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Penwell TE, Bedard SP, Eyre R, Levinson CA. Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers. Psychiatr Serv 2024; 75:944-952. [PMID: 38716514 DOI: 10.1176/appi.ps.20230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Although eating disorders are associated with high rates of psychological and physical impairments and mortality, only about 20% of individuals with eating disorders receive treatment. No study has comprehensively assessed treatment access for those with these disorders in the United States. The authors examined access to eating disorder treatments and how it might vary among some populations. METHODS Seekers of treatment for eating disorders (N=1,995) completed an online assessment of clinical demographic and anthropometric characteristics, barriers to eating disorder treatment access, and eating disorder symptomatology. Analyses were conducted to identify treatment access barriers, compare barriers to treatment access across demographic groups, and investigate relationships between barriers to treatment access and eating disorder symptoms. RESULTS Financial barriers (e.g., lack of insurance coverage) were the most frequently reported barrier to treatment access. Participants with historically underrepresented identities and with a diagnosis of other specified feeding or eating disorder (OSFED) reported more barriers related to financial challenges, geographic location, eating disorder identification, sociocultural factors, and treatment quality compared with those with historically represented identities (e.g., White and cisgender persons). Higher frequencies of reported barriers to treatment access were associated with more severe eating disorder symptoms and poorer illness trajectories. CONCLUSIONS Financial barriers were the most significant impediment to accessing treatment among individuals seeking eating disorder treatment. Barriers to treatment access disproportionally affected underrepresented groups and those with an OSFED diagnosis.
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Affiliation(s)
- Taylor E Penwell
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
| | - Samantha P Bedard
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
| | - Rebecca Eyre
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
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Eating Disorder Screening and Treatment in a Medically Underserved Southern State: Data Collected by a Legislative Eating Disorder Council and Implications for Statewide Assessment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:342-355. [PMID: 36472704 DOI: 10.1007/s10488-022-01240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
Healthcare providers play a key role in early identification of eating disorders (EDs), especially in underserved states where ED treatment resources are lacking. Currently, there is little known about ED screening and treatment practices in underserved states. The current study assessed current ED screening and treatment practices among healthcare providers in an underserved state using data collected by a government-formed state ED council. Healthcare providers (N = 242; n = 209 behavioral health providers; n = 33 medical providers) practicing in Kentucky completed a brief, anonymous survey on ED screening and treatment practices, comfort with screening for EDs, and interest in continued education. Over half of healthcare providers indicated screening for EDs, with the majority using a clinical interview. After identification of ED symptoms, providers reported a combination of treating in-house, referring out, or seeking consultation. In bivariate analyses, medical providers were significantly more likely than behavioral health providers to use a screening tool specifically designed for EDs. The majority of medical providers indicated that they received education about EDs and feel knowledgeable about ED screening tools, though most reported infrequent use of these screening tools in their practice. Nearly all behavioral health and medical providers expressed interest in continuing education on ED screening and treatment. These findings indicate a need for, and interest in, education on evidence-based ED screening and treatment resources in underserved states and demonstrate the utility of a state ED council to collect these data to inform future education and treatment strategies.
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Russon J, Mensinger J, Herres J, Shearer A, Vaughan K, Wang SB, Diamond GS. Identifying Risk Factors for Disordered Eating among Female Youth in Primary Care. Child Psychiatry Hum Dev 2019; 50:727-737. [PMID: 30847634 DOI: 10.1007/s10578-019-00875-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14-24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.
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Affiliation(s)
- Jody Russon
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, USA.
| | - Janell Mensinger
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Joanna Herres
- Psychology Department, The College of New Jersey, Jersey City, NJ, USA
| | - Annie Shearer
- School of Medicine, University of Pittsburgh, Pittsburg, PA, USA
| | - Katherine Vaughan
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Shirley B Wang
- Psychology Department, The College of New Jersey, Jersey City, NJ, USA
| | - Guy S Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
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Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr 2019; 109:1402-1413. [PMID: 31051507 DOI: 10.1093/ajcn/nqy342] [Citation(s) in RCA: 620] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) lead to multiple psychiatric and somatic complications and thus constitute a major public health concern. OBJECTIVES The aim of this study was to give an exhaustive view of the studies reporting the prevalence of the different EDs or total EDs and to study their evolution. METHODS A literature search following PRISMA Guidelines and limited to studies in English or French published between 2000 and 2018 was performed and relevant studies were included in this systematic review on the prevalence of EDs. The literature search revealed 94 studies with accurate ED diagnosis and 27 with broad ED diagnosis. RESULTS In 94 studies with accurate ED diagnosis, the weighted means (ranges) of lifetime ED were 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. The weighted means (ranges) of 12-month ED prevalence were 2.2% (0.8-13.1%) for women and 0.7% (0.3-0.9%) for men. The weighted means (ranges) of point prevalence were 5.7% (0.9-13.5%) for women and 2.2% (0.2-7.3%) for men. According to continents, the weighted means (ranges) of point prevalence were 4.6% (2.0-13.5%) in America, 2.2% (0.2-13.1%) in Europe, and 3.5% (0.6-7.8%) in Asia.In addition to the former, 27 other studies reported the prevalence of EDs as broad categories resulting in weighted means (ranges) of total point prevalence of any EDs of 19.4% (6.5-36.0%) for women and 13.8% (3.6-27.1%) for men. CONCLUSIONS Despite the complexity of integrating all ED prevalence data, the most recent studies confirm that EDs are highly prevalent worldwide, especially in women. Moreover, the weighted means of point ED prevalence increased over the study period from 3.5% for the 2000-2006 period to 7.8% for the 2013-2018 period. This highlights a real challenge for public health and healthcare providers.
