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Cited by 98Eating Disorders and BehaviorsNutrition, Health and Food BehaviorAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Depression and eating pathology: Prospective reciprocal relations in adolescents

Open access
Presnell, Katherine, Stice, Eric, Seidel, Anke, Madeley, Mary Clare·2009·Clinical Psychology & Psychotherapy
DOI 10.1002/cpp.630PMC PMC3398979
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Abstract

The association between disordered eating and depression has been established, but less is known about the temporal relations between these two disturbances. Accordingly, the current study examined the reciprocal relations between depressive and bulimic symptoms over an 8‐year period, with longitudinal data from a community sample of 496 female adolescents. Depressive symptoms predicted future increases in bulimic symptoms, and bulimic symptoms likewise predicted increases in depressive symptoms, controlling for earlier levels of symptoms for each outcome. These results provide evidence consistent with the hypothesis that the two disorders contribute reciprocally to each other, and indicate that successful prevention or treatment of one disorder may yield effects for the other. However, the relatively small predictive effect sizes imply that some third variable may contribute to both conditions (e.g., temperamental negative affectivity). Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: • Depression and bulimia contribute reciprocally to each other. • Successful treatment or prevention of one disorder may yield effects for the other. • Third variable may also contribute to both conditions.

AI snapshot

Written from the paper’s full text.

TL;DR

In a community sample of 496 female adolescents followed over 8 years, depressive and bulimic symptoms prospectively predicted increases in each other. The effects were statistically significant but small, suggesting possible shared third-variable influences.

Key findings

  • Depressive symptoms predicted future increases in bulimic symptoms, controlling for prior bulimic symptoms: \(t(3181) = 7.02\), \(B = 0.12\), \(p < .001\), 2% variance explained.
  • Bulimic symptoms predicted future increases in depressive symptoms, controlling for prior depressive symptoms: \(t(3181) = 5.79\), \(B = 0.10\), \(p < .001\), 3% variance explained.
  • The small predictive effect sizes led the authors to conclude that a third variable, such as temperamental negative affectivity, may contribute to both conditions.

Methods

  • Longitudinal community sample of 496 female adolescents recruited from four public and four private middle schools in a Southwestern U.S. metropolitan area; age at entry 11–15 years (\(M = 13.5\), \(SD = 0.67\)), with baseline and seven annual follow-ups.
  • Bulimic symptoms were assessed with the Eating Disorder Diagnostic Interview, adapted from the Eating Disorder Examination; depressive symptoms were assessed with the K-SADS semi-structured diagnostic interview.
  • Two \(N - 1\) lagged growth models with time-varying covariates were estimated in HLM 6, testing each 1-year lagged predictor while controlling for the 1-year lag of the dependent variable.

Limitations

  • Stated: an unmeasured third variable may explain the observed prospective effects, as in all longitudinal research.
  • Stated: the study relied exclusively on adolescent report; peer or parent reports would provide additional information.
  • Stated: the moderate participation rate and inclusion of relatively few individuals from certain ethnic groups suggest findings should be generalized with caution. Evident: the observational design cannot establish causality, and the small effect sizes further limit strong causal conclusions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/cpp.630

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 27 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In a community sample of female adolescents, bulimic symptoms at one assessment predicted future increases in depressive symptoms at the next annual assessment, controlling for the 1-year lag of depressive symptoms, over seven 1-year intervals; the effect was B = 0.10, t(3181) = 5.79, p < .001, with 3% variance explained.

    “The 1-year lag of bulimic symptoms, controlling for the 1-year lag of depressive symptoms, predicted higher levels of depressive symptoms over the seven time points, t (3181) = 5.79, B = 0.10, p < .001, 3% variance explained.”
    • Also stated in: § Abstract · plain
      “Depressive symptoms predicted future increases in bulimic symptoms, and bulimic symptoms likewise predicted increases in depressive symptoms, controlling for earlier levels of symptoms for each outcome.”
    • Also stated in: § Discussion · plain
      “Results indicated that depressive symptoms prospectively predicted future increases in bulimic symptoms, and that bulimic symptoms likewise predicted future increases in depressive symptoms in adolescent females over this developmental period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 1-year lag between assessments is sufficient to capture the prospective influence of depressive symptoms on bulimic symptoms and vice versa.
  • Findingown data

    In a community sample of female adolescents, depressive symptoms at one assessment predicted future increases in bulimic symptoms at the next annual assessment, controlling for the 1-year lag of bulimic symptoms, over seven 1-year intervals; the effect was B = 0.12, t(3181) = 7.02, p < .001, with 2% variance explained.

