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Cadwallader JS, Orri M, Barry C, Falissard B, Hassler C, Huas C. Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression. J Eat Disord 2023; 11:185. [PMID: 37858179 PMCID: PMC10585727 DOI: 10.1186/s40337-023-00901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND International guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs. METHODS Retrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs. RESULTS 1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP ("during" profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs. CONCLUSIONS Data extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.
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Affiliation(s)
- Jean Sébastien Cadwallader
- School of Medicine, Department of General Practice, Sorbonne Université, Paris, France.
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France.
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Caroline Barry
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Bruno Falissard
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Christine Hassler
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Caroline Huas
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
- Fondation Santé des Etudiants de France (FSEF), Service Hospitalo-Universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte (SAMAJA), Paris, France
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles-Saint-Quentin-en-Yvelines (UVSQ), 78180, Montigny le Bretonneux, France
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2
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Couturier J, Gayowsky A, Findlay S, Webb C, Sami S, Chan A, Chanchlani R, Kurdyak P. A diagnostic subgroup comparison of health care utilization patterns in individuals with eating disorders diagnosed in childhood and/or adolescence. Int J Eat Disord 2023; 56:1919-1930. [PMID: 37449455 DOI: 10.1002/eat.24024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study examined a 2-year period after diagnosis of an eating disorder to compare health care utilization in diagnostic subgroups including: anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified eating disorders (Other). METHOD We conducted a retrospective study of children diagnosed with AN (n = 674), BN (n = 230), BED (n = 59), ARFID (n = 171), and Other (n = 315). We used a general population cohort for comparison, matched 5:1 to the diagnostic subgroups on sex and birth date. We then conducted a separate analysis using the ARFID subgroup as a reference group compared to the other subgroups. Outcomes were determined using data linkage with health administrative databases and included hospitalizations, emergency department, general practitioner, psychiatry, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcome) were calculated. RESULTS Mental health care utilization was higher for all subgroups compared to the general population. When the subgroups were compared to the ARFID subgroup, those with ARFID appeared to have similar health care utilization to the other subgroups, except when compared to those with AN. The AN subgroup had higher odds of a mental health related hospitalization (OR 1.62, 95% CI 1.04-2.5) higher rates of mental health related pediatrician visits (RR 1.76, 95% CI 1.26-2.46) and psychiatry visits (RR 1.69, 95% CI 1.07-2.68). CONCLUSIONS Those with ARFID have similar utilization as other subtypes of eating disorders, except when compared to those with AN who have higher health care utilization. PUBLIC SIGNIFICANCE Our study found that the health service needs of young people with all types of eating disorders are substantially higher than the general population, and it appears that Avoidant/Restrictive Food Intake Disorder (ARFID) has similar health care utilization to other eating disorders.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada
| | | | - Sheri Findlay
- McMaster University, Department of Pediatrics, Hamilton, Ontario, Canada
| | - Cheryl Webb
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sadaf Sami
- McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada
| | - Anthony Chan
- McMaster University, Department of Pediatrics, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- McMaster University, Department of Pediatrics, Hamilton, Ontario, Canada
| | - Paul Kurdyak
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
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3
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Couturier J, Gayowsky A, Findlay S, Webb C, Sami S, Chan AKC, Chanchlani R, Kurdyak P. A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence. Int J Eat Disord 2022; 55:1316-1330. [PMID: 35920409 DOI: 10.1002/eat.23789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined a 2-year period following an eating disorder (ED) diagnosis in order to determine patterns of health care utilization. METHOD We conducted a retrospective cohort study of children (n = 1560) diagnosed with an ED between 2000 and 2017. The ED diagnosis was made at a tertiary level hospital for children and adolescents presenting for outpatient assessment by specialist adolescent medicine physicians and recorded in a program database over this period of time. We then created three sex- and age-matched comparison cohorts using provincial health administrative databases including: a general population cohort, a diabetes cohort (to compare nonmental health care utilization) and a mood disorder cohort (to compare mental health care utilization). Outcomes included hospitalizations, emergency department visits, as well as general practitioner, psychiatrist, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcomes) were calculated. RESULTS Compared to the general population cohort, the ED cohort had higher odds and rates of all types of health care utilization. Compared to the diabetes cohort, the ED cohort had higher odds of nonmental health-related admissions (OR 1.45, 95% CI 1.09-1.95) and higher rates of nonmental health-related emergency department visits (RR 1.59, 95% CI 1.18-2.13). Compared to the mood disorder cohort, the ED cohort had higher rates of pediatrician visits, which were mental health-related (RR 14.88, 95% CI 10.64-20.82), however most other types of mental health service utilization were lower. DISCUSSION These patterns indicate that the service needs of young people diagnosed with EDs are higher than those with diabetes with respect to nonmental health admissions and emergency department visits, while in terms of mental health service utilization, there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits. These findings must be interpreted in the context of under-detection and under-treatment of EDs. PUBLIC SIGNIFICANCE STATEMENT Our study found that the health service needs of young people with EDs are higher than those with diabetes with respect to admissions and emergency department visits, while there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits.
