Publications by authors named "Joseph M Donahue"

12 Publications

  • Page 1 of 1

Predictors of Stepping Up to Higher Level of Care Among Eating Disorder Patients in a Partial Hospitalization Program.

Front Psychol 2021 21;12:667868. Epub 2021 Jul 21.

Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.

Partial hospitalization programming (PHP) is a treatment option available for individuals with eating disorders (ED) who have made insufficient progress in outpatient settings or are behaviorally or medically unstable. Research demonstrates that this level of care yields efficacy for the majority of patients. However, not all patients achieve recovery in PHP and later admit to a higher level of care (HLOC) including residential treatment or inpatient hospitalization. Although PHP is an increasingly common treatment choice for ED, research concerning outcome predictors in outpatient, stepped levels of care remains limited. Thus, the current study sought to identify the predictors of patients first admitted to PHP that later enter residential or inpatient treatment. Participants were 788 patients (after exclusions) enrolled in adolescent or adult partial hospitalization programs in a specialized ED clinic. When compared to patients who maintained treatment in PHP, a significantly greater proportion of patients who discharged to a HLOC had previously received ED residential treatment. Moreover, patients who discharged to a HLOC were diagnosed with a comorbid anxiety disorder and reported greater anxious and depressive symptomatology. A logistic regression model predicting discharge from PHP to a HLOC was significant, and lower body mass index (BMI) was a significant predictor of necessitating a HLOC. Supplemental programming in partial hospitalization settings might benefit individuals with previous ED residential treatment experience, higher levels of anxiety and depression, and lower BMIs. Specialized intervention for these cases is both practically and economically advantageous, as it might reduce the risk of rehospitalization and at-risk patients needing to step up to a HLOC.
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http://dx.doi.org/10.3389/fpsyg.2021.667868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336564PMC
July 2021

Sexual Orientation-Based Differential Item Functioning in Measures of Body Image Concerns and Ideals among Men.

Psychol Men Masc 2021 Jan 26;22(1):1-6. Epub 2020 Oct 26.

University at Albany, State University of New York, Department of Psychology, Albany, NY.

Body image concerns and body ideals are linked with eating disorders and psychological health. Body image and ideals among men differ by sexual orientation, which may influence the utility of common measures of such constructs. The present study used differential item functioning (DIF) analyses to examine whether item endorsement differs as a function of sexual orientation in three commonly used measures of body image concerns and ideals. Participants were sexual minority (n=209) and heterosexual (n=494) men in the United States. Scores on the Drive for Muscularity Scale (DMS), Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), and Objectified Body Consciousness Scale (OBCS) were examined. DIF was tested in a three-step regression wherein item scores were predicted by: (1) subscale score, (2) subscale and sexual orientation, and (3) subscale, sexual orientation and their product term. Model fit and variance explain comparisons identified DIF. Δ pseudo R value ≥ .035 from step 1 to 3 signified clinical significant DIF. There was no evidence of clinically significant DIF for the DMS, SATAQ-4, or OBSC. Findings suggest that DMS, SATAQ-4, and OBSC perform similarly for sexual minority and heterosexual men.
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http://dx.doi.org/10.1037/men0000273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943039PMC
January 2021

Eating disorder pathology and compulsive exercise during the COVID-19 public health emergency: Examining risk associated with COVID-19 anxiety and intolerance of uncertainty.

Int J Eat Disord 2020 12 24;53(12):2049-2054. Epub 2020 Oct 24.

Department of Psychology, University at Albany, State University of New York, Albany, New York, USA.

Objective: COVID-19 has led to disruptions in daily living and increased uncertainty about physical, financial, social, and psychological consequences, which may contribute to anxiety, eating disorder (ED) pathology, and compulsive exercise. Individual factors, such as intolerance of uncertainty, may impact risk for ED pathology and CE in response to COVID-19 anxiety. The current study examined associations between COVID-19 anxiety, trait intolerance of uncertainty, and COVID-19 intolerance of uncertainty and ED pathology and compulsive exercise.

Method: Undergraduate participants (N = 295) completed a series of online questionnaires between March and April of 2020.

