Clinical and socio-demographic characteristics of university students referred to an eating disorders service

Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa-A Retrospective Chart Review

BACKGROUND

The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years.

METHODS

The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting.

RESULTS

We included 1001 girls (aged 12-17.9 years) and 1371 women (aged 18-73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m2 (SD = 1.43; range 10.67-18.47) in adolescents and 14.63 kg/m2 (SD = 2.02; range 8.28-18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m2. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; p = 2.4 × 10-4). In adults, BMI was not correlated with age (r = -0.03; p = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = -0.35; p < 0.001 and r = -0.09; p = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; p < 0.001) and adolescent (r = 0.09 p = 0.005) patients and we detected no evidence for stunting.

CONCLUSIONS

In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m2. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.

Transitions from child and adolescent to adult mental health services for eating disorders: an in-depth systematic review and development of a transition framework

BACKGROUND

Eating disorders (EDs) peak in mid-to-late adolescence and often persist into adulthood. Given their early onset and chronicity, many patients transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) for ongoing, speciality ED care. This transition typically occurs at 18 years of age, when important biological, psychosocial, and vocational changes take place. Thus, smooth and effective transitions are paramount for ensuring service continuity, as well as reducing the risk of ED relapse and premature death. Here, we synthesized evidence on transitions from CAMHS to AMHS for young people with EDs, aiming to inform future research, clinical practice, and healthcare policy.

METHODS

A systematic review of the literature was conducted. This adhered to PRISMA guidelines. PubMed, Embase, and Scopus electronic databases were queried from inception to December 3, 2023. Leveraging the PICOS framework, study eligibility was evaluated in the qualitative synthesis. Data regarding methodology, analytic approach, and associated outcomes were then extracted. The quality of evidence was examined using critical appraisal tools. Finally, concept mapping was applied to organize findings into a transition framework.

RESULTS

The search returned 76 articles. Of these, 14 were included in the final review. Articles were grouped into 'qualitative' (n = 10), 'cross-sectional' (n = 2), and 'longitudinal cohort' (n = 2) studies based on research design. Overall, ED transitions were complex, multifaceted, and challenging for patients, caregivers, and providers alike. This resulted from an interplay of temporal- (e.g., timing of ED onset and transition), stakeholder- (e.g., patient ambivalence towards recovery) and systemic- (e.g., differences between services) related factors. Most studies were of moderate-to-high quality. Findings informed the development of five transition strategies designed to facilitate effective transfers across ED care: Timely talks, Readiness, Inclusion, Preparation, and Synergy (TRIPS).

CONCLUSIONS

Transitions from CAMHS to AMHS appear problematic for young people with EDs and other involved stakeholders. The field stands to benefit from TRIPS, an actionable, evidence-based framework that aims to alleviate challenges of transitioning and subsequently improve ED trajectories. As a logical next step, future work should empirically test the TRIPS framework, exploring its predictive utility and clinical value.

Implementation of an all-age eating disorders service in the National health service in England: The Dorset experience

This article provides a commentary on the development of an integrated all-age eating disorders service in the Eating disorders service within the NHS in Dorset. Previously separate services existed for those under the age of 18 and those age 18 and over. The change from traditional age based services to the all age service was prompted by the observed problems with transitions for patients, their families and the service such as discontinuities in care, and distress to patients and families. In addition the literature on transitions although limited in eating disorders showed that patient and carer perspectives were mostly negative about transitions. The aim was to create an all-age service working with patients of different ages, through developing the competencies of the team to appropriately meet the needs of the all age population. This paper describes the context and rationale for this change, its implementation using the organisational change policy approach to service transformation, including addressing the concerns of the stakeholders (patients, carers, staff, and mental health service commissioners), as well as observed changes in the service and its development. Since the all-age service started in 2016, new research has become available on both the improvement of the transition experience and the potential advantages of all-age services and relevant aspects are discussed.