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Affiliation(s)
- Jennifer Couturier
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sheri Findlay
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Webb
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sadaf Sami
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Rohrbach PJ, Dingemans AE, van Furth EF, Spinhoven P, van Ginkel JR, Bauer S, van den Akker‐Van Marle ME. Cost-effectiveness of three internet-based interventions for eating disorders: A randomized controlled trial. Int J Eat Disord 2022; 55:1143-1155. [PMID: 35748112 PMCID: PMC9546196 DOI: 10.1002/eat.23763] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The primary aim was assessing the cost-effectiveness of an internet-based self-help program, expert-patient support, and the combination of both compared to a care-as-usual condition. METHOD An economic evaluation from a societal perspective was conducted alongside a randomized controlled trial. Participants aged 16 or older with at least mild eating disorder symptoms were randomly assigned to four conditions: (1) Featback, an online unguided self-help program, (2) chat or e-mail support from a recovered expert patient, (3) Featback with expert-patient support, and (4) care-as-usual. After a baseline assessment and intervention period of 8 weeks, five online assessments were conducted over 12 months of follow-up. The main result constituted cost-utility acceptability curves with quality-of-life adjusted life years (QALYs) and societal costs over the entire study duration. RESULTS No significant differences between the conditions were found regarding QALYs, health care costs and societal costs. Nonsignificant differences in QALYs were in favor of the Featback conditions and the lowest societal costs per participant were observed in the Featback only condition (€16,741) while the highest costs were seen in the care-as-usual condition (€28,479). The Featback only condition had the highest probability of being efficient compared to the alternatives for all acceptable willingness-to-pay values. DISCUSSION Featback, an internet-based unguided self-help intervention, was likely to be efficient compared to Featback with guidance from an expert patient, guidance alone and a care-as-usual condition. Results suggest that scalable interventions such as Featback may reduce health care costs and help individuals with eating disorders that are currently not reached by other forms of treatment. PUBLIC SIGNIFICANCE STATEMENT Internet-based interventions for eating disorders might reach individuals in society who currently do not receive appropriate treatment at low costs. Featback, an online automated self-help program for eating disorders, was found to improve quality of life slightly while reducing costs for society, compared to a do-nothing approach. Consequently, implementing internet-based interventions such as Featback likely benefits both individuals suffering from an eating disorder and society as a whole.
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Affiliation(s)
- Pieter J. Rohrbach
- GGZ Rivierduinen Eetstoornissen UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | | | - Eric F. van Furth
- GGZ Rivierduinen Eetstoornissen UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | - Philip Spinhoven
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands,Institute of PsychologyLeiden UniversityLeidenNetherlands
| | | | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity of HeidelbergHeidelbergGermany
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5
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Associations between probable eating disorders and healthcare use among post-9/11 veteran men and women. J Psychosom Res 2022; 157:110811. [PMID: 35413512 DOI: 10.1016/j.jpsychores.2022.110811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Healthcare use is elevated among individuals with eating disorders (EDs); however, most people with EDs do not receive ED-specific care, likely due to factors such as the cost and availability of treatment as well as stigma. U.S. military veterans historically have been understudied in ED research. We investigated healthcare use and barriers to care among recently separated veteran men and women. METHOD In this cross-sectional study, 1494 participants completed an online or paper survey assessing ED symptoms, healthcare use, and logistical and attitudinal barriers to care. We estimated logistic regression models to investigate the association of ED status with healthcare use variables and examined gender similarities and differences in barriers to care. RESULTS Men and women with probable EDs reported low rates of ED treatment but greater healthcare use, during military service and since separating from service, compared to veterans without probable EDs (odds ratios = 1.57-7.05). Large proportions of participants reported that they did not know where to get help for EDs and that treatment is too costly. There were few gender differences in barriers to care (Cramer's V = 0.02-0.32). CONCLUSION Veterans reported high healthcare use but low rates of ED treatment. Findings underscore the need to increase the reach and accessibility of ED treatment in potentially vulnerable groups.
