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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [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: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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Hyam L, Yeadon-Ray O, Richards K, Semple A, Allen K, Owens J, Jackson A, Semple L, Glennon D, Di Clemente G, Griffiths J, Mills R, Schmidt U. "FREED instils a bit of hope in the eating disorder community… that things can change.": an investigation of clinician views on implementation facilitators and challenges from the rapid scaling of the First Episode Rapid Early Intervention for Eating Disorders programme. Front Psychiatry 2024; 15:1327328. [PMID: 38596636 PMCID: PMC11002146 DOI: 10.3389/fpsyt.2024.1327328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction First Episode Rapid Early Intervention for Eating Disorders (FREED) is the leading eating disorder (ED) early intervention model for young people. Research has shown that it reduces the duration of untreated illness, improves clinical outcomes, and has cost savings. However, less is known about the experience of implementing FREED. This study aimed to investigate the views and experiences of adopting, implementing, and sustaining FREED from the perspective of clinical staff. Methods Seven focus groups were conducted involving 26 clinicians. Thematic analysis was used, with the Non-Adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability (The NASSS framework) framework being applied to organise subthemes and determine facilitators and barriers. The NASSS framework was also used to rate the complexity of themes as either simple (straightforward, predictable, few components), complicated (multiple interrelating components), or complex (dynamic, unpredictable, not easily divisible into constituent components). Results There were 16 subthemes identified under seven broader themes representing each domain of the NASSS framework. Key barriers and areas of complexity included factors related to EDs as an illness (e.g., high acuity and prevalence), and organisational complexity (e.g., staffing shortages, lack of managerial/team support). Key facilitators included positive clinician/adopter attitudes, a supportive national network, and the ability for FREED to be flexible/adaptable over time. Conclusion The FREED model appears to be desirable to clinical staff. Wider team and managerial support was perceived to be particularly important to its successful implementation, as were the national network and supervision. Key areas of complexity include staffing issues and high ED acuity/prevalence. These barriers to implementation need to be managed and investment continued to expand and improve early intervention for EDs further.
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Affiliation(s)
- Lucy Hyam
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Olivia Yeadon-Ray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Katie Richards
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Semple
- Health Innovation Network, Academic Health Science Network, London, United Kingdom
| | - Karina Allen
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Eating Disorders Outpatient Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jill Owens
- Health Innovation Network, Academic Health Science Network, London, United Kingdom
| | - Aileen Jackson
- Health Innovation Network, Academic Health Science Network, London, United Kingdom
| | - Laura Semple
- The Academic Health Science Network, Hosted by Manchester Foundation Trust, London, United Kingdom
| | - Danielle Glennon
- Eating Disorders Outpatient Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Giulia Di Clemente
- Eating Disorders Outpatient Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jess Griffiths
- Eating Disorders Outpatient Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Regan Mills
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Eating Disorders Outpatient Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
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3
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Daugelat MC, Pruccoli J, Schag K, Giel KE. Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives. EUROPEAN EATING DISORDERS REVIEW 2023; 31:752-768. [PMID: 37352132 DOI: 10.1002/erv.2999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals. METHOD This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies. RESULTS A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking. DISCUSSION Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.
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Affiliation(s)
- Melissa-Claire Daugelat
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
| | - Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, Pediatric Neuropsychiatry Unit, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
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Giacomini G, Elhadidy HSMA, Paladini G, Onorati R, Sciurpa E, Gianino MM, Borraccino A. Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192012988. [PMID: 36293569 PMCID: PMC9602016 DOI: 10.3390/ijerph192012988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 05/08/2023]
Abstract
Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual's well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people's mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs' hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ to 22.2‱). Significant hospitalization rate increases were observed both in 15-19 and in 10-14 females' age groups in 2021. Non-significant increases were observed in all males' age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.