Results: COVID-19 anxiety and intolerance of uncertainty were associated with ED pathology, but not compulsive exercise. Additionally, both trait and COVID-19 intolerance of uncertainty moderated associations between COVID-19 anxiety and compulsive exercise and ED pathology. COVID-19 anxiety was more strongly related to compulsive exercise and ED pathology for individuals with lower intolerance of uncertainty.

Discussion: COVID-19 anxiety may increase risk for ED pathology and may be specifically important in determining risk for ED pathology and compulsive exercise among individuals with lower intolerance of uncertainty. These results contribute to a growing body of research aimed at understanding the mental health consequences of the COVID-19 and suggest that individual factors (e.g., anxiety and intolerance of uncertainty) are important in determining risk for ED pathology and compulsive exercise in the context of the pandemic.
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http://dx.doi.org/10.1002/eat.23395DOI Listing
December 2020

Differential item functioning analysis for the Eating Disorder Examination Questionnaire among heterosexual and sexual minority men.

Eat Weight Disord 2021 Aug 6;26(6):2071-2076. Epub 2020 Oct 6.

Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA.

Purpose: Sexual minority (SM) men are at a higher risk for eating disorders and related issues, relative to heterosexual men. However, it is currently unknown whether commonly used measures of eating pathology are appropriate to use among diverse groups of men. Determining the unique functioning of existing assessments may help better and more accurately understand eating disorder pathology within this population. The present study examined differences in item endorsement between sexual orientation in the Eating Disorder Examination Questionnaire (EDE-Q) through differential item functioning (DIF).

Methods: Heterosexual and SM men (N = 703) completed the EDE-Q and a demographic questionnaire. EDE-Q scores were examined for clinically significant DIF based on participants' self-reported sexual orientation (e.g., heterosexual men vs SM men).

Results: SM men reported higher EDE-Q symptom composite scores than heterosexual men. DIF was observed for all EDE-Q items relative to the global score; however, only one item met clinical significance (EDE-Q #19; ∆R ≥ 0.13).

Conclusion: Results suggest that SM men experience greater levels of ED pathology than heterosexual men. While the EDE-Q is a commonly used measure of eating pathology, findings suggest that sexual orientation bias may impact many items on the EDE-Q. However, results from this study indicated that only one item introduces bias that has clinical implications. Additional research is needed to further explore and replicate this finding among more diverse samples of SM and heterosexual men.

Level Of Evidence: Level III, case-control analytic study.
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http://dx.doi.org/10.1007/s40519-020-01035-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021598PMC
August 2021

Practitioners' perspectives on ethical issues within the treatment of eating disorders: Results from a concept mapping study.

Int J Eat Disord 2020 12 12;53(12):1941-1951. Epub 2020 Sep 12.

Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA.

Objective: Treating patients with eating disorders (EDs) is associated with an array of ethical concerns, including balancing patients' health and autonomy, access to care, and use of harm-reduction versus recovery-oriented treatment models. The primary aim of the current study is to gain a better understanding of ethical issues faced by ED practitioners by using a concept mapping, or Q-sort, approach.

Method: A total of 12 practitioners completed the brainstorming phase and generated statements regarding ethical issues they faced while treating patients with EDs. A subsequent 38 practitioners completed a sorting task, where they created and labeled piles, into which they grouped each statement. Of those 38 participants, 30 rated both the frequency with which they encountered each ethical issue and its impact on patient care.

Results: A total of six clusters emerged: Insufficient Level of Care, Lack of Evidence-Based Practice, Insurance Barriers, Family Involvement, Patient Autonomy, and Limited Access to Expertise. Lack of Evidence-Based Practice, Insurance Barriers, and Insufficient Level of Care was the most frequent problem faced by ED practitioners, whereas Insurance Barriers and Patient Autonomy had the greatest impact.

Discussion: Findings outline frequent and impactful areas of ethical concern that arise when treating patients diagnosed with EDs. Practitioners most commonly reported that patient- and insurance-driven factors limited patient access to appropriate care. Regulations supporting the provision of evidence-based care should be emphasized in public health policy and advocacy efforts, given their impact in limiting the delivery of adequate patient care.
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http://dx.doi.org/10.1002/eat.23381DOI Listing
December 2020

Examining day hospital treatment outcomes for sexual minority patients with eating disorders.

Int J Eat Disord 2020 10 18;53(10):1657-1666. Epub 2020 Aug 18.