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Gómez Del Barrio A, Ruiz Guerrero F, Benito Gonzalez P, Perez Fernandez M, Sanchez Blanco L, Losa Mugica E, Calcedo Giraldo G, González Gómez J. A retrospective investigation of the prodromal stages of eating disorders and use of health services in young patients the year prior to the diagnosis. Early Interv Psychiatry 2022; 16:162-167. [PMID: 33725745 DOI: 10.1111/eip.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/01/2021] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to analyse the characteristics and the frequency of medical consultations in the year prior to the diagnosis and the intervention onset of the Eating Disorder, as well as the different prodromal symptoms. The final aim was to understand the origin of all referrals and their possible influence on the duration of untreated illness. METHODS We selected 99 young patients (15-25 years) and 61 healthy controls. Their primary and specialized care medical records were both studied retrospectively. RESULTS 87.6% of patients attended different consultations (primary care, specialized care and emergency department) the year prior compared to 67.2% of the controls (p = .002). The average number of consultations was 3.59 in the case group and 1.57 in the control group (p < .001). These consultations were related to prodromal symptoms in 57.4% compared to 16.4% for the controls (p < .001). They ranged from 29.8% of unspecific digestive symptoms, 22.8% of psychological symptoms, 19.3% of gynaecologic symptoms, 11.9% of weight variation, 8.8% of analytical changes, to 5.3% of malnutrition symptoms. Patients were mainly referred by Primary Care (42.7%). Overall, the mean of the Duration of Untreated Illness was of 7.45 months. CONCLUSIONS The majority of reasons for consultation were related to symptoms that could be prodromal symptoms, but the patients were not diagnosed with an eating disorder. These findings highlight the importance of professionals understanding how to identify the warning signs of an eating disorder, so they can refer patients to a specialized unit to establish an early treatment.
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Affiliation(s)
- Andrés Gómez Del Barrio
- Eating Disorders Unit, Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental, CIBERSAM, Madrid, Spain.,Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Francisco Ruiz Guerrero
- Eating Disorders Unit, Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Pilar Benito Gonzalez
- Eating Disorders Unit, Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Marta Perez Fernandez
- Eating Disorders Unit, Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | | | - Gabriel Calcedo Giraldo
- Eating Disorders Unit, Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Jana González Gómez
- Eating Disorders Unit, Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain.,Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
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7
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Yan CL, Kao LT, Yeh MK, Chien WC, Yeh CB. Healthcare utilisation for eating disorders among patients with depression: a cross-sectional study in Taiwan. BMJ Open 2019; 9:e032108. [PMID: 31888926 PMCID: PMC6937097 DOI: 10.1136/bmjopen-2019-032108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED. DESIGN A cross-sectional study. SETTING This population-based study used claims data from Taiwan's National Health Insurance Research database between 2001 and 2012. PARTICIPANTS The study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED. OUTCOME MEASURES We tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups. RESULTS Patients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED. CONCLUSION Depression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.
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Affiliation(s)
- Chiu-Lan Yan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry and Keelung branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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8
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Katzman DK, Madden S, Nicholls D, Mawjee K, Norris ML. From questions to answers: Examining the role of pediatric surveillance units in eating disorder research. Int J Eat Disord 2017; 50:259-265. [PMID: 28093801 DOI: 10.1002/eat.22663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 11/09/2022]
Abstract
Pediatric Surveillance Units (PSUs) provide a unique model for the study of pediatric eating disorders (EDs). Australia, Britain, and Canada have surveillance programs that have generated valuable epidemiological and clinical data on early-onset eating disorders (EOED). The PSUs represent an important collaborative tool that has helped shape our understanding of EOEDs and offers potential to contribute to decisions regarding health resource allocation and public health policy. This paper reviews the role of PSUs as a unique model to study pediatric EDs and its success in translating the knowledge generated by these programs into improving the health of children and adolescents with EDs worldwide.
