Received 14 July 2016; accepted 9 August 2016; published 12 August 2016
Adolescence is comprised between the age group from 10 and 19 years old  , phase of life which is characterized by several changes in social, cultural and economic fields  . A great attention to questions related to physical and mental wellbeing, such as weight changes and depressive symptoms are essential, in order to provide a healthy adulthood. In this period, physical size and body shape become issues of concern for adolescents, because leanness has a big tendency for acceptance before society. Besides that, there are some professions with particular physical requirements, like athletes, ballet dancers and models, which are often charged by a rigid maintenance and/or weight loss, which may thus become risk professions   .
These requirements in relation to physical characteristics, exalting certain default appearance is something common in our society  . In this context, women are more susceptible to the changes, in the pursuit of what is considered perfect, which many times contrasts with the ideal of health  . In this perspective, an “optimal” female body has been shown by the media, primarily symbolizing by female models, characterized by compulsory body measures, which are extremely strict and provide an idea of patterned and correct body image  .
Professional models use their appearance to represent products and brands, through advertisements and events  . This need for the body to have certain measures, associated to a difficult career, with family removal and sometimes exacerbated focus on glamour may expressively impact on lifestyle, on depressive symptoms and on quality of life (QoL). However, to our knowledge, these outcomes have not been investigated in models. Although recent studies  have been emerging investigating the role of model profession on physical health (body composition, physical fitness and dietary intake), the role of the lifestyle followed by professional models on depressive symptoms and QoL are unclear. Thus, the purpose of the present study was to compare depressive symptoms and QoL levels between female models and their non-models counterparts.
The sample of the study was composed by runaway and/or commercial female models between the ages of 15 and 25 from Cast One Models agency from the city of Caxias do Sul, Rio Grande do Sul, Brazil and also by adolescent and young adult students from public/private schools and universities from Caxias do Sul, Rio Grande do Sul, Brazil. The sample of the study was selected by convenience, being made contact with 16 models from Cast One Models agency, in which 10 accepted to participate in the study (MG). After the selection of the models, a total of 8 non model girls were invited to participate in the study, of which 8 accepted it and were part of the study (NM). These girls were also selected by convenience, in compliance with the same age group and homecity of the models, only avoiding the inclusion of obese girls, by believing that this would generate a huge comparative bias, once obesity is associated to depressive symptoms and poor QoL.
Data were collected in a single day. Participants filled in the quality of life (QoL) and depressive symptoms instruments, along with an anamnesis record and an informed consent form. All the data collections were accomplished at EstaçãoSaúde gym in Caxias do Sul, Rio Grande do Sul, Brazil. The reading and the signature of the consent form were individually made (for girls over the age of 18 years) and with the company of those responsible for them (for girls under the age of 18). An assent form was also filled to secure agreement between the study and the locals of the subjects’ recruitment.
2.3. Depressive Symptoms
Depressive symptoms were evaluated using the Portuguese version of the Depression Escale CES-D  . This instrument is self-applicable, trans cultural, consisting of 20 statements, each one had four possible responses corresponding to the numbers 1, 2, 3 and 4. The score ranges from 0 to 60. Higher scores mean an increased level of depressive symptoms.
QoL was assessed using the World Health Organization Quality of Life-Bref (WHOQOL-BREF)  . The WHOQOL-BREF is a self-assessment, 26-item, short version of the WHOQOL-100 instrument. The results are presented in four domains (physical, psychological, social relation ships, and environment) with scores ranging from 0 to 100 (0 indicates the worst QoL and 100 better QoL). The WHOQOL-BREF has excellent psychometric proprieties and was transculturally adapted and validated for the Brazilian population  (Supplementary Material).
2.5. Statistical Analysis
As descriptive statistics the mean and standard deviation values were used. Categorical variables were presented by the sample n. The normality and homogeneity of the data were evaluated by the Shapiro-Wilk and Levene tests, respectively. For the comparison between the variables of the models and the non models the independent t-test was used. When comparing categorical variables, we used Fisher’s exact test. It was adopted a 5% significance level. All analyzes were performed using SPSS program, version 20.0.
