View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of East Anglia digital repository An exploration of the relationship between insulin misuse and eating disorder psychopathology in adults with type 1 diabetes Victoria Matthews Doctoral Programme in Clinical Psychology University of East Anglia Primary Research Supervisor: Dr Bonnie Teague, University of East Anglia Secondary Research Supervisor: Dr Sian Coker, University of East Anglia March 5th, 2019 33,296 Words "This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with the author and that use of any information derived therefrom must be in accordance with current UK Copyright Law. In addition, any quotation or extract must include full attribution.” 2 ABSTRACT FOR THESIS PORTFOLIO .............................................................................. 7 ACKNOWLEDGEMENTS ..................................................................................................... 9 INTRODUCTION TO THESIS PORTFOLIO ...................................................................... 10 A NOTE ON LANGUAGE ...................................................................................................... 13 GLOSSARY OF TERMS ......................................................................................................... 14 CHAPTER ONE - SYSTEMATIC REVIEW ....................................................................... 16 ABSTRACT ........................................................................................................................... 18 INTRODUCTION ................................................................................................................. 18 AIMS AND OBJECTIVES ...................................................................................................... 22 METHODS ............................................................................................................................ 22 DATA SOURCES AND SEARCHES ........................................................................................ 22 ELIGIBILITY CRITERIA ....................................................................................................... 24 STUDY SELECTION ............................................................................................................. 24 DATA EXTRACTION AND QUALITY ASSESSMENT ............................................................. 25 DATA SYNTHESIS AND ANALYSIS ..................................................................................... 26 RESULTS .............................................................................................................................. 26 NARRATIVE SYNTHESIS .................................................................................................. 39 POPULATIONS .................................................................................................................... 39 STUDY DESIGN ................................................................................................................... 40 MEASURES ......................................................................................................................... 40 RESULTS ............................................................................................................................. 41 QUALITY ............................................................................................................................ 42 DISCUSSION ........................................................................................................................ 42 STRENGTHS AND LIMITATIONS .......................................................................................... 43 3 THEORETICAL AND CLINICAL IMPLICATIONS .................................................................... 44 CONCLUSIONS .................................................................................................................... 45 REFERENCES ....................................................................................................................... 46 CHAPTER TWO - BRIDGING CHAPTER ......................................................................... 52 2.1 INTRODUCTION ............................................................................................................ 53 2.2 CONSEQUENCES OF INSULIN MISUSE ........................................................................... 54 2.3 DIABETES AND MENTAL HEALTH ................................................................................ 55 2.4 DIABETES-RELATED DISTRESS .................................................................................... 57 2.5 DIABETES AND EATING DISORDERS ............................................................................ 58 CHAPTER THREE - EMPIRICAL PAPER ......................................................................... 60 ABSTRACT ...................................................................................................................... 62 INTRODUCTION ............................................................................................................ 60 RESEARCH DESIGN AND METHODS ........................................................................ 65 DESIGN ......................................................................................................................... 65 PARTICIPANTS AND PROCEDURE ................................................................................. 65 STATISTICAL ANALYSIS ............................................................................................... 67 MEASURES ................................................................................................................... 67 RESULTS ......................................................................................................................... 68 PARTICIPANT CHARACTERISTICS ................................................................................. 68 RESULTS OF INSULIN MEASURE .................................................................................. 70 BETWEEN-GROUPS COMPARISONS .............................................................................. 73 PREDICTIVE ANALYSIS ................................................................................................ 76 ONE-WAY MULTIVARIATE ANALYSIS OF VARIANCE (MANOVA) .............................. 77 DISCUSSION ................................................................................................................... 77 STRENGTHS AND LIMITATIONS .................................................................................... 81 4 CLINICAL RELEVANCE ................................................................................................. 82 ACKNOWLEDGEMENTS ................................................................................................ 83 REFERENCES ................................................................................................................. 84 CHAPTER FOUR - EXTENDED METHODOLOGY ......................................................... 89 4.1 ETHICAL CONSIDERATIONS ......................................................................................... 90 4.3 ADJUSTMENTS TO INSULIN MEASURE ......................................................................... 92 4.4 EXTENDED PROCEDURE ............................................................................................... 93 4.5 DATA PREPARATION AND SCREENING ......................................................................... 95 CHAPTER FIVE - EXTENDED RESULTS ......................................................................... 99 5.1 DISCONTINUATIONS ................................................................................................... 100 5.3 PREDICTIVE ANALYSIS .............................................................................................. 103 5.4 ONE-WAY MULTIVARIATE ANALYSIS OF VARIANCE (MANOVA) ............................ 105 5.5 EXPLORATORY ANALYSES ......................................................................................... 107 CHAPTER SIX - DISCUSSION AND CRITICAL EVALUATION ................................. 113 6.1 RESEARCH AIMS ........................................................................................................ 114 6.2 SUMMARY OF MAIN FINDINGS .................................................................................. 114 6.3 SUMMARY OF ADDITIONAL FINDINGS ....................................................................... 116 6.4 STRENGTHS AND LIMITATIONS .................................................................................. 118 6.5 THEORETICAL IMPLICATIONS .................................................................................... 122 6.6 CLINICAL IMPLICATIONS ............................................................................................ 126 6.7 FUTURE WORK ........................................................................................................... 128 6.8 CONCLUSIONS ............................................................................................................ 131 REFERENCES ..................................................................................................................... 132 LIST OF TABLES AND FIGURES 5 TABLE 1 SYSTEMATIC REVIEW: SEARCH STRATEGY FOR SYSTEMATIC REVIEW OF LITERATURE