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Affiliation(s)
- Debra K Katzman
- Professor of Pediatrics, Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Senior Associate Scientist, Research Institute, Director, Health Science Research, Undergraduate Medical Education, University of Toronto School of Medicine, Canada
| | - Sloane Madden
- Head of Department, Eating Disorders, The Sydney Children's Hospital Network, Clinical Lecturer, The University of Sydney, Sydney, Australia
| | - Dasha Nicholls
- Feeding and Eating Disorders Service, Great Ormond Street Hospital and Honorary Senior Lecturer, UCL Institute of Child Health, London, United Kingdom
| | - Karizma Mawjee
- Division of Adolescent Medicine, The Hospital for Sick Children, Canada
| | - Mark L Norris
- Associate Professor of Pediatrics, Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO) and the University of Ottawa, Clinical Investigator, CHEO Research Institute, Canada
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9
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de Jong M, Korrelboom K, van der Meer I, Deen M, Hoek HW, Spinhoven P. Effectiveness of enhanced cognitive behavioral therapy (CBT-E) for eating disorders: study protocol for a randomized controlled trial. Trials 2016; 17:573. [PMID: 27914473 PMCID: PMC5135785 DOI: 10.1186/s13063-016-1716-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 11/19/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND While eating disorder not otherwise specified (EDNOS) is the most common eating disorder (ED) diagnosis in routine clinical practice, no specific treatment methods for this diagnosis have yet been developed and studied. Enhanced cognitive behavioral therapy (CBT-E) has been described and put to the test as a transdiagnostic treatment protocol for all EDs, including EDNOS. Initial research in the UK suggests that CBT-E is more effective for EDs, especially bulimia nervosa (BN) and EDNOS, than the earlier version of CBT. These positive results of CBT-E have to be replicated in more detail, preferably by independent researchers in different countries. Being the first Dutch study into CBT-E, the results from this national multicenter study - on three sites specialized in EDs - will deliver important information about the effectiveness of CBT-E in several domains of ED pathology, while providing input for the upcoming update of the Dutch Multidisciplinary Guideline for the Treatment of Eating Disorders. METHODS/DESIGN A multicenter randomized controlled trial will be conducted. One hundred and thirty-two adult outpatients (aged 18 years and older) with an ED diagnosis and a Body Mass index (BMI) of between 17.5 and 40 will be randomly allocated to the control or the intervention group. Subjects in the control group will receive Treatment as Usual (standard outpatient treatment provided at the participating sites). Subjects in the intervention group will receive 20 sessions of CBT-E in 20 weeks. The design is a 2 (group) × 5 (time) repeated measures factorial design in which neither therapists nor patients will be blinded for treatment allocation. The primary outcome measure is recovery from the ED. Secondary outcome measures include ED psychopathology, common mental disorders, anxiety and depressive symptoms, health-related quality of life, health care use and productivity loss. Self-esteem, perfectionism and interpersonal problems will be examined as putative predictors and mediators of the effect of treatment. Also, an economic evaluation from a societal perspective will be undertaken. All relevant effects, direct and indirect costs will be included. Utility scores will measure the effects. Measurements will take place at pretreatment, 6 weeks, 20 weeks, 40 weeks and 80 weeks. DISCUSSION This effectiveness study into CBT-E has the aim of broadening the scope and generalizability of former studies. If CBT-E appears to be at least as effective as traditional diagnosis-specific treatments for a broad range of ED patients, training in one protocol would be sufficient for clinicians to treat patients with different kinds of EDs. It gives the opportunity to offer treatment for a severe mental disorder with fewer resources, thereby increasing the accessibility of specialized care for patients with an ED. TRIAL REGISTRATION Netherlands Trial Register, NTR4485 . Registered on 2 April 2014.
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Affiliation(s)
- Martie de Jong
- Center for Eating Disorders - PsyQ, part of Parnassia Psychiatric Institute, The Hague, The Netherlands.