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Affiliation(s)
- Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | | | - Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Piedmont Region, 10195 Grugliasco, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
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Goh AQY, Lo NYW, Davis C, Chew ECS. #EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram. Eat Weight Disord 2022; 27:1535-1545. [PMID: 34537927 DOI: 10.1007/s40519-021-01279-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Limited research has evaluated the role of Social Networking Sites (SNS) in eating disorder (ED) recovery. While research has demonstrated the deleterious effects of pro-ED SNS content, less is known regarding SNS content documenting ED recovery. This study evaluates orientation towards help-seeking, ongoing ED warning signs and recovery themes on ED recovery SNS hashtags. METHODS 600 Instagram posts were retrieved from two popular hashtags: #EDrecovery and #EatingDisorderRecovery. They were categorized into four thematic concerns: Food, Quotes, People or Others. Posts were analysed for behavioural and psychological signs of ED based on the Mental Health First Aid Eating Disorders Guidelines, and whether they encouraged seeking professional help. Thematic qualitative analysis to evaluate themes posted on recovery hashtags was conducted. RESULTS Of the 600 posts, 405 were used for analysis. The majority of posts were on Food (49.6%), Quotes (24.2%) and People (22.7%). Behavioural and psychological signs suggestive of EDs were present in 18.0% and 22.5% of images, respectively. Only 9.4% of posts encouraged seeking professional help. Important themes that emerged from the qualitative analysis included the recovery journey, increased awareness and stigma for EDs and the development of a supportive community. CONCLUSIONS Despite identifying with ED recovery, posts had a high prevalence of ongoing ED behaviour and low prevalence of help-seeking. Thematic analysis emphasized the role of recovery as a journey and the role of stigma and community in recovery. These findings suggest that SNSs could potentially be leveraged as a platform to improve help-seeking and encourage recovery for users with eating disorders. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Aaron Qi Yang Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore, 308232, Singapore
| | - Nicholas Yong Wai Lo
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore, 308232, Singapore
| | - Courtney Davis
- Adolescent Medicine Service, Department of Paediatrics, KK Women & Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore
| | - Elaine Chu Shan Chew
- Adolescent Medicine Service, Department of Paediatrics, KK Women & Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
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Nicula M, Pellegrini D, Grennan L, Bhatnagar N, McVey G, Couturier J. Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review. J Eat Disord 2022; 10:21. [PMID: 35164872 PMCID: PMC8845232 DOI: 10.1186/s40337-022-00543-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier. METHODS Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18-25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review. RESULTS Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns. CONCLUSIONS The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone-like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.
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Affiliation(s)
- Maria Nicula
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | | | - Laura Grennan
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Neera Bhatnagar
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Gail McVey
- University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Jennifer Couturier
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada. .,McMaster Children's Hospital, Hamilton, ON, Canada.
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7
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Grilo CM, Udo T. Examining the significance of age of onset in persons with lifetime anorexia nervosa: Comparing child, adolescent, and emerging adult onsets in nationally representative U.S. study. Int J Eat Disord 2021; 54:1632-1640. [PMID: 34263464 PMCID: PMC8416938 DOI: 10.1002/eat.23580] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study compared sociodemographic and clinical profiles of adult patients with lifetime DSM-5-defined anorexia nervosa (AN) categorized by age-of-onset using data from U.S. national sample of adults. METHOD Study included 216 participants from Third National Epidemiological Survey Alcohol and Related Conditions (NESARC-III) who met criteria for lifetime AN based on structured diagnostic interviews (AUDADIS-5) with age-of-onset prior to age 25. Of the 216 participants, 30 were categorized as child-onset (<15 years old), 104 adolescent-onset (15-18 years of age), and 82 "emerging-adult" (19-24 years of age); the three groups were compared on their clinical characteristics. RESULTS Among participants with lifetime diagnoses of AN with onsets earlier than 25 years, adjusted prevalence rates for the three groups were: 11.8% (SE = 2.04; child-onset), 39.6% (SE = 2.69; adolescent-onset), and 48.6% (SE = 2.67; emerging-adult). Child-onset group reported more frequent adverse childhood experiences (ACEs), lowest BMI, longest episode-duration, was least likely to attend college, and had highest rate of lifetime psychiatric comorbidity. Child-onset group had earliest age of help-seeking and were most likely to have been hospitalized. Group differences persisted in analyses adjusting for sociodemographic characteristics and duration of AN episode. DISCUSSION Our findings, based on a nationally representative sample of U.S. adults with lifetime diagnoses of AN, suggest that those with child-onset had more severe AN, greater life difficulties, and greater lifetime psychiatric comorbidity. Findings emphasize the importance of earlier recognition and rapid referral to effective treatments.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York
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Richards KL, Flynn M, Austin A, Lang K, Allen KL, Bassi R, Brady G, Brown A, Connan F, Franklin-Smith M, Glennon D, Grant N, Jones WR, Kali K, Koskina A, Mahony K, Mountford VA, Nunes N, Schelhase M, Serpell L, Schmidt U. Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model. BJPsych Open 2021; 7:e98. [PMID: 33958020 PMCID: PMC8142541 DOI: 10.1192/bjo.2021.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package. AIMS This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study. METHOD Participants were 259 emerging adults (aged 16-25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined. RESULTS There were significant increases (16-40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used. CONCLUSIONS This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination.
