Measuring Knowledge, Attitudes, and Barriers to Medication Adherence in Potential Bariatric Surgery Patients

Background Bariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery.Methods The final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations.Results Attitude to adherence was associated with alexithymia (beta = 2.228; p < 0.001) and binge eating disorder (beta = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (beta = 0.113; p = 0.012) and alexithymia (beta = -2.256; p < 0.001); with age (beta = 0.161; p = 0.002) and psychiatric comorbidity (beta =0.107; p = 0.021) manifesting in the barrier subscale.Conclusion We demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done

Preliminary Validation of the Italian Night Eating Questionnaire (I-NEQ-16): Item Analysis and Factor Structure

Night eating syndrome (NES) severity is usually assessed with the Night Eating Questionnaire (NEQ). Although the most common version of the NEQ is composed of 14 items (NEQ-14), two additional items measuring distress associated with the night eating have been proposed, but they have never been included in past psychometric studies. The aim of the present study was to create an Italian version of the NEQ-16 (I-NEQ-16), with the inclusion of the proposed items for assessing the distress associated with night eating. A major objective of the study was to propose a unidimensional version of the I-NEQ-16 and investigate its psychometric properties. 482 Italian adults (380 women and 102 men; mean age = 25.5, SD = 10.9 years old) were administered the Italian versions of the NEQ, the Night Eating Diagnostic Questionnaire (NEDQ), and questionnaires measuring binge eating, emotional and external eating, diurnal chronotype, insomnia, and anxiety and depression severity. In order to improve the unidimensionality of the I-NEQ-16, we removed from further analyses items 1, 4, and 7, because they increased the heterogeneity of the measure. Confirmatory factor analysis, indicated the fit of a modified one-factor model, allowing correlated errors between three pairs of items. I-NEQ-16 scores were significantly associated with all concurrent questionnaire scores and were able to categorize individuals according to their diagnosis of NES according to the NEDQ. Thus, the I-NEQ-16 is a valid measure that is potentially useful for investigating correlates of night eating in the general population

Construct Validity and Reliability of the Adult Rejection Sensitivity Questionnaire: A Comparison of Three Factor Models

Objectives and Methods. The aim of the study was to investigate the construct validity of the ARSQ. Methods. The ARSQ and self-report measures of depression, anxiety, and hopelessness were administered to 774 Italian adults, aged 18 to 64 years. Results. Structural equation modeling indicated that the factor structure of the ARSQ can be represented by a bifactor model: a general rejection sensitivity factor and two group factors, expectancy of rejection and rejection anxiety. Reliability of observed scores was not satisfactory: only 44% of variance in observed total scores was due to the common factors. The analyses also indicated different correlates for the general factor and the group factors. Limitations. We administered an Italian version of the ARSQ to a nonclinical sample of adults, so that studies which use clinical populations or the original version of the ARSQ could obtain different results from those presented here. Conclusion. Our results suggest that the construct validity of the ARSQ is disputable and that rejection anxiety and expectancy could bias individuals to readily perceive and strongly react to cues of rejection in different ways

Evaluating the Factor Structure of the Emotion Dysregulation Scale-Short (EDS-s): A Preliminary Study

Emotion dysregulation (ED) can be considered a psychopathological transdiagnostic dimension, the presence of which should be reliably screened in clinical settings. The aim of the current study was to validate the Italian version of the Emotion Dysregulation Scale-short (EDS-s), a brief self-report tool assessing emotion dysregulation, in a non-clinical sample of 1087 adults (768 women and 319 men). We also assessed its convergent validity with scales measuring binge eating and general psychopathology. Structural equation modeling suggested the fit of a one-factor model refined with correlations between the errors of three pairs of items (χ2 = 255.56, df = 51, p < 0.001, RMSEA = 0.08, CFI = 0.94, TLI = 0.93, SRMR = 0.04). The EDS-s demonstrated satisfactory internal consistency (ordinal alpha = 0.94). Moreover, EDS-s scores partly explained the variance of both binge eating (0.35, p < 0.001) and general psychopathology (0.60, p < 0.001). In conclusion, the EDS-s can be considered to be a reliable and valid measure of ED

