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An Exploratory Analysis of Psychological and Genetic Based Outcomes Related to Binge Drinking and Binge Eating Behaviors in a College-Age Population

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An Exploratory Analysis of Psychological and Genetic Based Outcomes Related to Binge Drinking and Binge Eating Behaviors in a College-Age Population Medical University of South Carolina MEDICA MUSC Theses and Dissertations 2017 An Exploratory Analysis of Psychological and Genetic Based Outcomes Related to Binge Drinking and Binge Eating Behaviors in a College-Age Population Carley Garris Lovell Medical University of South Carolina Follow this and additional works at: https://medica-musc.researchcommons.org/theses Recommended Citation Lovell, Carley Garris, "An Exploratory Analysis of Psychological and Genetic Based Outcomes Related to Binge Drinking and Binge Eating Behaviors in a College-Age Population" (2017). MUSC Theses and Dissertations. 369. https://medica-musc.researchcommons.org/theses/369 This Dissertation is brought to you for free and open access by MEDICA. It has been accepted for inclusion in MUSC Theses and Dissertations by an authorized administrator of MEDICA. For more information, please contact [email protected]. ! ! An Exploratory Analysis of Psychological and Genetic Based Outcomes Related to Binge Drinking and Binge Eating Behaviors in a College-Age Population Carley Garris Lovell A dissertation submitted to the faculty of the Medical University of South Carolina in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the College of Nursing. September 15, 2017 ii! ! ACKNOWLEDGEMENTS I would like to thank my dissertation committee: Drs. Gayenell Magwood, Amy Adkins, Martina Mueller, and Dace Svikis. Dr. Magwood has been my advisor during my entire course of study, and her consistent encouragement and support as my chair allowed me to successfully complete my studies. She supplied valuable guidance throughout the journey, literally starting from day one. I appreciate her invaluable support. Dr. Mueller is one of the clearest thinkers that I have met, and I value her contributions to my study immensely. She was always invested, available, and helped me to move forward in a way that was directive, steady and realistic, but challenging and ensured quality. She provided timely input and thoughtful responses each time I reached out to ask for her help. Dr. Adkins has been invested in my project since before she was a member of the committee. I thank her for being interested in my topic and brave enough to take on a nurse who knew nothing about genetics and large data sets, and spend the ample time necessary in order for the study aims to come true in a way that assured quality. I cannot thank Dr. Adkins enough for her role in my development. When Dr. Linda Hancock referred her to me she said, “She’s probably going to kill me for recommending her; but she’s a true developer”. This proved to be so true. This study would not have been possible without her mentorship. Without Dr. Svikis, this study would have taken a very different form. She suggested the rich resource of Spit for Science (S4S) and stood by my side in forming my proposal until she felt that I was in a good place to move forward with my aims and study iii! ! team. She provided invaluable contributions of clarity when I needed to speak about any issue. I would also like to thank: •! Dr. Nancy Langston, former dean of VCU School of Nursing, for believing in the power of nursing science and me as a scientist enough to encourage VCU and VCU School of Nursing to support this endeavor financially. •! Dean Jean Giddens of VCU School of Nursing for honoring the vision that Dr. Langston supported. •! VCU School of Nursing Intramural Grants Program, and Dr. Debbie McGuire for encouraging me to apply. •! Dr. Michelle Nichols for being a peer mentor early in my journey. •! Dean Gail Stewart for hosting PhD students and MUSC faculty in her lovely home. The grace and warmth of that event during residency when our school was under construction and we entered an impersonal building each day remained with me over the course of my time as a distance learner, and set a warm impression of MUSC College of Nursing. •! Dr. Nancy McCain for demonstrating that forming one’s conceptual framework can be a delightful, seemingly magical quest; and for making work not feel like work at all. She still is the only person that I have “worked” with who managed to bring the aspect of true fun to my work, and it did not feel like work at all. •! Drs. Ann Hamric and Debbie McGuire for being local and gracious hosts at the conclusion of each semester for myself and my coworkers/peers Shelly Orr and Lana Sargent who were undertaking the PhD program with me. They made me iv! ! feel supported and were genuinely interested in our process/progress. When busy admired leaders share their home and their expertise and time, it is the demonstration and essence of grace. •! Dr. Fazil Aliev, who was a delight to get to know personally and professionally in his role as the S4S genetic statistician. He is a brilliant individual, and I feel privileged to have been able to work with him in this capacity. •! Dr. Danielle Dick for her underlying support