1
|
Hail L, Drury CR, McGrath RE, Murray SB, Hughes EK, Sawyer SM, Le Grange D, Loeb KL. Parent version of the Eating Disorder Examination: Reliability and validity in a treatment-seeking sample. J Eat Disord 2024; 12:101. [PMID: 39026364 DOI: 10.1186/s40337-024-01062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Assessment of eating disorders (ED) in youth relies heavily on self-report, yet persistent lack of recognition of the presence and/or seriousness of symptoms can be intrinsic to ED. This study examines the psychometric properties of a semi-structured interview, the parent version of the Eating Disorder Examination (PEDE), developed to systematically assess caregiver report of symptoms. METHODS A multi-site, clinical sample of youth (N = 522; age range: 12 to 18 years) seeking treatment for anorexia nervosa (AN) and subsyndromal AN were assessed using the Eating Disorder Examination (EDE) for youth and the PEDE for collateral caregiver report. RESULTS Internal consistencies of the four PEDE subscales were on par with established ranges for the EDE. Significant medium-sized correlations and poor to moderate levels of agreement were found between the corresponding subscales on each measure. For the PEDE, confirmatory factor analysis of the EDE four-factor model provided a poor fit; an exploratory factor analysis indicated that a 3-factor model better fits the PEDE. CONCLUSIONS Findings suggest that the PEDE has psychometric properties on par with the original EDE. The addition of the caregiver perspective may provide incremental information that can aid in the assessment of AN in youth. Future research is warranted to establish psychometric properties of the PEDE in broader transdiagnostic ED samples.
Collapse
Affiliation(s)
- Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA
| | - Catherine R Drury
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA.
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA.
| | - Robert E McGrath
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth K Hughes
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience (emeritus), The University of Chicago, Chicago, IL, USA
| | - Katharine L Loeb
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
- Chicago Center for Evidence-Based Treatment, Chicago, IL, USA
| |
Collapse
|
2
|
Rodgers RF, Gordon AR, Burke NL, Ciao A. Parents and caregivers as key players in the prevention and identification of body image concerns and eating disorders among early adolescents. Eat Disord 2024:1-24. [PMID: 38913912 DOI: 10.1080/10640266.2024.2366546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Early adolescence (ages 11-14 years) is a key period for the emergence of body image and eating concerns, and early identification and access to treatment are imperative for positive outcomes. Despite research identifying this critical developmental period, few prevention resources are available for early adolescents. Parents are key players for this age group and important socializing agents. As such, they are well positioned to help youth access resources or support where needed. However, programs to position and involve parents as interventionists are lacking. Our aims are two-fold. First, we review the evidence for the effectiveness of parents as body image interventionists and the existing data regarding parental needs. Second, we provide directions for future research and outline a framework for empowering parents as interventionists, identifying key domains in which parents may play a role in addressing body image and eating concerns among early adolescents. Based on the extent literature, these domains include facilitating engagement with or co-utilizing intervention content to decrease body image and eating concerns in at-risk children, which may also help to increase parents' effectiveness in their efforts to support youth. In addition, parents may deliver content to decrease or reverse risk-factors and early symptoms, or disrupt the early disorder phase of illness. To date, parents constitute an underutilized resource in eating disorder and disordered eating prevention, and efforts should be made to increase the evidence-based strategies to leverage their relationship with at-risk children.
