Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Abstract

Objective: This systematic review and meta-analysis examine the contribution of duration to treatment outcome for eating disorders. Method: Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta-analyses, aimed at increasing homogeneity, were conducted. Results: First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r = .05, 95% CI: −.03:.13), with high heterogeneity. Second, we conducted three subgroup analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from .02-.08), with low to medium heterogeneity. Third, two stand-alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of .23/−.06, respectively. High levels of heterogeneity were present. Discussion: Duration did not influence treatment outcome across any of our metaanalyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology. Resumen Antecedentes: Esta revisión sistemática y metaanálisis examinan la contribución de la duración al resultado del tratamiento para los trastornos de la conducta alimentaria. Métodos: Se identificaron estudios (n = 31) que examinaron las asociaciones (r) entre la duración y 45 diferentes resultados. No fue posible extraer r para siete estudios (nueve resultados) y se extrajo r para 36 resultados en 24 estudios (2349 participantes). Los indicadores del resultado del tratamiento fueron heterogéneos y, por lo

Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high‐quality, cost‐effective services?

“…It is a surrogate marker of medical risk approximating to the need to access more intensive forms of treatment but there is uncertainty about its role as a prognostic or stage marker. Duration also has not always been found to be associated with a negative prognosis (Fernández-Aranda et al, 2020;Radunz, Keegan, Osenk, & Wade, 2020). However, in SHARED (multicentre OPD trial in UK) depression in combination with duration was associated with a worse outcome whereas duration alone did not (Ambwani et al, 2020).…”

The impact of duration of illness on treatment nonresponse and drop‐out: Exploring the relevance of enduring eating disorder concept

“…Disorders, fifth edition (DSM-5) and International Classification of Diseases 11th revision (ICD-11) (Ambwani et al, 2020;Krug et al, 2021;Radunz, Keegan, Osenk, & Wade, 2020). Both aspects (severity and enduringness) are dimensional and are not necessarily intercorrelated (Krug et al, 2021).…”

“…Both aspects (severity and enduringness) are dimensional and are not necessarily intercorrelated (Krug et al, 2021). Some studies have reported no relationship between duration of illness and treatment outcome in EDs in general (Radunz et al, 2020), or for specific therapeutic approaches, such as cognitive behaviour therapy (CBT; Raykos, Erceg-Hurn, McEvoy, Fursland, & Waller, 2018), whereas other studies have found that duration of illness is associated with a poor outcome (Austin et al, 2021;Wild et al, 2016).…”

Neuropsychological Learning Deficits as Predictors of Treatment Outcome in Patients with Eating Disorders

“…A recent systematic review regarding the diagnosis prevalence of EDs established that worldwide, around 8.4% of women and 2.2% of men will be diagnosed with this condition at some point in their lifetime [ 6 ]. The main treatments for EDs, which are based on cognitive–behavioral therapy (CBT), have been demonstrated to be useful in reducing symptoms [ 7 , 8 ]; however, these current treatments have not always reported successful outcomes [ 9 , 10 , 11 , 12 ].…”