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Affiliation(s)
- Marie Galmiche
- TargEDys SA, Rouen, France.,Inserm UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy Rouen University, France.,Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Pierre Déchelotte
- Inserm UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy Rouen University, France.,Department of Nutrition, Rouen University Hospital, Rouen, France
| | | | - Marie Pierre Tavolacci
- Inserm UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy Rouen University, France.,ClC-CRB 1404, Rouen University Hospital, Rouen, France
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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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Weigel A, Rossi M, Wendt H, Neubauer K, von Rad K, Daubmann A, Romer G, Löwe B, Gumz A. Duration of untreated illness and predictors of late treatment initiation in anorexia nervosa. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0642-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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To W, Wong M. Does oligomenorrhoea/amenorrhoea and underweight imply athlete triad syndrome in young female dancers? Eur J Sport Sci 2011. [DOI: 10.1080/17461391.2010.521583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Allen S, Dalton WT. Treatment of eating disorders in primary care: a systematic review. J Health Psychol 2011; 16:1165-76. [PMID: 21459921 DOI: 10.1177/1359105311402244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review evaluated psychological treatments for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder conducted in primary care. Five studies met inclusion criteria. Guided self-help cognitive-behavioral therapy via a self-help book may be a beneficial, first-line treatment for reducing binging and purging symptoms. Outcomes combining self-help with antidepressants remain unclear, although antidepressants alone may provide reduction of symptoms. High attrition and non-compliance rates among studies reviewed indicate the importance of a strong therapeutic alliance between provider and patient. Further research in primary care is needed to develop a standard of care for patients with eating disorders.
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Affiliation(s)
- Suzanne Allen
- East Tennessee State University, Johnson City, TN, USA
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Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. The Female Athlete Triad. Med Sci Sports Exerc 2007; 39:1867-82. [PMID: 17909417 DOI: 10.1249/mss.0b013e318149f111] [Citation(s) in RCA: 573] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The female athlete triad (Triad) refers to the interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis. With proper nutrition, these same relationships promote robust health. Athletes are distributed along a spectrum between health and disease, and those at the pathological end may not exhibit all these clinical conditions simultaneously. Energy availability is defined as dietary energy intake minus exercise energy expenditure. Low energy availability appears to be the factor that impairs reproductive and skeletal health in the Triad, and it may be inadvertent, intentional, or psychopathological. Most effects appear to occur below an energy availability of 30 kcal.kg(-1) of fat-free mass per day. Restrictive eating behaviors practiced by girls and women in sports or physical activities that emphasize leanness are of special concern. For prevention and early intervention, education of athletes, parents, coaches, trainers, judges, and administrators is a priority. Athletes should be assessed for the Triad at the preparticipation physical and/or annual health screening exam, and whenever an athlete presents with any of the Triad's clinical conditions. Sport administrators should also consider rule changes to discourage unhealthy weight loss practices. A multidisciplinary treatment team should include a physician or other health-care professional, a registered dietitian, and, for athletes with eating disorders, a mental health practitioner. Additional valuable team members may include a certified athletic trainer, an exercise physiologist, and the athlete's coach, parents and other family members. The first aim of treatment for any Triad component is to increase energy availability by increasing energy intake and/or reducing exercise energy expenditure. Nutrition counseling and monitoring are sufficient interventions for many athletes, but eating disorders warrant psychotherapy. Athletes with eating disorders should be required to meet established criteria to continue exercising, and their training and competition may need to be modified. No pharmacological agent adequately restores bone loss or corrects metabolic abnormalities that impair health and performance in athletes with functional hypothalamic amenorrhea.
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