Collapse
Affiliation(s)
- Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Anna Ciao
- Department of Psychology, Western Washington University, Bellingham, Washington, USA
| |
Collapse
|
3
|
İnce B, Phillips MD, Zenasni Z, Shearer J, Dalton B, Irish M, Mercado D, Webb H, McCombie C, Au K, Kern N, Clark-Stone S, Connan F, Johnston AL, Lazarova S, Zadeh E, Newell C, Pathan T, Wales J, Cashmore R, Marshall S, Arcelus J, Robinson P, Byford S, Landau S, Lawrence V, Himmerich H, Treasure J, Schmidt U. Autopsy of a failed trial part 2: Outcomes, challenges, and lessons learnt from the DAISIES trial. EUROPEAN EATING DISORDERS REVIEW 2024; 32:476-489. [PMID: 38109218 DOI: 10.1002/erv.3058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The relative merits of inpatient or day-treatment for adults with anorexia nervosa (AN) are unknown. The DAISIES trial aimed to establish the non-inferiority of a stepped-care day patient treatment (DPT) approach versus inpatient treatment as usual (IP-TAU) for improving body mass index (BMI) at 12 months in adults with AN. The trial was terminated due to poor recruitment. This paper presents outcomes and investigates the reasons behind the trial's failure. METHOD Fifteen patients with AN (of 53 approached) participated and were followed-up to 6 or 12 months. Summary statistics were calculated due to low sample size, and qualitative data concerning treatment experiences were analysed using thematic analysis. RESULTS At baseline, participants in both trial arms rated stepped-care DPT as more acceptable. At 12 months, participants' BMIs had increased in both trial arms. Qualitative analysis highlighted valued and challenging aspects of care across settings. Only 6/12 sites opened for recruitment. Among patients approached, the most common reason for declining participation was their treatment preference (n = 12/38). CONCLUSIONS No conclusions can be drawn concerning the effectiveness of IP-TAU and stepped-care DPT, but the latter was perceived more positively. Patient-related, service-related and systemic factors (COVID-19) contributed to the trial's failure. Lessons learnt can inform future studies.
Collapse
Affiliation(s)
- Başak İnce
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Matthew D Phillips
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Zohra Zenasni
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - James Shearer
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Bethan Dalton
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Madeleine Irish
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Daniela Mercado
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hannah Webb
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Catherine McCombie
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nikola Kern
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Clark-Stone
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Ewa Zadeh
- South West London and St George's Mental Health NHS Trust, London, UK
| | - Ciarán Newell
- Dorset HealthCare University NHS Foundation Trust, Poole, UK
| | - Tayeem Pathan
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Jackie Wales
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Rebecca Cashmore
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Sandra Marshall
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Barcelona, Spain
| | - Paul Robinson
- Division of Medicine, University College London, London, UK
| | - Sarah Byford
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Lebow J, Sim L, Redmond S, Billings M, Mattke A, Gewirtz O'Brien JR, Partain P, Narr C, Breland R, Soma D, Schmit T, Magill S, Leonard A, Crane S, Le Grange D, Loeb K, Clark M, Phelan S, Jacobson RM, Enders F, Lyster-Mensh LC, Leppin A. Adapting Behavioral Treatments for Primary Care Using a Theory-Based Framework: The Case of Adolescent Eating Disorders. Acad Pediatr 2024; 24:208-215. [PMID: 37567443 DOI: 10.1016/j.acap.2023.08.004] [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] [Received: 04/10/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
Evidence-based treatments have been developed for a range of pediatric mental health conditions. These interventions have proven efficacy but require trained pediatric behavioral health specialists for their administration. Unfortunately, the widespread shortage of behavioral health specialists leaves few referral options for primary care providers. As a result, primary care providers are frequently required to support young patients during their lengthy and often fruitless search for specialty treatment. One solution to this treatment-access gap is to draw from the example of integrated behavioral health and adapt brief evidence-based treatments for intra-disciplinary delivery by primary care providers in consultation with mental health providers. This solution has potential to expand access to evidence-based interventions and improve patient outcomes. We outline how an 8-step theory-based process for adapting evidence-based interventions, developed from a scoping review of the wide range of implementation science frameworks, can guide treatment development and implementation for pediatric behavioral health care delivery in the primary care setting, using an example of our innovative treatment adaptation for child and adolescent eating disorders. After reviewing the literature, obtaining input from leaders in eating disorder treatment research, and engaging community stakeholders, we adapted Family-Based Treatment for delivery in primary care. Pilot data suggest that the intervention is feasible to implement in primary care and preliminary findings suggest a large effect on adolescent weight gain. Our experience using this implementation framework provides a model for primary care providers looking to develop intra-disciplinary solutions for other areas where specialty services are insufficient to meet patient needs.