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Affiliation(s)
- Katie L Richards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Amelia Austin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katie Lang
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Karina L Allen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
| | - Ranjeet Bassi
- Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
| | - Gabrielle Brady
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, UK
| | - Amy Brown
- Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
| | - Frances Connan
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, UK
| | - Mary Franklin-Smith
- Eating Disorder Service, Leeds and York Partnership NHS Foundation Trust, UK
| | - Danielle Glennon
- Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
| | - Nina Grant
- Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
| | - William Rhys Jones
- Eating Disorder Service, Leeds and York Partnership NHS Foundation Trust, UK
| | - Kuda Kali
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, UK
| | - Antonia Koskina
- Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
| | - Kate Mahony
- Eating Disorder Service, North East London NHS Foundation Trust, UK
| | - Victoria A Mountford
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK; and Maudsley Health Eating Disorder Service, Maudsley Health, United Arab Emirates
| | - Nicole Nunes
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, UK
| | - Monique Schelhase
- Eating Disorder Service, Leeds and York Partnership NHS Foundation Trust, UK
| | - Lucy Serpell
- Eating Disorder Service, North East London NHS Foundation Trust, UK; and Division of Psychology and Language Sciences, University College London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK
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9
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Kästner D, Weigel A, Buchholz I, Voderholzer U, Löwe B, Gumz A. Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals. J Eat Disord 2021; 9:28. [PMID: 33640028 PMCID: PMC7913310 DOI: 10.1186/s40337-021-00381-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed. OBJECTIVE Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach. METHOD To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis. RESULTS In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were 'recognizing and addressing' by close others, 'waiting times and availability' and 'recommendations and referrals' by health care professionals. 'Positive role models for treatment' were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability. CONCLUSION Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03713541 .
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Affiliation(s)
- Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany.
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Ines Buchholz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
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Potterton R, Austin A, Flynn M, Allen K, Lawrence V, Mountford V, Glennon D, Grant N, Brown A, Franklin-Smith M, Schelhase M, Jones WR, Brady G, Nunes N, Connan F, Mahony K, Serpell L, Schmidt U. "I'm truly free from my eating disorder": Emerging adults' experiences of FREED, an early intervention service model and care pathway for eating disorders. J Eat Disord 2021; 9:3. [PMID: 33407906 PMCID: PMC7789709 DOI: 10.1186/s40337-020-00354-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) typically start during adolescence or emerging adulthood, periods of intense biopsychosocial development. FREED (First Episode Rapid Early Intervention for EDs) is a service model and care pathway providing rapid access to developmentally-informed care for emerging adults with EDs. FREED is associated with reduced duration of untreated eating disorder and improved clinical outcomes, but patients' experiences of treatment have yet to be assessed. OBJECTIVE This study aimed to assess emerging adults' experiences of receiving treatment through FREED. METHOD This study triangulated qualitative data on participants' experiences of FREED treatment from questionnaires and semi-structured interviews. Participants were 106 emerging adults (aged 16-25; illness duration < 3 yrs) (questionnaire only = 92; interview only = 6; both = 8). Data were analysed thematically. RESULTS Most participants reported psychological and behavioural changes over the course of treatment (e.g. reduction in symptoms; increased acceptance and understanding of difficulties). Participants identified five beneficial characteristics of FREED treatment: i) rapid access to treatment; ii) knowledgeable and concerned clinicians; iii) focusing on life beyond the eating disorder; iv) building a support network; v) becoming your own therapist. CONCLUSION This study provides further supports for the implementation of early intervention and developmentally-informed care for EDs. Future service model development should include efforts to increase early help-seeking.
