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IntroductionBreast cancer is the most common cancer among women worldwide. While increasing numbers of women are living beyond breast cancer, treatment-related body image concerns are common and associated with adverse consequences. Nonetheless, rigorously evaluated and effective body image interventions are lacking among this group. Accepting your Body after Cancer (ABC) has indicated promise in relation to inperson delivery. However, online delivery may increase accessibility and facilitate sustainability of the intervention. Therefore, we aim to establish the feasibility of conducting a fully powered randomised controlled trial to evaluate online delivery of ABC.Methods and analysis120 women who have received treatment for breast cancer and are experiencing body image concerns will be randomised equally to either the ABC or standard care control group. All participants in both conditions will receive a body image booklet for people who have had cancer. ABC participants will also take part in a weekly seven-session, group-based cognitive behavioural therapy intervention, delivered online by a psychologist and cancer support specialist. Outcome measures will be completed at baseline and 9 weeks, 20 weeks and 32 weeks post baseline. Quantitative data on recruitment, retention, ABC attendance and questionnaire completion rates will be analysed using descriptive statistics. Qualitative data will also be collected to better understand the feasibility and acceptability of the research process and intervention, with data analysed using ‘codebook’ thematic analysis.Ethics and disseminationThe study has received ethical approval from the Newcastle North Tyneside Research Ethics Committee (ref: 24/NE/0092). The findings will be disseminated to academic and health professionals via a peer-reviewed publication and presentations at relevant conferences. Results will also be disseminated to participants, national cancer organisations and the general public via accessible reports, online presentations and different communication channels.Trial registration numberClinicalTrials.gov NCT06412341; ISRCTN ISRCTN88199566; IRAS 327507; REC reference 24/NE/0092; funder reference NIHR205415.

RationaleBody dissatisfaction is prevalent in mid-adolescence and may be associated with the onset of depression.ObjectiveThe study assessed the influence of body dissatisfaction on the occurrence of later depressive episodes in a population-based sample of British adolescents.MethodParticipants were 2078 females and 1675 males from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Logistic regression was used to test if body dissatisfaction at 14 years old predicted the onset of depressive episodes at 18 years old, controlling for baseline depression.ResultsAmong females, body dissatisfaction predicted mild (OR=1.63, 95% CI=1.31, 2.04), moderate (OR=1.67, 95% CI=1.28, 2.18) and severe depressive episodes (OR=1.84, 95% CI=1.09, 3.12). Among males, body dissatisfaction predicted mild (OR=1.50, 95% CI=1.00, 2.25) and severe depressive episodes (OR=2.85, 95% CI=1.18, 6.87) at 18 years of age.ConclusionsThis is the first prospective study to demonstrate that body dissatisfaction in adolescence predicts the occurrence of later depressive episodes in a cohort born in the early 1990s. The findings highlight that body dissatisfaction is a public health concern.

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls.

The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people ‘in recovery’ from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond.

Purpose The provision of practical and emotional support for men who have been diagnosed with breast cancer in the UK falls primarily on their partners, close family members or friends. However, informal carers’ experiences are omitted from the research literature. Therefore, the present study aimed to explore the care-giving experiences of informal carers (ICs) of men with breast cancer in the UK and identify psychosocial support needs and preferences. Methods Semi-structured interviews, conducted on the telephone or via online video calls, explored ICs’ experiences of providing support, the psychosocial issues they faced and the impact of the illness on themselves and their relationship with the patient. They were also asked about any support previously offered to them, in addition to their support preferences. Twelve ICs participated (11 females, 1 male), and 9 were spouses. Interview transcripts were analysed with reflexive thematic analysis using NVIVO software. Results Four key themes were identified: “ The impact of caring ”, “ Lack of awareness ”, “ Isolated and alone ” and “ Making a difference ”. Conclusions The physical, emotional, financial and social impact of providing emotional and practical care and support for a man diagnosed with breast cancer can be considerable. ICs may experience significant levels of distress and often feel isolated. Greater awareness and more research is needed to better understand the psychosocial impact and support needs for ICs of men with breast cancer. There is an evident necessity to address their information needs and offer sources of support throughout the cancer journey.

Eating pathology is increasingly common among Indian adolescents. However, brief validated measures of disordered eating in Indian contexts are scarce. This study adapted and validated a culturally appropriate English language version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) among 385 adolescents (mean age = 13.42 years; 47.3% girls) in urban India. Confirmatory factor analysis indicated that a two-factor eight-item solution had an acceptable fit to the data across gender: an ‘Eating Concerns and Restraint’ subscale and a ‘Weight and Shape Concerns’ subscale. Further, the questionnaire can be utilised as both a unidimensional and multidimensional tool. This allows for the computation of a total score on the primary factor of ‘Child Eating Pathology’, as well as the two subscales. Internal consistency of the ‘Weight and Shape Concerns’ subscale (α = 0.825) and ‘Eating Concerns and Restraint’ subscale (α = 0.649) was satisfactory. Concurrent validity was established through medium significant correlations with measures of body image and broader mental health. The results support the use of the ChEDE-Q for assessing disordered eating among urban Indian adolescents, thus providing the research community and practitioners with a measure to investigate the nature and scale of disordered eating among adolescents in India.

Survival rates for breast cancer have improved over the recent decades, and increasing numbers of women in midlife are coming to terms with the consequences of the disease and its treatment. Among the various side-effects associated with treatment are appearance and bodily alterations, which can elicit body image concerns and subsequently impose long-lasting adverse impacts upon psychological and physical health. Governments, health services, and support organisations have stressed the importance of the development, evaluation, and dissemination of psychosocial interventions that provide support for women adjusting to the residual consequences of the diagnosis and treatment of cancer, including body image distress. The overall aim of this thesis was to develop and assess the acceptability of an evidence-informed psychosocial intervention targeting body image among women in midlife who have undergone treatment for breast cancer. The thesis adopted a mixed-method pragmatic approach, and followed the Medical Research Council’s framework for the development and evaluation of complex interventions (Craig et al., 2008). First, a systematic review of existing body image interventions for women in midlife, including those treated for breast cancer, was conducted to assess the current status of the literature and identify existing effective interventions. Interventions targeting women in midlife (n=11) were found to have longer-lasting and larger effects on body image at post-test and were evaluated in studies of greater methodological rigour, compared with interventions targeting women who had undergone treatment for breast cancer (n=22). Second, an online survey tested and compared an established sociocultural model of body image (Tripartite Influence Model; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999) between women in midlife who were treated (n=169), and not treated (n=323), for breast cancer, in order to assess potential targets for body image interventions and the applicability of research and interventions among women in midlife for use with women treated for breast cancer. This study revealed a similar pattern of risk factors among both groups, whereby sociocultural and psychological factors proposed within the model influenced body image. Next, an integration of findings from the systematic review and online survey informed the adaptation of an existing evidence-based and rigorously evaluated body image intervention for women in midlife (McLean, Paxton, & Wertheim, 2011) for use among women treated for breast cancer. Finally, the adapted intervention was evaluated for its acceptability through focus groups and interviews with women who had undergone treatment for breast cancer (n=22) and health professionals involved in their psychosocial care (n=5). The adapted intervention was found to be acceptable to both participant groups, pending some further amendments. In addition to informing the adaptation of an existing body image intervention for use with women who have undergone treatment for breast cancer, the findings also provide important implications for practice, theory, and research. The present research has identified previously unexplored sociocultural and psychological influences on the body image of women who have undergone treatment for breast cancer and reveals the value of a theoretical model developed within the wider body image field for a group with an altered appearance.