6,031 participants. A series of multigroup confirmatory factor analyses (CFAs) were carried out examining configural invariance, metric invariance, and scalar invariance. The CFAs using the combined dataset supported the configural invariance and metric invariance but not scalar invariance. Therefore, EAI factor scores from five countries are not comparable because the use or interpretation of the scale was different in the five nations. However, the covariates of exercise addiction can be studied from a cross-cultural perspective because of the metric invariance of the scale. Gender differences among exercisers in the interpretation of the scale also emerged. The implications of the results are discussed, and it is concluded that the study’s findings will facilitate a more robust and reliable use of the EAI in future research

Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes

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Prevalence of the Risk of Exercise Addiction Based on a New Classification: A Cross-Sectional Study in 15 Countries

Exercise addiction is widely studied, but an official clinical diagnosis does not exist for this behavioral addiction. Earlier research using various screening instruments examined the absolute scale values while investigating the disorder. The Exercise Addiction Inventory-3 (EAI-3) was recently developed with two subscales, one denoting health-relevant exercise and the other addictive tendencies. The latter has different cutoff values for leisure exercisers and elite athletes. Therefore, the present 15-country study (n = 3,760) used the EAI-3 to classify the risk of exercise addiction (REA), but only if the participant reported having had a negative exercise-related experience. Based on this classification, the prevalence of REA was 9.5% in the sample. No sex differences, and few cross-national differences were found. However, collectivist countries reported greater REA in various exercise contexts than individualist countries. Moreover, the REA among athletes was (i) twice as high as leisure exercisers, (ii) higher in organized than self-planned exercises, irrespective of athletic status, and (iii) higher among those who exercised for skill/mastery reasons than for health and social reasons, again irrespective of athletic status. Eating disorders were more frequent among REA-affected individuals than in the rest of the sample. These results do not align with recent theoretical arguments claiming that exercise addiction is unlikely to be fostered in organized sports. The present study questions the current research framework for understanding exercise addiction and offers a new alternative to segregate self-harming exercise from passionate overindulgence in athletic life

Prevalence of the Risk of Exercise Addiction Based on a New Classification: A Cross-Sectional Study in 15 Countries

Exercise addiction is widely studied, but an official clinical diagnosis does not exist for this behavioral addiction. Earlier research using various screening instruments examined the absolute scale values while investigating the disorder. The Exercise Addiction Inventory-3 (EAI-3) was recently developed with two subscales, one denoting health-relevant exercise and the other addictive tendencies. The latter has different cutoff values for leisure exercisers and elite athletes. Therefore, the present 15-country study (n = 3,760) used the EAI-3 to classify the risk of exercise addiction (REA), but only if the participant reported having had a negative exercise-related experience. Based on this classification, the prevalence of REA was 9.5% in the sample. No sex differences, and few cross-national differences were found. However, collectivist countries reported greater REA in various exercise contexts than individualist countries. Moreover, the REA among athletes was (i) twice as high as leisure exercisers, (ii) higher in organized than self-planned exercises, irrespective of athletic status, and (iii) higher among those who exercised for skill/mastery reasons than for health and social reasons, again irrespective of athletic status. Eating disorders were more frequent among REA-affected individuals than in the rest of the sample. These results do not align with recent theoretical arguments claiming that exercise addiction is unlikely to be fostered in organized sports. The present study questions the current research framework for understanding exercise addiction and offers a new alternative to segregate self-harming exercise from passionate overindulgence in athletic life