    “The 1-year lag of depressive symptoms, controlling for the 1-year lag of bulimic symptoms, predicted higher levels of bulimic symptoms over the seven time points, t (3181) = 7.02, B = 0.12, p < .001, 2% variance explained.”
    • Also stated in: § Abstract · plain
      “Depressive symptoms predicted future increases in bulimic symptoms, and bulimic symptoms likewise predicted increases in depressive symptoms, controlling for earlier levels of symptoms for each outcome.”
    • Also stated in: § Discussion · plain
      “Results indicated that depressive symptoms prospectively predicted future increases in bulimic symptoms, and that bulimic symptoms likewise predicted future increases in depressive symptoms in adolescent females over this developmental period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 1-year lag between assessments is sufficient to capture the prospective influence of depressive symptoms on bulimic symptoms and vice versa.
  • Premisecitation

    Negative affect predicts later increases in bulimic symptoms among female adolescents.

    “In support of this hypothesis, prospective research has found that negative affect predicts later increases in bulimic symptoms (Stice, 2001; Stice, Akutagawa, Gaggar, & Agras, 2000; Tyrka, Waldron, Graber, & Brooks-Gunn, 2002) and onset of binge eating and compensatory behaviors (Stice & Agras, 1998; Stice, Killen, Hayward, & Taylor, 1998) among female adolescents.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Stice, 2001

      Not checked in the free run.

    • cites Stice, Akutagawa, Gaggar, & Agras, 2000

      Not checked in the free run.

    • cites Tyrka, Waldron, Graber, & Brooks-Gunn, 2002

      Not checked in the free run.

  • Interpretationown data

    The relatively small predictive effect sizes imply that some third variable may contribute to both depressive and bulimic symptoms.

    “However, the relatively small predictive effect sizes imply that some third variable may contribute to both conditions (e.g., temperamental negative affectivity).”
    • Also stated in: § Discussion · hedged
      “When considering the relatively small magnitude of the predictive effects observed in the current study, another possibility is that some third variable contributes to both conditions.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Successful prevention or treatment of one disorder may yield effects for the other.

    “These results provide evidence consistent with the hypothesis that the two disorders contribute reciprocally to each other, and indicate that successful prevention or treatment of one disorder may yield effects for the other.”
    • Also stated in: § Discussion · hedged
      “For example, findings from prospective studies suggesting that depression and bulimia are reciprocally related imply that prevention and treatment programs that reduce levels of one disorder should also impact the other.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 14
  • May combine two claims. 11
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Premisecitation

    Purging may be employed to reduce anxiety about weight gain, creating a self-perpetuating cycle of bulimic symptoms.

    “Purging may then be employed to reduce anxiety about weight gain, creating a self-perpetuating cycle of bulimic symptoms (Fairburn, 1995).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fairburn, 1995

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Bulimic and depressive symptoms are reciprocally related, with each increasing the risk for the other.

    “These results provide evidence consistent with the hypothesis that the two disorders contribute reciprocally to each other, and indicate that successful prevention or treatment of one disorder may yield effects for the other.”
    • Also stated in: § Discussion · hedged
      “Overall, these findings indicate that bulimic and depressive symptoms are reciprocally related, with each increasing the risk for the other.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 1-year lag between assessments is sufficient to capture the prospective influence of depressive symptoms on bulimic symptoms and vice versa.

  • Classified as probably not a substantial claim.

    Premisecitation

    Binge eating is a maladaptive coping method by which an individual attempts to escape and alleviate affective distress by focusing on external food cues.

    “The escape theory (Heatherton & Baumeister, 1991) conceptualizes binge eating as a maladaptive coping method by which an individual attempts to escape and alleviate affective distress by focusing on external food cues.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Heatherton & Baumeister, 1991

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    The temporal nature of the relation between bulimia and depression remains unclear.

    “Despite consistent evidence regarding the association between bulimia and depression, the temporal nature of this relation remains unclear.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Reliance exclusively on adolescent report may limit findings; reports from peers or parents would provide additional information.

