Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction

Abstract

Background Despite major research efforts, current recommendations of treatment interventions for adolescents with anorexia nervosa are scarce, and the importance of patient satisfaction for treatment outcome is yet to be established. The overall aim of the present study was to examine treatment interventions and patient satisfaction in a naturalistic sample of adolescents with anorexia nervosa or subthreshold anorexia nervosa and possible associations to outcome defined as being in remission or not at treatment follow-up. Methods Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat). The samples consisted of 1899 patients who were follow-up registered 1 year after entering treatment and 474 patients who had completed a 1-year patient satisfaction questionnaire. A two-step cluster analysis was used for identifying subgroups of patients who received certain combinations and various amounts of treatment forms. Results Patients who received mainly family-based treatment and/or inpatient care were most likely to achieve remission at 1-year follow-up, compared to patients in the other clusters. They were also younger, in general. Individual therapy was the most common treatment form, and was most appreciated among the adolescents. At 1-year follow-up, many patients reported improvements in eating habits, but far fewer reported improvements regarding cognitive symptoms. Overall, the patients rated the therapist relationship in a rather positive way, but they gave quite low ratings to statements associated with their own participation in treatment. Conclusions The results indicate that young adolescents who receive mainly family-based treatment and/or inpatient care respond more rapidly to treatment compared to older adolescents who receive mainly individual therapy or mixed treatment interventions. At 1-year follow-up, the adolescents reported improvements in behavioral symptoms and seemed quite satisfied with the therapist relationship.

From efficacy to effectiveness: child and adolescent eating disorder treatments in the real world (part 1)—treatment course and outcomes

“…It has been shown that in FBT, parent alliance with the therapist is often stronger than that of the young people [ 50 ]. In a recent Swedish cohort study [ 17 ], of young people with AN who predominantly received outpatient treatment (93%), participants were asked to evaluate different aspects of their relationship with their therapist. They highly rated the therapist’s ability to listen and therapist’s knowledge about ED, but rated lower the therapist’s ability to help them, their own participation in treatment and their agreement with the therapist about how treatment should be conducted.…”

“…Participants who ended treatment prematurely (28.8%) had a decreased chance of achieving remission. Furthermore, patients who received family-based treatment and/or inpatient care were most likely to achieve remission at 1-year-follow-up [ 17 ].…”

Transition to Inpatient Telepsychiatry Services and Impact on Quality of Care

“…This report also further supports the utilization of telepsychiatry on an acute eating disorder unit, with patients reporting high levels of satisfaction with telepsychiatry in our program evaluation. In comparison with our results, in a study of in-person inpatient eating disorder treatment, 54% of the patients rated the therapist as understanding their problems “always/very often.”12 In another study that created a validated survey tool to evaluate patient experience and satisfaction with telepsychiatry treatment for anorexia nervosa, the researchers reported that 44% of patients gave a rating of 5/5 or “very satisfied” for comfort in telepsychiatry and 52% rated that they were very satisfied with the psychiatrist’s ability to explain their diagnoses 13. The percentages of patients in our study who reported being “very satisfied” were higher than found in these earlier studies, allowing us to take comfort that quality of care was not impacted during the transition to telepsychiatry.…”

The focus on weight in the inpatient care of anorexia nervosa: A qualitative investigation of consumer perspectives

“…Such dynamics during inpatient admissions are a likely antecedent to poor satisfaction with care, with reported satisfaction scores akin to those experiencing involuntary inpatient treatment (Zugai et al, 2018b). Consumers' poor satisfaction with care must be addressed, as treatment dissatisfaction is liable to increase the risk of premature treatment termination and poor subsequent outcomes (Lindstedt et al, 2020). Notably, consumers' negative appraisals of care are largely related to the focus on physical restoration and outcomes.…”

“…care must be addressed, as treatment dissatisfaction is liable to increase the risk of premature treatment termination and poor subsequent outcomes (Lindstedt et al, 2020). Notably, consumers' negative appraisals of care are largely related to the focus on physical restoration and outcomes.…”