Impending Transition From Pediatric to Adult Health Services: A Qualitative Study of the Experiences of Adolescents With Eating Disorders and Their Caregivers

Background: There is a dearth of research that identifies pediatric to adult health care transition practices that yield positive outcomes for young people with eating disorders (EDs). Further, adolescent and caregiver perspectives are poorly understood and underrepresented in the literature. The purpose of this study, focused on the impending transition from pediatric to adult health services, was twofold: (a) to identify adolescent and caregiver perspectives of barriers and facilitators of a successful transition for adolescents with EDs; and (b) to understand adolescent and caregiver suggestions of interventions for a successful transition. Design/Method: We recruited five adolescents with EDs who were about to be transferred out of pediatric care as well as their caregivers. We conducted a qualitative study in accordance with the principles of interpretive description. Through conducting semi-structured, in-depth interviews with adolescents and caregivers, we investigated their knowledge about health system transitions and anticipated experiences. We identified participants' perceptions of barriers and facilitators regarding a successful transition, as well as their recommendations to improve the transfer of care. Results: Participants possessed a limited understanding of transition processes despite the fact that they were about to be transferred to adult care. From our analyses, the following themes were identified as barriers during the transition process: re-explaining information to adult healthcare providers, lack of professional support while waiting for uptake into the adult health system, and late timing of transition of care discussions. Both adolescents and caregivers expressed that involvement of parents and the pediatric healthcare team helped to facilitate a successful transfer of care. In addition, participants expressed that the implementation of a Transition Coordinator and Transition Passport would be helpful in facilitating a seamless transfer between systems of care. Discussion: These findings demonstrate a significant gap in the system and highlight the importance of developing interventions that facilitate a successful transition. The themes that emerged from this study can inform the development of interventions to facilitate a coordinated transition from pediatric to adult health services for adolescents with EDs.

Sociodemographic and clinical characteristics of eating disorder patients treated in the specialized residential settings in Belgium

INTRODUCTION

Epidemiologic information on sociodemographic and clinical characteristics in eating disorders in Western European countries are scarce.

PURPOSE

In this study, we report demographic and clinical characteristics of eating disorder (ED) patients undergoing treatment in five specialized ED centers in Flanders (Belgium).

METHOD

Data from 642 ED patients were collected by means of a structured questionnaire.

RESULTS

Data show that 93.8% of patients are female, with an average age of 22.6 years. The largest subgroup in our sample suffers from anorexia nervosa, namely 52.8%. Bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) account for 17.7%, 10.7% and 18.8% of the sample, respectively. Mean age of onset was 17 years. Mean duration of illness was 5.6 years, but 20.2% of patients had their illness for over 8 years. Anorexia nervosa patients of the restricting type (AN-R) have the shortest duration of illness. BED patients stood out because they were older on average, more often in a relationship and more often in ambulatory treatment. 70% of patients over 20 years old completed higher education, but one-third of this group was unemployed and/or disabled. Remarkably, ED patients grow more up in intact families compared to the general population.

CONCLUSIONS

Epidemiology of ED patients in treatment in Flanders (Belgium) seems to resemble worldwide findings. The long duration of illness, the common evolution towards chronicity and the early work impairment underline the severe personal and societal impact of ED and call to the need for early detection and treatment of these patients.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

Defining and predicting service utilisation in young adulthood following childhood treatment of an eating disorder

BACKGROUND

Eating disorder services are often separated into child and adolescent eating disorder services (CAEDSs) and adult eating disorder services (AEDSs). Most patients in CAEDSs present with first-episode illness of short duration, which with appropriate treatment, have a good prognosis. However, some individuals receive further treatment as adults. Little is known about service utilisation in adulthood following childhood/adolescent treatment of an eating disorder.

AIMS

This study aims (a) to estimate the proportion of patients in a CAEDS who use mental health services as young adults, (b) to delineate service utilisation following treatment in CAEDSs and (c) to identify factors in CAEDSs that predict service utilisation in young adulthood.

METHOD

A consecutive cohort of 322 patients (aged 13-17 years) seen in a CAEDS in the UK over a 5-year period were included in this audit. Data regarding their use of UK-wide adult mental health services as young adults (i.e. when aged 18-25) were extracted from local and national hospital records.