| | - Kees Korrelboom
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Iris van der Meer
- Center for Eating Disorders - PsyQ, part of Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Leiden University, Institute of Psychology, Methodology and Statistics Unit, Leiden, The Netherlands
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Philip Spinhoven
- Leiden University, Institute of Psychology, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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10
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Cadwallader JS, Godart N, Chastang J, Falissard B, Huas C. Detecting eating disorder patients in a general practice setting: a systematic review of heterogeneous data on clinical outcomes and care trajectories. Eat Weight Disord 2016; 21:365-381. [PMID: 27043947 DOI: 10.1007/s40519-016-0273-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The incidence and prevalence of eating disorders (ED) is low in general practice (GP) settings. Studies in secondary care suggest that the general practitioner has an important role to play in the early detection of patients with EDs. The aim of this study was to describe the effect (clinical outcomes and care trajectory) of screening for EDs among patients in general practice settings. METHODS A systematic review was conducted on Medline, PsycINFO, CINAHL, Embase and WOS. The studies included were to have been carried out in a primary care setting, with screening explicitly performed in GP practices and follow-up information. RESULTS Ten studies met the inclusion criteria. For all ED patients, there was an increase in the frequency of consultations in GP setting, referrals to psychiatric resources and drug prescriptions such as antidepressants, following screening procedures. Clinical outcomes remained unclear and heterogeneous. One study focused on the course and outcome of ED patients identified by screening in the GP setting and reported recovery for anorexia nervosa (AN) and BN in more than half of the cases, after 4.8 years of mean follow-up. In this study, early age at detection predicted better recovery. CONCLUSION Most of the literature on the role of the GP in screening for and managing EDs consists of opinion papers and original studies designed in a secondary care perspective. The impact of systematically screening for EDs in a primary care setting is not clarified and requires further investigation in collaborative cohort studies with a patient-centered approach, and outcomes focused on symptoms.
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Affiliation(s)
- Jean Sébastien Cadwallader
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France.
- Department of General Practice, Faculty of Medicine Pierre and Marie Curie, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
| | - Nathalie Godart
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Julie Chastang
- Department of General Practice, Faculty of Medicine Pierre and Marie Curie, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France
| | - Caroline Huas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Villejuif, France
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Halvorsen TF, Rosvold EO, Rydså BJ, Skarbø T, Haavet OR. Communication about symptoms of eating disorders in the general practitioner surgery. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:2052-6. [PMID: 25387929 DOI: 10.4045/tidsskr.13.1223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND An eating disorder is a complex disease in which the patient subjects his or her body to the various eating disorder symptoms in the absence of other ways of dealing with everyday life. There are seven symptoms of an eating disorder that generally appear in different combinations from one period to another in one and the same patient. Feelings of shame may cause information on symptoms to be withheld. MATERIAL AND METHOD Patients aged 18 and above with serious eating disorders responded anonymously to a questionnaire before entering treatment in two specialist departments. The main focus was on whether the patient had talked with a general practitioner (GP) about relevant eating disorder symptoms and ailments that could be related to the eating disorder. RESULTS Altogether 114 patients participated (of which three were men). A total of 91 (80%) had discussed the eating disorder with their GP during the past year. Of these, 67% of those who had reduced their food intake over the past year had discussed this with their GP. Altogether 68% of those who had vomited and 33% of those who had over-exercised had communicated this. None of the respondents had revealed their use of diuretic or weight-loss drugs to their GP. 85% of respondents stated that the GP must ask specifically about each symptom of an eating disorder in order to reveal these. At least half had discussed the association between current ailments and the eating disorder. A total of 49% had been weighed. INTERPRETATION In order to be able to establish the best possible basis for a medical assessment, the GP should ask specifically about each symptom of an eating disorder.
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Affiliation(s)
- Tori Flaatten Halvorsen
- Seksjon for allmennmedisin Studentsamskipnaden i Oslo - SiO Helse og Spiseforstyrrelsespoliklinikken på Gaustad Seksjon for personlighetspsykiatri Oslo universitetssykehus
| | - Elin Olaug Rosvold
- Avdeling for allmennmedisin Institutt for helse og samfunn Universitetet i Oslo
| | | | - Tove Skarbø
- Regionalt senter for spiseforstyrrelser Nordlandssykehuset Bodø
| | - Ole Rikard Haavet
- Avdeling for allmennmedisin Institutt for helse og samfunn Universitetet i Oslo og Lillestrøm Legesenter
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Waller G, Micali N, James A. General Practitioners are poor at identifying the eating disorders. ACTA ACUST UNITED AC 2014; 2:146-157. [PMID: 24955292 PMCID: PMC4047629 DOI: 10.1080/21662630.2013.859437] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child health, University College London, London, UK
| | - Alison James
- University Health Service, University of Sheffield, Sheffield, UK
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Halvorsen TF, Haavet OR, Rydså BJ, Skarbø T, Rosvold EO. Pasienterfaringer med allmennlegers oppfølging ved alvorlig spiseforstyrrelse. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:2047-51. [DOI: 10.4045/tidsskr.13.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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