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Affiliation(s)
- Rachel Potterton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Amelia Austin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michaela Flynn
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karina Allen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria Mountford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | | | - Nina Grant
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Amy Brown
- South London and Maudsley NHS Foundation Trust, London, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | | | | | | | - Gabrielle Brady
- Central and North West London NHS Foundation Trust, London, UK
| | - Nicole Nunes
- Central and North West London NHS Foundation Trust, London, UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust, London, UK
| | - Kate Mahony
- North East London NHS Foundation Trust, London, UK
| | - Lucy Serpell
- North East London NHS Foundation Trust, London, UK.,Division of Psychology and Language Sciences, University College London, London, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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11
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Flynn M, Austin A, Lang K, Allen K, Bassi R, Brady G, Brown A, Connan F, Franklin-Smith M, Glennon D, Grant N, Jones WR, Kali K, Koskina A, Mahony K, Mountford V, Nunes N, Schelhase M, Serpell L, Schmidt U. Assessing the impact of First Episode Rapid Early Intervention for Eating Disorders on duration of untreated eating disorder: A multi-centre quasi-experimental study. EUROPEAN EATING DISORDERS REVIEW 2020; 29:458-471. [PMID: 33112472 DOI: 10.1002/erv.2797] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/07/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Duration of untreated eating disorder (DUED), that is, the time between illness onset and start of first evidence-based treatment, is a key outcome for early intervention. Internationally, reported DUED ranges from 2.5 to 6 years for different eating disorders (EDs). To shorten DUED, we developed FREED (First Episode Rapid Early Intervention for EDs), a service model and care pathway for emerging adults with EDs. Here, we assess the impact of FREED on DUED in a multi-centre study using a quasi-experimental design. METHODS Two hundred and seventy-eight patients aged 16-25, with first episode illness of less than 3 years duration, were recruited from specialist ED services and offered treatment via FREED. These were compared to 224 patients, of similar age and illness duration, seen previously in participating services (treatment as usual [TAU]) on DUED, waiting times and treatment uptake. RESULTS FREED patients had significantly shorter DUED and waiting times than TAU patients. On average, DUED was reduced by ∼4 months when systemic delays were minimal. Furthermore, 97.8% of FREED patients took up treatment, versus 75.4% of TAU. DISCUSSION Findings indicate that FREED significantly improves access to treatment for emerging adults with first episode ED. FREED may reduce distress, prevent deterioration and facilitate recovery.
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Affiliation(s)
- Michaela Flynn
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Amelia Austin
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Katie Lang
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Karina Allen
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ranjeet Bassi
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gabrielle Brady
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, London, UK
| | - Amy Brown
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Frances Connan
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, London, UK
| | - Mary Franklin-Smith
- Eating Disorder Service, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Danielle Glennon
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nina Grant
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - William Rhys Jones
- Eating Disorder Service, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kuda Kali
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, London, UK
| | - Antonia Koskina
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Mahony
- Eating Disorder Service, North East London NHS Foundation Trust, Rainham, UK
| | - Victoria Mountford
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Nicole Nunes
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, London, UK
| | - Monique Schelhase
- Eating Disorder Service, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Lucy Serpell
- Eating Disorder Service, North East London NHS Foundation Trust, Rainham, UK.,Division of Psychology and Language Sciences, University College London, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, London, UK
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