Collapse
Affiliation(s)
- Jocelyn Lebow
- Department of Psychiatry and Psychology (J Lebow, L Sim, M Clark), Mayo Clinic School of Medicine, Rochester, Minn; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (J Lebow, RM Jacobson, F Enders), Rochester, Minn; Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn.
| | - Leslie Sim
- Department of Psychiatry and Psychology (J Lebow, L Sim, M Clark), Mayo Clinic School of Medicine, Rochester, Minn
| | - Sarah Redmond
- Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | - Marcie Billings
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Angela Mattke
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | | | - Paige Partain
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Cassandra Narr
- Department of Undergraduate Nursing (C Narr), Winona State University, Winona, Minn
| | - Renee Breland
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - David Soma
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Tammy Schmit
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Saraphia Magill
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Antoinette Leonard
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Sarah Crane
- Department of Internal Medicine (S Crane), Mayo Clinic School of Medicine, Rochester, Minn
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences (D Le Grange), University of California, San Francisco; Department of Psychiatry and Behavioral Neuroscience (D Le Grange), The University of Chicago, Chicago, Ill
| | - Katharine Loeb
- Chicago Center for Evidence-Based Treatment (K Loeb), Chicago, Ill
| | - Matthew Clark
- Department of Psychiatry and Psychology (J Lebow, L Sim, M Clark), Mayo Clinic School of Medicine, Rochester, Minn
| | - Sean Phelan
- Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | - Robert M Jacobson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (J Lebow, RM Jacobson, F Enders), Rochester, Minn; Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn; Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | - Felicity Enders
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (J Lebow, RM Jacobson, F Enders), Rochester, Minn; Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | | | - Aaron Leppin
- Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| |
Collapse
|
5
|
Drury CR, Hail L, Rienecke RD, Accurso EC, Coelho JS, Lock J, Le Grange D, Loeb KL. Psychometric properties of the Parent Eating Disorder Examination Questionnaire. Int J Eat Disord 2023; 56:1730-1742. [PMID: 37248808 PMCID: PMC10524762 DOI: 10.1002/eat.23999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE-Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants. METHODS A multi-site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE-Q) and their parents completed the PEDE-Q. RESULTS The internal consistencies of the PEDE-Q subscales were on par with established EDE-Q ranges (.73 to .90), both when examined using the original four-factor EDE-Q subscales and the seven-item, three-factor subscales of the brief EDE-Q. Statistically significant medium- to large-sized correlations and poor to moderate levels of agreement were found between the corresponding EDE-Q and PEDE-Q subscales. Receiver-operator characteristic (ROC) curves showed that the PEDE-Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full-syndrome AN, whereas the EDE-Q did not. Based on chi-square analyses, the PEDE-Q identified a statistically significantly greater number of AN cases than the EDE-Q. The EDE-Q yielded a BN diagnosis more frequently than the PEDE-Q, although this difference was not statistically significant. DISCUSSION Results suggest that the PEDE-Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN. PUBLIC SIGNIFICANCE There exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE-Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE-Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.
Collapse
Affiliation(s)
- Catherine R Drury
- School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey, USA
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Katharine L Loeb
- Chicago Center for Evidence-Based Treatment, Chicago, Illinois, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
6
|
Phillips M, İnce B, Webb H, Dalton B, McCombie C, Irish M, Mercado D, Peachey G, Zenasni Z, Himmerich H, Robinson P, Arcelus J, Byford S, Treasure J, Landau S, Lawrence V, Schmidt U. Autopsy of a failed trial part 1: A qualitative investigation of clinician's views on and experiences of the implementation of the DAISIES trial in UK-based intensive eating disorder services. EUROPEAN EATING DISORDERS REVIEW 2023; 31:489-504. [PMID: 36952308 PMCID: PMC10946575 DOI: 10.1002/erv.2975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The DAISIES trial, comparing inpatient and stepped-care day patient treatment for adults with severe anorexia nervosa was prematurely terminated in March 2022 due to poor recruitment. This qualitative study seeks to understand the difficulties faced during the trial by investigating stakeholders' views on and experiences of its implementation. METHOD Semi-structured interview and focus group transcripts, and trial management and oversight group meeting minutes from May 2020-June 2022 were analysed using thematic analysis. Participants were 47 clinicians and co-investigators involved with the DAISIES trial. The Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was applied to the interpretive themes to classify barriers and facilitators to implementation. RESULTS Five themes were identified: incompatible participation interests; changing standard practice; concerns around clinical management; systemic capacity and capability issues; and Covid-19 disrupting implementation. Applying the NASSS framework indicated the greatest implementation challenges to arise with the adopters (e.g. patients, clinicians), the organisational systems (e.g. service capacity), and the wider socio-political context (e.g. Covid-19 closing services). CONCLUSIONS Our findings emphasise the top-down impact of systemic-level research implementation challenges. The impact of the Covid-19 pandemic accentuated pre-existing organisational barriers to trial implementation within intensive eating disorder services, further limiting the capacity for research.