3.1. Flow of Participants
Twenty-four girls were contacted, 16 of them were models and eight were non models. A total of six subjects left the study, all of the MG (three because of time constraints, one due family problems, one refused to participate and one because of address change). In this way, the final population of the study consisted of 18 subjects (MG; n = 10 and NM; n = 8). In Figure 1, the flowchart of the individuals over the study can be visualized.
All the girls who proposed to participate in the study were born and created in the same region, frequenting similar places. In MG, all the models were contracted by the same agency, despite from different backgrounds (regional, national and international models). It is noteworthy to mention the great importance that the MG components gave to the collection of the data (a large number of the models performed the collection procedures in order to obtain more information about their health status). In the same way, the non models participated in the study in order to obtain information that would favor their health and QoL.
3.3. Sample Characterization
The characterization of the final sample (analyzed subjects) is presented on Table 1.
General QoL and in physical health, psychological health, social relationships and environment domains did not show differences between groups (p > 0.05). These analyses are demonstrated on Table 2.
Figure 1. Flow of participants.
3.5. Depressive Symptoms
As well as in QoL, no differences were found between the groups in relation to depressive symptoms (p > 0.05). These analyses are demonstrated on Table 3.
In general, our results demonstrate that the simple fact of being a model does not implicate in a lower QoL or in a greater number of depressive symptoms, because girls of a same age group and region seem to have these out- comes in a similar number, despite the different labor routine.
Table 1. Sample characterization.
Age data are presented as median and inter quartile range; Career duration is presented as mean ± SD; other variables are presented by n of each group.
Table 2. General QoL and in physical, psychological, social relationships and environment domains for the models group (MG) and non models (NM) assessed using WHOQOL-BREF.
Data are presented as mean ± SD. α: 0.05. Analysis was made using independent t-test.
Table 3. Depressive symptoms for the models group (GM) and non models (NM) using CES-D instrument.
Data are presented as mean ± SD. α: 0.05. Analysis was made using independent t-test.
The results obtained in our study corroborate the findings of Pires et al.  , who evaluating QoL in professional adolescent models also found levels of general QoL, physical, social relationships and environment domains similar to the non models. Different from our results, Pires et al.  found a greater quality of life in the psychological domain in the models in comparison to the non models.
The results are somehow surprising, because the model profession has particularities of substantial impact on people’s daily lives, like family removal, daily pressures, body exposure and high competiveness, which lead us to think in a possible deterioration of the QoL. However, even with these particularities, QoL does not seem to be impaired.
In relation to depressive symptoms, the lack of difference between the groups is also a positive factor to those girls who wish to begin or are working in the model career. Besides these results are in accordance with results found for QoL, they also show similar behavior to physical fitness related to health  . Although there are missing studies with this population analyzing the association between these different outcomes, there are some evidences  relating physical fitness components, like VO2max, to depressive symptoms. Still in this direction, the study of Fleck et al.  using the same instrument applied in this study (CES-D) found inverse association between depressive symptoms and several indicators of health and wellbeing of Brazilians. This lead us to the reflection that far beyond labor particularities, habits related to physical exercise, nutrition, as well as genetic component can play an important role in the mental health of these girls.
However, caution should be exercised in interpreting the depressive symptoms results, because in spite of the lack of statistical difference, the mean value of the MG is presented a little higher than the mean values of the NM. Also, the CES-D cut-off for presence of increased depressive symptoms is 11, and both the MG and the NM are above this cut-off. Thus, we claim for the need for care about this outcome.
Based on the results of our study, model profession seems to not significantly interfere on QoL and on depressive symptoms. Yet, even considering these results as positive for those girls who are inserted or wish to be within this fashion world, more studies with models are necessary to a better understanding about the relationship between this profession and aspects related to health.
6. Limitations, Strengths and Future Perspectives
The present study has some limitations. The small number of participants, the fact that all models are from the same agency are the main limitations of, despite of the different professional levels. Therefore future studies should expand the research about this universe in order to obtain a clearer understanding on mental health of professional levels. However, we believe that this study has innovative character for the originality of the proposal, investigating clinically relevant outcomes in a population very little studied. The main strength of the present study is the fact that the women that composed the non model group were from the same socio-cultural context (living in neighborhood with similar socio economical characteristics), and same age than our model group.
WHOQOL-ABREVIADO (FLECK et al. 2000)-Versão em Português
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( ) Eu pensei que minha vida tem sido um fracasso.
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