Department of Psychiatry, University of California, San Diego, San Diego, California, USA.

Objective: Epidemiological data support that sexual minorities (SM) report higher levels of eating pathology. Theories suggest these disparities exist due to stressors specific to belonging to a minority group; however, few studies have specifically explored differences between SM and heterosexual individuals in clinical eating disorder samples. Thus, the present study compared SM and heterosexual patients with eating disorders on demographic characteristics and eating disorder and psychological outcomes during day hospital treatment.

Method: Patients (N = 389) completed surveys of eating pathology, mood, anxiety, and skills use at treatment admission, 1-month post-admission, discharge, and 6-month follow-up. Overall, 19.8% of patients (n = 79) identified as SM, while 8.0% (n = 32) reported not identifying with any sexual orientation. SM were more likely to present across genders (17.7% of females, 24.2% of males, 33.3% of transgender patients, and 87.5% of nonbinary patients).

Results: SM patients were significantly more likely to endorse major depressive disorder, panic disorder, and self-harm at admission than their heterosexual counterparts. Multilevel models demonstrated that across time, SM patients demonstrated greater eating pathology, emotion dysregulation, depressive symptoms, and anxiety symptoms. Significant interactions between sexual orientation and time were found for eating pathology and emotion dysregulation, such that although SM patients started treatment with higher scores, they improved at a faster rate compared to heterosexual patients.

Discussion: Consistent with minority stress theory, SM patients report greater overall eating disorder and comorbid symptoms. Importantly, results do not support that there appear to be significant disparities in treatment outcome for SM patients in this sample of day hospital patients.
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http://dx.doi.org/10.1002/eat.23362DOI Listing
October 2020

Factor structure of the Eating Disorder Examination - Questionnaire among heterosexual and sexual minority males.

Eat Behav 2020 08 29;38:101403. Epub 2020 May 29.

University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, United States of America.

Eating disorder (ED) pathology is increasingly recognized among males; however, presentations within males differ from traditional descriptions of ED pathology in females. Additionally, experiences of ED pathology differ between sexual minority (SM) and heterosexual males. These differences suggest that existing ED assessments, which are primarily based on female samples, do not adequately capture ED pathology in SM and heterosexual males. The Eating Disorder Examination-Questionnaire (EDE-Q) is a commonly used assessment of ED pathology; however, at present the factor structure of this instrument in SM and heterosexual males is unclear. This study aimed to determine the most appropriate factor structure of the EDE-Q by evaluating proposed factor structures in a large, non-clinical sample consisting of heterosexual and SM men. Additionally, this study examined differences in the factor structures and severities of ED pathology between SM and heterosexual males. Confirmatory Factor Analyses examining existing factor structures of the EDE-Q indicated that the brief three-factor model was the best fitting model for both heterosexual and SM males. Subsequent comparisons of factor scores between groups indicated that SM males in our sample experienced higher levels of dietary restraint, overvaluation of shape and weight, and body dissatisfaction than heterosexual males. Results provide preliminary support for the use of the brief three-factor model of the EDE-Q when assessing ED pathology among SM and heterosexual males in non-clinical research settings.
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http://dx.doi.org/10.1016/j.eatbeh.2020.101403DOI Listing
August 2020

Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting.

Eat Weight Disord 2021 Jun 7;26(5):1345-1356. Epub 2020 Jun 7.

Department of Psychology, University at Albany, State University of New York, Albany, NY, USA.

Objective: There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample.

Method: The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD) = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients' medical charts.

Results: In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not.

Conclusions: Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation.

Level Of Evidence: Level IV, uncontrolled intervention.
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http://dx.doi.org/10.1007/s40519-020-00939-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903880PMC
June 2021

Expectancies about the Effects of Cannabis Use on Eating Disorder Symptoms.

Subst Use Misuse 2020 23;55(11):1825-1833. Epub 2020 May 23.

Psychology, Social Sciences, University at Albany, the State University of New York, Albany, New York, USA.

