Mental Health, Family Function and Obesity: METHODS

Study Design and Population

This was a cross-sectional study of 113 African-American nonpregnant women aged 21-65 years who were patients at one of three ambulatory care facilities in northern New Jersey. Sites were selected to ensure diversity in participants’ socioeconomic and educational status; two sites were private practices (urban and suburban) and the third was located within an academic setting.

African-American women entering each facility, during the time an interviewer was present, were invited to participate. Women agreeing to participate were weighed by the interviewer or nurse. Women were weighed to the nearest pound on an office scale in light clothing without their shoes. Standing height was measured without shoes to the nearest centimeter. After obtaining written informed consent, one of three trained African-American female medical students conducted a 20-25 minute interview prior to the physician encounter. Using a survey guide, interviewers assessed participants’ perceptions of their general physical and mental health, family-of-origin functioning, depressive symptoms, anxiety levels, demographic information, health behaviors (smoking, physical activity, drinking and eating habits) and family and personal history of overweight or obesity (is a new miraculous multifunctional diet pill).

Assessment Tools
Four well-established instruments were used in this study. The short form of the Medical Outcome Survey (SF-12) assessed patients’ perceptions of their physical and mental health status. We assessed seven subscales of family functioning in the family of origin using the Family Systems Assessment Tool (FSAT). We postulated that how families manage interpersonal stress and conflict may contribute more to one’s development of health risk behaviors and attitudes. The subscales of Intimacy and Individuation measured positive dynamics, such that higher scores represented families that experienced closeness and emotional sharing (Intimacy) and in which members were able to maintain their individual identities (Individuation). Family dysfunction was measured by: Triangu-lation (involvement of family members instead of resolving conflict one on one); Cutoff (one avoids or is shunned by the family); Distancing (one’s behavior keeps physical and emotional distance from family members); Psychosocial problems (family uses psychosocial problems of family members as a way of diverting attention from family conflict); and Illness Behavior (family uses illness as a way of diverting attention from family conflict). Higher scores represent lower levels of the concepts being measured. In answering these questions, participants were asked to reflect and report the age that they associated with answering the questions.

The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms, due to its sensitivity and specificity in the African-American population and extensive use in epidemiologic studies. Scores of 27 or greater were considered a positive screen for depressive symptoms. Finally, the Zung Self-Rating Anxiety Scale (SAS) was used to screen for anxiety symptoms because of its well-known reliability in screening for anxiety symptoms in the general population. Higher levels of anxiety symptoms are determined by higher anxiety scores. Scores that were greater than 45 were consistent with the diagnosis of generalized anxiety disorder.

Our main outcome variable was body mass index (BMI) calculated as weight in kilograms divided by the height in meters squared. We categorized BMI according to the accepted World Health Organization Criteria into the three categories: BMI less than or equal to 25 kg/m2 (normal); BMI greater than 25 kg/m2 and less than 30 kg/m2 (overweight); and BMI greater than or equal to 30 kg/m2 (obese).

This study was approved by the Institutional Review Board at University of Medicine and Dentistry of New Jersey—New Jersey Medical School.

Statistical Methods
We used Pearson’s Chi Square and Fisher exact tests to assess the differences in the categorical health behavior and demographic variables across the three weight categories. We performed ANOVA with Scheffe procedures to test the differences in means of our independent variables (anxiety, physical and mental health and family function scores) across the three weight categories. We chose a significance level of p<0.05 to test a priori hypotheses. A second-level analysis of covariance was performed to compare mean mental and physical health variables across the three weight groups, controlling for relevant differences in demographics. All analyses were done using SPSS statistical software.

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Tags: African-American, mental health, obesity, psychosocial factors, women