The Association between Food Addiction and Early Maladaptive Schemas in Overweight and Obese Women: A Preliminary Investigation

In recent years, there has been a growing focus on early maladaptive schemas (EMSs) as core features associated with eating psychopathology. The aims of the present study were to assess in overweight and obese women: (i) the association between dysfunctional eating patterns (i.e., food addiction and binge eating) and EMSs, and (ii) the association between food addiction and EMSs after controlling for potential confounding variables (i.e., binge eating severity and psychopathology). Participants were 70 overweight and obese women seeking low-energy-diet therapy. The patients were administered self-report measures investigating food addiction, binge eating, EMSs, anxiety symptoms, and depressive symptoms. Food addiction severity was strongly associated with all main schema domains. Binge eating severity was positively related to disconnection/rejection (r = 0.41; p < 0.01), impaired limits (r = 0.26; p < 0.05), and other-directedness domains (r = 0.27; p < 0.05). The disconnection/rejection schema was independently associated with food addiction severity, after controlling for the presence of other potential confounding variables (i.e., binge eating severity and psychopathology) suggesting that this domain may be a crucial factor for the development of food addiction

Factor Structure of the Binge Eating Scale in a Large Sample of Obese and Overweight Patients Attending Low Energy Diet Therapy

In the present study, we evaluated the dimensionality and psychometric properties of the Italian version of the Binge Eating Scale (BES) in a 669 (127 men and 542 women) obese and overweight patients seeking weight loss treatment. All participants were administered the Italian version of the BES. Fit statistics for the alternative SEM models demonstrated that both the one-factor and competing two-factor models had a comparable fit to the data. Thus, we selected the one-factor model as the most parsimonious. The BES had good internal consistency reliability (α = 0.89) with a moderate mean inter-item correlation (rii  = 0.34). Given that we were not able to clearly determine the best model among the competing two-factor models and a comparable fit of these models with the one-factor model, we have suggested that the one-factor model is the best fitting model describing the dimensionality of the BES. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association

Psychometric properties of the Italian Yale Food Addiction Scale in overweight and obese patients

To assess the dimensionality and psychometric properties of an Italian version of the Yale Food Addiction Scale (YFAS) in a sample of obese/overweight patients attending low-energy diet therapy

Weight Bias Internalization Scale Discriminates Obese and Overweight Patients with Different Severity Levels of Depression: the Italian Version of the WBIS

We have investigated the psychometric properties of the Italian version of the weight bias internalization scale (WBIS) in overweight and obese patients who were attending weight loss programs. Participants were 386 overweight and obese patients admitted in two medical centers specializing in the treatment of obesity. All the patients were administered the WBIS, and measures of binge eating, depression, self-esteem, and body dissatisfaction. Confirmatory factor analysis failed to confirm the fit of the original 11-item unidimensional model. Item analysis and exploratory factor analysis indicated that 9 items included in the original measure (the items 1 and 9 were excluded because low item-total correlations) formed a reliable unidimensional measure of internalized weight bias (WBIS-9). The WBIS-9 was significantly correlated with convergent measures and was able to categorize individuals with different severity levels of depression (sensitivity of 0.72 and specificity of 0.70). The WBIS-9 may be useful in clinical practice to discriminate patients with more severe psychopathology, comorbid disordered eating patterns, and risk for poor outcomes

Assessing psychopathology in bariatric surgery candidates: discriminant validity of the SCL-90-R and SCL-K-9 in a large sample of patients

Pre-surgical psychosocial evaluation of bariatric surgery (BS) patients should identify psychiatric issues that could worsen after surgery and those requiring additional ongoing intervention. In this view, the use of reliable, appropriate and concise evaluating instruments is of critical importance. The aim of the present study was to investigate the clinical utility of both the Symptom Checklist 90-Revised (SCL-90-R) and its brief unidimensional version, the so-called Symptom-Checklist-K-9 (SCL-K-9) in detecting the presence of psychiatric disorders among bariatric surgery (BS) candidates