RESULTS

A total of 68.3% of CAEDS patients received no mental health treatment as young adults. Although 13% of people seen in a CAEDS had brief eating disorder treatment as young adults, 10% received longer/or more intensive eating disorder treatment. Overall, 10.8% transitioned directly to an AEDS and 7.6% were re-referred following discharge from CAEDS. In our sample, older age and increased use of CAEDSs predicted increased eating disorder treatment in young adulthood.

CONCLUSIONS

Our results indicate that most people seen in CAEDSs do not receive further mental health treatment as young adults. Several features in CAEDSs distinguish mental health service utilisation in young adulthood, which were identified clinically and could be targeted during treatment.

A qualitative study on the experiences of young adults with eating disorders transferring from pediatric to adult care

The study's objective was to identify systemic facilitators and barriers of transferring young adults (ages 17-21) with eating disorders from pediatric to adult health and mental health services. Qualitative interviews were conducted and three themes emerged: (a) difficulties navigating care during the transfer period; (b) challenges achieving and maintaining recovery due to systemic barriers after the transfer of care;and (c) recommendations for facilitating the transfer between systems of care. From the perspective of young adults with eating disorders our study shows that the transition to adult care services may be improved with increased coordination, communication, and collaborative partnerships between pediatric and adult providers.

How Black women make sense of ‘White’ and ‘Black’ fashion magazines: A qualitative think aloud study

This qualitative think aloud study explored how Black women ( n = 32) processed information from a White or Black fashion magazine. Comments to the ‘White’ magazine were characterised by rejection, being critical of the media and ambivalence, whereas they responded to the ‘Black’ magazine with celebration, identification and a search for depth. Transcending these themes was their self-identity of being a Black woman that was brought to the fore either by a sense of exclusion (White magazine) or engagement (Black magazine). Such an identity provides resilience against the media’s thin ideals by minimising the processes of social comparison and internalisation.

[The relationship between eating disorders and parent-adolescent communication in middle school students in rural areas]

PURPOSE

The purpose of this study was to examine the relationship between eating disorders and parent-adolescent communication in middle school students.

METHOD

There were 267 adolescents taken as participants from two middle schools in rural areas. Data were collected from June to July 2005, using the Eating Disorder Inventory-2 questionnaire (23 items) and Parent-Adolescent Communication Inventory (10 items for open family communication, 10 items for problem in family communication). The SPSS Win version 12.0 was used for descriptive analysis, t-test, and partial correlation coefficient.

RESULT

The mean score on the eating disorder was 2.74 (range: 1-6). Meanwhile, the mean scores on the parent-adolescent communication was 3.37 (range: 1-5). There were significant differences in eating disorders according to gender, age, negative perception of the participant's body weight, family's perception of obesity, diet experiences, and BMI. Eating disorders showed a significant negative correlation with parent-adolescent communication.

CONCLUSION

In this study, there was a significant negative correlation between eating disorders and parent-adolescent communication. In order to prevent an eating disorder, education and training to enhance communication skills should be provided to adolescents and their parents as well.

Treating young people with eating disorders: transition from child mental health to specialist adult eating disorder services

BACKGROUND

The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) of young people with eating disorders may pose a number of difficulties, including an inconsistent referral process and age boundaries.

METHODS

We compared young adults referred to a specialist Adult Eating Disorders Service (AEDS) who had previous involvement with CAMHS for the treatment of their eating disorder with those who did not. Information regarding the socio-demographic characteristics and eating disorders symptomatology of patients assessed by an AEDS over a 4-year period was collected.

RESULTS

Patients who had previous involvement with CAMHS (particularly the ones treated as in-patients) presented with a lower self-esteem and more maturity fears (MF) than those without previous involvement.

CONCLUSIONS

This study discusses the implication of these results in transitional arrangements between CAMHS and Adult services. It also highlights the need for heightened awareness of particular issues of self-esteem and maturation in these patients moving between services.