A framework for conceptualising early intervention for eating disorders

Allen, Karina L.; Mountford, Victoria; Elwyn, Rosiel; Flynn, Michaela; Fursland, Anthea; Obeid, Nicole; Partida, Georgina; Richards, Katie; Schmidt, Ulrike; Serpell, Lucy; Silverstein, Scout; Wade, Tracey D.

doi:10.1002/erv.2959

Cited by 30 publications

(32 citation statements)

References 116 publications

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“…These results are in line with the staging model of EDs 27 , which suggests that, while illness progresses, neurobiological and psychosocial maintaining factors develop and make persons suffering from EDs more resist ant to treatment 81 . These data further indicate the importance of pro viding sufficient resources to enable early diagnosis and treat ment, and of reducing barriers and delays to treatment access in young people 82,83 . For this purpose, services and policy makers should look at family and general practitioner education 31 , and the strict division still existing in many settings between child and adult mental health services should be overcome 34,84,85 .…”

Section: Discussionmentioning

confidence: 81%

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Solmi,

Monaco,

Højlund

et al. 2024

World Psychiatry

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Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta‐analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD‐defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all‐cause and ED‐related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow‐up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44‐49, n=283, mean follow‐up: 44.9±62.8 months, no significant ED‐group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23‐29, n=170, mean follow‐up: 59.3±71.2 months, no significant ED‐group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2‐0.7, n=214, mean follow‐up: 72.2±117.7 months, no significant ED‐group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person‐years (95% CI: 4.4‐6.1, n=167, mean follow‐up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18‐36, n=18, mean follow‐up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self‐injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio‐demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family‐based therapy, cognitive‐behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self‐help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

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Section: Discussionmentioning

confidence: 81%

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Solmi,

Monaco,

Højlund

et al. 2024

World Psychiatry

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“…Given the overwhelming demand for, and inadequate supply of, treatment services, the ED field must innovate to provide effective options to benefit high volumes of people as efficiently as possible (Allen et al, 2023). One strategy is to develop single session interventions as stand‐alone or adjunctive to multi‐session treatments (Schleider et al, 2023).…”

Section: Recommendations To Address Research and Practice Gapsmentioning

confidence: 99%

Toward a more comprehensive understanding and support of parents with a child experiencing an eating disorder

Wilksch

2023

Intl J Eating Disorders

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Objective The majority of eating disorder (ED) carer research has been conducted with parents of adult patients, using qualitative methodologies, focusing on carer burden and distress during treatment. This article aimed to use results from a large, national, quantitative survey of parents of child or adolescent patients as a springboard for encouraging a more comprehensive investigation of parent experiences. Methods The online survey assessed treatment experiences and parent distress (DASS‐21) but also less commonly investigated topics including symptom detection, experiences with primary care providers, and impacts on parent physical and psychological health, romantic relationship, finances, and employment. Results Key findings included parents (N = 439; 91.6% female): were the first person to notice the ED symptoms in 81.8% of cases; had only a 14.7% chance of a helpful experience with both the first general practitioner and first therapist they saw; needed to see M = 3.55 therapists before finding one that could help; reported worse than normal psychological health (96.0%), physical health (70.5%), and romantic relationship (92.7%); required M = 70.06 days leave from work to care for their child (per household); and 91.8% accessed treatment in the private sector with median out‐of‐pocket expenses of AUD 10,0001–AUD 20,000. Discussion Recommendations to address research and practice gaps include: increased focus on supporting initial symptom detection; improving primary care and treatment experiences; and, increasing the number of ED treatment providers. Urgently needed are solutions to the overwhelming demand for services and clearly, more support for parents. Such strategies are vital for reducing the overall burden of EDs. Public Significance Most eating disorder (ED) caregiver research has focused on experiences of supporting adult patients during treatment. This article used a large national survey to explore parent experiences of their child or adolescent's ED in less commonly investigated areas, such as detection, primary care, impact on parent physical and psychological health, romantic relationship, employment and finances. Findings suggested mixed experiences with health care providers and a very significant toll of the illness on the domains measured. Recommendations were provided for how these important areas can be addressed.

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“…For example, in the UK, there is a focus on early intervention, where an evidence-based model, the First Episode Rapid Early Intervention for Eating Disorders (FREED) has been scaled up in over 80% of adult ED services in the country [ 15 ]. Similarly, Australia has responded by implementing the FREED model in community-based settings [ 16 ], training all primary care mental health providers on ED detection and early treatment, and offering brief interventions to those on waitlists for ED services [ 17 ]. The learnings of where costs could be best routed were essential to these shifts.…”

Section: The Path Forward: Translating Research To Clinical Practicementioning

confidence: 99%

The economic impact of eating disorders in children and youth in Canada: a call to action to improve youth eating disorder research and care

et al. 2023

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The COVID-19 pandemic has led to an unprecedented rise in rates and symptoms of eating disorders among Canadian youth. To date, there is a lack of national surveillance and costing data in Canada to inform policymakers and healthcare leaders on how to best address the surge in new and existing cases. This has resulted in the Canadian healthcare system being unprepared to adequately respond to the increased needs. Therefore, clinicians, researchers, policymakers, decision-makers, and community organizations across Canada are collaborating to compare pre-and post-pandemic costing data from national and province-level healthcare systems in an effort to address this gap. Results from this economic cost analysis will be an important first step in informing and guiding policy on possible adaptations to services to better fulfill the needs of youth with eating disorders in Canada. We highlight how gaps in surveillance and costing data can impact the field of eating disorders in an international context.

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A framework for conceptualising early intervention for eating disorders

Cited by 30 publications

References 116 publications

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Toward a more comprehensive understanding and support of parents with a child experiencing an eating disorder

The economic impact of eating disorders in children and youth in Canada: a call to action to improve youth eating disorder research and care

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