Substance use, specifically cannabis use, is common among individuals with eating disorder (ED) symptoms; however, few studies have specifically explored the relation between EDs and cannabis use. The present study examined expectancies about the impact of cannabis on cognitive, affective and behavioral ED symptoms. Additionally, this study explored associations between cannabis-related expectancies, cannabis use and cannabis-related problems. Cannabis users with ED symptoms ( = 137) reported on frequency of cannabis use, cannabis-related problems and expectancies about the impact of cannabis on ED symptoms, Participants expected cannabis to decrease restrictive eating, compensatory behaviors, and preoccupation with body shape and weight and fear of eating and weight gain. In contrast, cannabis was expected to increase binge-eating behaviors. Expectancies about the impact of cannabis use on ED symptoms were not associated with more frequent cannabis use nor were they associated with cannabis-related problems. These findings suggest that individuals believe cannabis will improve some ED symptoms; however, these expected improvements are not associated with increased cannabis use and problems. Future research should examine cannabis expectancies in clinical populations and should further explore the association between cannabis expectancies, use, and ED symptoms longitudinally.
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http://dx.doi.org/10.1080/10826084.2020.1766503DOI Listing
June 2021

Evaluating Associations Between Perfectionism, Emotion Regulation, and Eating Disorder Symptoms in a Mixed-Gender Sample.

J Nerv Ment Dis 2018 11;206(11):900-904

Department of Psychology, University at Albany, State University of New York, Albany, New York.

Prior research supports maladaptive perfectionism as a risk factor for eating disorders; however, not all individuals with elevated levels of perfectionism endorse eating pathology, suggesting additional variables may interact with perfectionism to account for this association. The current study examined the influence of difficulties in emotion regulation on the relation between perfectionism and eating disorders. Undergraduate students (N = 309, 50.7% male) from a large university completed measures of perfectionism, emotion dysregulation, and eating pathology. The results indicated that high levels of perfectionism only accounted for significant variance in eating disorder symptoms among individuals with limited access to adaptive strategies to regulate emotions, but not among those with greater access to adaptive strategies. Findings demonstrate that clinicians and researchers should consider the role of emotion regulation among individuals with elevated levels of perfectionism and eating pathology. Future research should prospectively evaluate these associations and examine mechanisms that may further elucidate these relations.
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http://dx.doi.org/10.1097/NMD.0000000000000895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209118PMC
November 2018

Weight suppression and its relation to eating disorder and weight outcomes: a narrative review.

Eat Disord 2019 Jan-Feb;27(1):52-81. Epub 2018 Jul 24.

a Department of Psychology , University at Albany, State University of New York, Albany, NY, USA.

Weight suppression (WS) refers to the discrepancy between highest adult weight and current weight, and has been examined as a key construct related to both: eating pathology and weight management. However, despite increasing interest in WS, findings regarding the clinical implications of WS are often conflicting. For instance, WS has been associated with both adaptive and maladaptive outcomes across various populations. Moreover, results regarding the predictive utility of WS within clinical samples have been inconsistent. The current paper aims to provide a narrative review of existing investigation related to WS, highlight gaps in the field's understanding of this construct, and outline recommendations for future study.
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http://dx.doi.org/10.1080/10640266.2018.1499297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377342PMC
June 2019

Evaluating the role of repetitive negative thinking in the maintenance of social appearance anxiety: An experimental manipulation.

Behav Res Ther 2018 03 5;102:36-41. Epub 2018 Jan 5.

University at Albany, State University of New York, 399 Social Sciences, 1400 Washington Avenue, Albany, NY 12222, USA.

Social appearance anxiety (SAA), or fear of having one's appearance negatively evaluated by others, is a risk factor for eating pathology and social anxiety, but maintenance processes for SAA remain unclear. The current study evaluated repetitive negative thinking (RNT) as a process through which SAA is maintained over time. Undergraduates (N = 126) completed self-report measurements, made an impromptu speech task to induce SAA, and were randomized to either engage in RNT or distraction following the speech task. Participants then attended a second appointment one day later and were asked to make a second speech. Results indicated positive associations between self-reported trait SAA and RNT. Individuals asked to engage in RNT following the appointment 1 speech task reported significantly higher state SAA than those who engaged in distraction. Findings indicated no significant effect of group on appointment 2 SAA, but post-hoc analyses suggested that naturally-occurring RNT may have accounted for increases in SAA across appointments. Overall, results provide support for the importance of RNT in maintaining various internalizing symptoms.
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http://dx.doi.org/10.1016/j.brat.2018.01.001DOI Listing
March 2018
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