that made my study aims possible. •! Dr. Leroy Thacker for being a true scholar and a gentleman, although he will never claim these attributes. He was patient and kind about inquiries regarding my data set and analyses in JMP so that I felt confident in my output and the quality of the results. •! Dr. Linda Wallinger for her excellent editorial review. •! VCU research librarian Roy Brown for his help with numerous literature searches. •! Sue Lindner, and Drs. Jeanne Walter and Jo Robins, and the countless additional coworkers who supported this journey. •! Dr. Grossman for the referral of Dr. Wallinger and for being my friend who has “been there and done that”. •! JF for the Mac that has been my primary instrument during this endeavor. •! Granny and Papa, who made it possible to inspire my value of education because of their belief in me and investments in my educational pursuits. •! My family and friends who encouraged me along the journey, and specifically my mother Linda and brother Luke, who are always there for me. v! ! ABSTRACT Purpose The purpose of this dissertation was to explore psychological and genetic associations of binge drinking and eating in college-age individuals, and to assess if overlap exists across phenotypes. Key contributing factors of binge drinking and binge eating informed the development of a hypothesized biobehavioral conceptual framework for binge behavior. Next, an integrative review of existing instruments that measure binge eating was conducted to observe concepts related to binge eating as applied clinically. Finally, a secondary analysis was carried out to investigate the phenotypes of interest in a study aim that focused on key concepts in the framework from survey data as well as an aim that investigated physiological concepts by way of genetic data. Problem Binge drinking and eating are prevalent behaviors in our society and within the college-age population. Binge eating rates are increasing, and binge eating disorder (BED) was included as a primary diagnosis in the current edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. Little is known about the etiology of binge eating; however, binge eating is regularly equated to substance use disorders in the literature. The specific aims of the dissertation study were to determine: Aim 1: If binge behaviors are associated with stress, impulsivity, and health outcome risks of obesity, anxiety, and depressive symptoms. vi! ! Aim 2: If shared single nucleotide polymorphisms (SNPs) present for binge drinking and binge eating from a Genome-Wide Association Study (GWAS) and a candidate gene approach. Design A secondary analysis of cross-sectional self-report data was conducted to achieve aim one within the framework of a mediation analysis, while a Genome-Wide Association Study (GWAS) was conducted to achieve aim two. Findings Binge as a mediator applied to binge eating but not to binge drinking. Females demonstrated higher rates of binge eating, anxiety, and depressive symptoms than males. Overweight and obese participants were more likely to binge eat than binge drink. Racial differences showed that more Whites binge drink compared to Asians, Blacks, and Hispanics. No racial differences were noted among binge eating outcomes. No genetic overlap was noted among phenotypes nor was statistically significant output noted for the binge drink GWAS. Gene-based significance for binge eat included the following: PURG, LYPD5, SKAP2, TRAPPC1, and NCOA2. Conclusions While binge drinking and binge eating are prevalent behaviors in college-age youth, binge eating shows heightened associations to pathologies without taking frequency into account. For the GWAS, preliminary analyses suggest that the binge drinking phenotype was oversaturated. It is probable that risky drinking behaviors were inseparable from problem drinking at this age by forming the phenotype from a binary approach assessing binge drinking within a month. vii! ! Keywords: binge drink, binge eat, genetic overlap, GWAS, comorbidity, college-age viii! ! TABLE OF CONTENTS ACKNOWLEDGEMENTS……………………………………………………………… ii ABSTRACT……………………………………………………………………………… v TABLE OF CONTENTS………………………………………………………………… viii LIST OF TABLES………………………………………………………………………. ix LIST OF FIGURES…………………………………………………………………….... xii CHAPTERS 1.! INTRODUCTION……………………………………………………………………. 1 2.! MANUSCRIPT 1…………………………………………………………………….. 23 Measurements for Binge Eating and Considerations Unique to Binge Eating Disorder: An Integrative Review of the Literature 3.! MANUSCRIPT 2……………………………………………………………………... 64 Association of Binge Drinking and Eating with Perceived Stress, Impulsivity, and Health Outcomes of Anxiety, Depressive Symptoms, and Obesity in College-Age Youth: A Mediation Model 4.! MANUSCRIPT 3…………………………………………………………………….. 110 A Genome-Wide Association Study Investigating Binge Drinking and Eating in College-Age Youth 5.! SUMMARY AND CONCLUSIONS………………………………………………… 150 APPENDICES Appendix AA. MUSC IRB Approval for the Study (non-human subjects research)…….. 159 Appendix BB. The IRB Approval Letter for Spit for Science……………………………. 171 Appendix C. Spit for Science Data Sharing Agreement………………………………….. 173 Appendix D. Spit for Science Progress Report…………………………………………… 174 Appendix E.
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