    “Second, we relied exclusively on adolescent report, and although adolescents are generally considered the best reporters of their own internalizing symptoms, reports from peers or parents would provide additional information.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Attrition analyses verified that participants missing data did not differ significantly from remaining participants on demographic factors or examined variables, indicating attrition did not introduce systematic bias.

    “Attrition analyses verified that participants who were missing data at any assessment point did not differ significantly from the remaining participants on demographic factors or any of the variables examined in the report, indicating that attrition did not introduce systematic bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Bulimic symptoms predict future increases in depressive symptoms and onset of depression among female adolescents.

    “Specifically, bulimic symptoms have been found to predict future increases in depressive symptoms (Stice & Bearman, 2001; Stice et al., 2004) and onset of depression (Stice et al., 2000) among female adolescents.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Stice & Bearman, 2001

      Not checked in the free run.

    • cites Stice et al., 2004

      Not checked in the free run.

    • cites Stice et al., 2000

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The K-SADS depression interview showed 1-week test-retest reliability (κ = 1.00) and inter-rater agreement (κ = 1.00) for depression diagnosis, and internal consistency (M α = .81), 1-week test-retest reliability (r = .86), and inter-rater agreement (r = .87) for the symptom composite.

    “This version of the K-SADS depression interview has shown 1-week test-retest reliability (κ = 1.00) and inter-rater agreement (κ = 1.00) for depression diagnosis and internal consistency (M α = .81), 1-week test-retest reliability (r = .86) and inter-rater agreement (r = .87) for the symptom composite (Nolen-Hoeksema et al., 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Nolen-Hoeksema et al., 2007

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The models controlled for the 1-year lag of the dependent variable (autoregressive effects).

    “controlling for the 1-year lag of the dependent variable.”
    • Also stated in: § Results · plain
      “controlling for the effects of bulimic symptoms at the prior assessment (i.e., to control for the autoregressive effects for the dependent variable).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The study used structured psychiatric interviews to assess the primary outcomes.

    “The confidence that can be placed in our findings is also strengthened by the fact that we used structured psychiatric interviews to assess the primary outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The eating disorder diagnostic interview showed high test-retest reliability for threshold and subthreshold diagnoses (κ = .96) and high inter-rater agreement (κ = .86).

    “resulting in high test-retest reliability for threshold and subthreshold diagnoses of anorexia nervosa, bulimia nervosa, and binge eating disorder (κ = .96).”
    • Also stated in: § Measures · plain
      “resulting in high inter-rater agreement (κ = .86).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Findings should be generalized with caution due to moderate participation rate and inclusion of relatively few individuals from certain ethnic groups.

    “Third, our moderate participation rate and inclusion of relatively few individuals from certain ethnic groups suggest that these findings should be generalized with caution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study used a large sample size of 496 female adolescents.

    “Strengths of the current study include a large sample size, long follow-up period, and low attrition rate, as well as the use of continuous measures that allowed detection of subthreshold levels of symptom domains that may nonetheless represent clinically significant impairment.”
    • Also stated in: § Participants · plain
      “Participants were 496 female adolescents recruited from four public (82%) and four private (18%) middle schools in a metropolitan area of the Southwestern United States, ranging in age from 11 to 15 (mean = 13.5, SD = 0.67) at the time of study entry.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The bulimic symptom composite showed internal consistency (α = .86 at pretest) and 1-month test-retest reliability (r = .81).

    “In the current trial the symptom composite showed internal consistency (α = .86 at pretest) and 1-month test-retest reliability for assessment-only controls (r = .81).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bulimic symptoms did not prospectively predict subsequent increases in depressive symptoms in adults.

    “However, one study involving adults did not find a prospective effect of bulimic symptoms (Procopio et al., 2006) on subsequent increases in depressive symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Procopio et al., 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Assessors demonstrated high inter-rater agreement (kappa > .80) before data collection and periodically during the study.

    “Assessors were required to demonstrate a high level of inter-rater agreement (kappa [k] > .80) with supervisors using tape-recorded interviews before collecting data. Interviews were recorded periodically during the study to ensure that assessors showed acceptable inter-rater agreement (k > .80).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The study had a long follow-up period of 8 years with seven annual follow-ups.

