Anne E. Becker

This commentary discusses a principal contribution of Monocello et al.'s paper presenting a cultural models approach to body fatness perceptions, which provides a rigorous and systematic means of identifying analytic categories that are locally meaningful, in contrast to categories derived from a solely universalizing perspective. In situating their work within an underrepresented population in eating disorders research—young men in South Korea—the authors step beyond the constraints of a universalizing, or etic, framework for probing how body dissatisfaction relates to eating disorder risk. The value of an alternative analytic framework, based on a culturally local, or emic, perspective on how bodies are perceived is demonstrated through the use of a cultural models approach exploring the relationship between culturally defined conceptualizations of body image and eating disorder risk. Understanding such relationships and the meanings attributed to the myriad aspects of body image through locally grounded frameworks provides an essential tool for investigators and clinicians to better understand the lived experience of body dissatisfaction and disordered eating, and also to inform more culturally salient approaches to diagnosis, treatment, and prevention. An emic approach that centers local perspectives and priorities also facilitates participation of communities underrepresented in research in knowledge production.

Background: The Zanmi Lasante Depression Symptom Inventory (ZLDSI) is a screening tool for major depression used in 12 primary care clinics in Haiti’s Central Plateau. Although previously validated in a clinic-based sample, the present study is the first to evaluate the validity and clinical utility of the ZLDSI for depression screening in a school-based population in central Haiti. Methods: We assessed depressive symptoms in a school-based sample of transitional age youth (18–22 years; n = 120) with the ZLDSI. Other mental health-related assessments included a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) for current Major Depressive Episode, the Center for Epidemiologic Studies Depression Scale, and selected items adapted from the Global School-Based Health Survey mental health module. Diagnostic assignments of major depressive episode (MDE) were based on modified SCID interviews. Results: The ZLDSI demonstrated good overall accuracy in identifying current MDE (Area under the Curve = .92, 95% CI = .86, .98, p < .001). We ascertained ≥12 as the optimal cut-off point to screen for depression with a sensitivity of 100% and a specificity of 73.9%. In addition, the ZLDSI was associated with other measures of depressive symptoms, suggesting that it demonstrates construct validity. Conclusions: Study findings support that the ZLDSI has clinical utility for screening for depression among school-going transitional age youth.

Objectives To understand the challenges faced by patients with tuberculosis (TB) and factors that influence TB treatment adherence in Ukraine. Design Qualitative study. Setting TB treatment facilities in Kyiv Oblast, Ukraine. Participants Sixty adults who had undergone treatment for drug-sensitive TB between June 2012 and August 2015. Methods We conducted semistructured, in-depth, individual interviews among a purposively selected clinical sample of patients previously treated for drug-sensitive TB. Interview content encompassed WHO’s framework for barriers to adherence to long-term therapies and included questions about patient preferences and motivators concerning treatment adherence. We examined treatment experience across strata defined by previously identified risk correlates of non-adherence. Results Among 60 participants, 19 (32.8%) were HIV positive, 12 (20.3%) had substance use disorder and 9 (15.0%) had not completed TB treatment. Respondents discussed the psychological distress associated with hospital-based TB care, as well as perceived unsupportive, antagonistic interactions with TB providers as major challenges to treatment adherence. An additional barrier to successful treatment completion included the financial toll of lost income during TB treatment, which was exacerbated by the additional costs of ancillary medications and transportation to ambulatory TB clinics. The high pill burden of TB treatment also undermined adherence. These challenges were endorsed among participants with and without major risk factors for non-adherence. Conclusions Our findings highlight important barriers to TB treatment adherence in this study population and suggest specific interventions that may be beneficial in mitigating high rates of poor treatment outcomes for TB in Ukraine.

Eating disorders are prevalent, potentially lethal, and treatable, yet remain underprioritised within clinical care, research and policy. Further, with rising public health focus on obesity, there is heightened risk for inadvertent exacerbation of disordered eating and further marginalisation of these serious mental disorders. This editorial calls for corrective action.

Between 1989 and 2003, Liberia experienced a brutal civil war characterized by ethnic killings, sexual violence and the use of child soldiers. Five years after the war ended, half the population of Liberia was under 18 years old. Understanding the needs of these youth is thus essential to the recovery of the nation. This study focuses on the narratives of two female adolescents, selected from 75 in-depth individual interviews with post-conflict Liberian youth conducted in 2012. A narrative analysis approach was employed to examine each interview for multiple layers of meaning. The aim of the study was to elucidate factors that may enable post-conflict youth to reclaim a sense of agency and return to normal developmental tasks. The study explores the ways in which these youth navigate complicated power dynamics in the post-conflict setting and how gender impacts their experiences of their own agency and capability. The dynamics between the participants and the interviewer are explored to further illustrate how power dynamics manifest. These narratives support the involvement of youth in projects that help others as an avenue for promoting agency and resilience for themselves.

Objective: There are a subset of individuals with eating disorders (EDs) who do not overevaluate body shape/weight (i.e., nonfat phobic ED; NFP‐ED). According to the transdiagnostic cognitive–behavioral conceptualization of EDs, a need for control, in general, is hypothesized as the core psychopathology of NFP‐EDs, with shape‐ and weight‐related motivations for ED behavior merely superimposed in FP‐ED presentations. This study tested the need for control as motivation for restriction in NFP‐ED, using items aimed at assessing control from the Eating Disorder Examination (EDE) Restraint scale.Method: Females ages 13–27 years consecutively admitted to residential treatment completed the EDE, Eating Disorder Inventory‐3 Drive for Thinness subscale (EDI‐DFT), and other self‐report measures of psychopathology. We included patients with DSM‐5 EDs, but excluded patients with avoidant/restrictive food intake disorder. Twenty participants had NFP‐ED (≤14 on EDI‐DFT) and 124 had fatphobic ED (FP‐ED; >14 on EDI‐DFT).Results: NFP‐ED scored significantly lower than FP‐ED on EDE Restraint scale shape/weight [χ²(1) = 10.73–35.62, p's < .01] and on control items [χ²(1) = 10.72–20.62, p's < .01], in addition to scoring lower on measures of general psychopathology and impairment.Discussion: Findings suggest those with NFP‐ED report lower psychopathology overall and the new EDE Restraint scale control items do not capture additional motivation for restriction beyond that captured in the original Restraint scale shape/weight items. Future research should examine whether this latter finding is due to a minimizing response style in NFP‐ED, an incomplete capture of desire for control by the EDE assessment method, or indeed reflects that need for control does not motivate restriction in NFP‐EDs.