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      A qualitative study of perceived social barriers to care for eating disorders: Perspectives from ethnically diverse health care consumers

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          Abstract

          Objective:

          The study aim was to identify and describe health consumer perspectives on social barriers to care for eating disorders in an ethnically diverse sample.

          Method:

          We conducted an exploratory secondary analysis of qualitative data comprising transcripts from semi-structured interviews with past and prospective consumers of eating disorder treatment ( n = 32). Transcripts were inputted into NVivo 8 for coding, sorting, and quantifying thematic content of interest within strata defined by ethnic minority and non-minority participants. We then examined the influence of key social barriers—including stigma and social stereotypes—on perceived impact on care.

          Results:

          The majority of respondents (78%) endorsed at least one social barrier to care for an eating or weight concern. Perceived stigma (or shame) and social stereotyping—identified both within social networks and among clinicians—had adversely impacted care for 59% and 19% of respondents, respectively.

          Discussion:

          Social barriers to care for eating and weight related concerns may be prevalent in the U.S. and impact both ethnic minority and non-minority health care consumers. © 2009 by Wiley Periodicals, Inc. (Int J Eat Disord 2010;)

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          Most cited references99

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          How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability

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            The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.

            Little population-based data exist on the prevalence or correlates of eating disorders. Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001-2003, were assessed using the WHO Composite International Diagnostic Interview. Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index or =40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment. Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.
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              How stigma interferes with mental health care.

              Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may impede treatment participation: It diminishes self-esteem and robs people of social opportunities. Given the existing literature in this area, recommendations are reviewed for ongoing research that will more comprehensively expand understanding of the stigma-care seeking link. Implications for the development of antistigma programs that might promote care seeking and participation are also reviewed. (c) 2004 APA, all rights reserved
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                Author and article information

                Journal
                Int J Eat Disord
                eat
                The International Journal of Eating Disorders
                Wiley Subscription Services, Inc., A Wiley Company
                0276-3478
                1098-108X
                01 November 2010
                05 October 2009
                : 43
                : 7
                : 633-647
                Affiliations
                [1 ]simpleDepartment of Global Health and Social Medicine, Harvard Medical School Boston, Massachusetts
                [2 ]simpleEating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital Boston, Massachusetts
                [3 ]simpleEliot Pearson Department of Child Development, Tufts University Medford, Massachusetts
                [4 ]simpleDepartment of Psychology, Wesleyan University Middletown, Connecticut
                Author notes
                * Correspondence to: Anne E. Becker, 641 Huntington Ave, Boston 02115, Massachusetts
                Article
                10.1002/eat.20755
                3020364
                19806607
                1eb99de2-b6c4-4580-b41f-d9554d2c8d4d
                Copyright © 2010 Wiley Periodicals, Inc., A Wiley Company

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                History
                : 29 July 2009
                Categories
                Regular Article

                Clinical Psychology & Psychiatry
                eating disorders,stereotypes,ethnicity,stigma,access to care
                Clinical Psychology & Psychiatry
                eating disorders, stereotypes, ethnicity, stigma, access to care

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