Collapse
Affiliation(s)
- Matthew Phillips
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Başak İnce
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Hannah Webb
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Bethan Dalton
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Catherine McCombie
- Department of Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Madeleine Irish
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Daniela Mercado
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Gemma Peachey
- South London and Maudsley NHS Foundation TrustMaudsley HospitalLondonUK
| | - Zohra Zenasni
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Hubertus Himmerich
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustMaudsley HospitalLondonUK
| | - Paul Robinson
- Division of MedicineUniversity College LondonLondonUK
| | - Jon Arcelus
- Institute of Mental HealthUniversity of NottinghamJubilee CampusNottinghamUK
| | - Sarah Byford
- Department of Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Janet Treasure
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustMaudsley HospitalLondonUK
| | - Sabine Landau
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Vanessa Lawrence
- Department of Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustMaudsley HospitalLondonUK
| |
Collapse
|
7
|
Levine MP, Sadeh-Sharvit S. Preventing eating disorders and disordered eating in genetically vulnerable, high-risk families. Int J Eat Disord 2023; 56:523-534. [PMID: 36579440 DOI: 10.1002/eat.23887] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To close the chasm between theory about families containing a parent with an eating disorders (EDs) history and lack of selective or indicated prevention programming for such families with an older child or adolescent who is, genetically, at high risk. METHOD A search of four major databases for January 2000 through September 2022 yielded no publications that (a) identified genetically high-risk families with offspring ages 10 through 18; (b) devised a prevention program for the family; and (c) evaluated program effects on risk/protective factors. To rectify this gap, research on three lines of family-based prevention is reviewed: (1) programs for adolescents at genetic risk for depression or anxiety; (2) the Stanford-Dresden project for adolescents at high risk for anorexia nervosa; and (3) Sadeh-Sharvit et al.'s work concerning the Parent-Based Prevention program for mothers with an EDs history and a child under age 5. RESULTS The significant challenges for innovative prevention programming should be addressed by experts in effective EDs, depression, and anxiety prevention, and in family-based treatment (FBT) for EDs, collaborating with people from genetically vulnerable families. Innovative programming should focus on robust risk factors for EDs, adaptive expression of non-specific risk factors (e.g., temperament), and strengthening family functioning. DISCUSSION The field is overdue for development of prevention programs designed for older children or adolescents who are at risk because a parent has an ED. Evidence-based prevention programs for EDs and for depression and anxiety, as well as parent-based prevention informed by FBT, provide a springboard for addressing this gap. PUBLIC SIGNIFICANCE The foundation of theory and research is available for stakeholders to develop prevention programming that closes the huge gap between theory and research about families that are genetically vulnerable for eating disorders versus the complete lack of prevention programming for such families that have an older child or adolescent at high risk.
Collapse
|
8
|
Abstract
OBJECTIVE Eating disorders (EDs) have their onset most frequently in adolescence and young adulthood. Treatment for EDs lack efficacy, and we have made little progress in improving outcomes for patients over the course of the last several decades. As with other mental health conditions, early intervention may greatly improve outcomes, yet, little research exists in this area. CONCLUSIONS More effective evidence-based treatments are sorely needed for EDs, particularly for early stages of the illness to minimise the potential harms of treatment and long-standing illness. Treatment service models would also benefit from taking an approach that ensures continuation of care from adolescence to young adulthood.
Collapse
Affiliation(s)
- Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,188668Orygen, Melbourne, VIC, Australia.,Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.,and Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,188668and Orygen, Melbourne, VIC, Australia
| | - Eóin Killackey
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,188668and Orygen, Melbourne, VIC, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, 4334The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study. Brain Sci 2022; 12:brainsci12020213. [PMID: 35203976 PMCID: PMC8870671 DOI: 10.3390/brainsci12020213] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.
Collapse
|