    “Strengths of the current study include a large sample size, long follow-up period, and low attrition rate, as well as the use of continuous measures that allowed detection of subthreshold levels of symptom domains that may nonetheless represent clinically significant impairment.”
    • Also stated in: § Procedures · plain
      “Participants completed a survey and participated in a structured interview at baseline (T1) and at seven annual follow-ups (T2, T3, T4, T5, T6, T7, and T8).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It is possible that some unmeasured third variable explains the observed prospective effects.

    “Although we used prospective analyses to test our hypotheses, it is possible that some unmeasured third variable explains the observed prospective effects, as is the case with all longitudinal research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Depressive symptoms were not predictive of later bulimic symptoms in middle-aged adults.

    “One study found that depressive symptoms were not predictive of later bulimic symptoms (Procopio, Holm-Denoma, Gordon, & Joiner, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Procopio, Holm-Denoma, Gordon, & Joiner, 2006

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The sample was representative of the ethnic composition and parental education of the schools and metropolitan area from which it was sampled.

    “which was representative of the ethnic composition of the schools from which we sampled”
    • Also stated in: § Participants · plain
      “which was representative of the metropolitan area from which we sampled”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Binge eating and purging may lead to feelings of shame and guilt, increased rumination about inability to control food intake, and impairment in interpersonal functioning.

    “On the other hand, bulimic symptoms may also contribute to depressed mood since binge eating and purging may lead to feelings of shame and guilt, increased rumination about one's inability to control food intake, and impairment in interpersonal functioning (Heatherton & Polivy, 1992; Keel, Mitchell, Miller, Davis, & Crow, 2000; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Heatherton & Polivy, 1992

      Not checked in the free run.

    • cites Keel, Mitchell, Miller, Davis, & Crow, 2000

      Not checked in the free run.

    • cites Nolen-Hoeksema, Stice, Wade, & Bohon, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The participation rate (56%) was comparable to rates in other school-recruited samples using active consent procedures and structured interviews.

    “resulting in an average participation rate of 56%, which was comparable to rates in other school-recruited samples that used active consent procedures and structured interviews (e.g., 61% for Lewinsohn et al., 1994).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lewinsohn et al., 1994

      Not checked in the free run.

22 of 22

  • The paper relies on this without support.

    The 1-year lag between assessments is sufficient to capture the prospective influence of depressive symptoms on bulimic symptoms and vice versa.

    “Additionally, Marmorstein et al. used a 3-year lag whereas the current study used a 1-year lag between assessments, and it is possible that depressive symptoms exert their influence on increases in eating pathology over a relatively short period of time.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Study duration is stated as both eight and seven years

    Minor

    The paper describes an 8-year period, but also calls it a 7-year study period. Baseline plus seven annual follow-ups spans seven years.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Bryk A.S., 2004, HLM 6: Hierarchical linear and nonlinear modeling (Version 6) [computer software]
  2. Puig‐Antich J., 1983, Schedule for affective disorders and schizophrenia for school‐age children (6–18 years)

Cited by

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Related

Authors
Presnell, K., Stice, E., Seidel, A., & Madeley, M. C.
Affiliations
  • Southern Methodist University (US)
  • Oregon Research Institute (US)
Corresponding author
Presnell, Katherine
ORCID
Stice, Eric
Venue
Clinical Psychology & Psychotherapy
Publisher
Wiley
Published
2009-06-29
Volume
16
Issue
4
Pages
357-365
ISSN
  • 1063-3995 (ISSN-L)
  • 1099-0879
DOI
10.1002/cpp.630
PMC
PMC3398979
OpenAlex
W2170896930
Cited by
98
References
45
Citations by year
2026: 4 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 5 · 2018: 1 · 2017: 4 · 2016: 8 · 2015: 13 · 2014: 8 · 2013: 10 · 2012: 5
FWCI
5.65
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Psychology & Psychotherapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (MH 01708, R01MH061957, K01MH001708)
  • National Institute of Diabetes and Digestive and Kidney Diseases (MH/DK 61957)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, bulimic symptoms, disordered eating, bidirectional relationship, adolescents, adolescent girls, temporal relations, negative affectivity, eating disorder prevention, comorbidities
MeSH terms
Adolescent, Adolescent Behavior, Bulimia, Depression, Female, Humans, Male, Psychiatric Status Rating Scales, Research Design, Risk Factors, Self Concept, Linear Models, Adolescent Development, Bulimia Nervosa

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