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Bryant E, Spielman K, Le A, Marks P, Touyz S, Maguire S, Brennan L, Bryant E, Byrne S, Caldwell B, Calvert S, Carroll B, Castle D, Caterson I, Chelius B, Chiem L, Clarke S, Conti J, Crouch L, Dammery G, Dzajkovski N, Fardouly J, Feneley J, Foroughi N, Fuller-Tyszkiewicz M, Fursland A, Gonzalez-Arce V, Gouldthorp B, Griffin K, Griffiths S, Hambleton A, Hannigan A, Hart M, Hart S, Hay P, Hickie I, Kay-Lambkin F, King R, Kohn M, Koreshe E, Krug I, Le A, Linardon J, Long R, Long A, Madden S, Maguire S, Maloney D, Marks P, McLean S, Meddick T, Miskovic-Wheatley J, Mitchison D, O’Kearney R, Paterson R, Paxton S, Pehlivan M, Pepin G, Phillipou A, Piccone J, Pinkus R, Raykos B, Rhodes P, Rieger E, Rodan S, Rockett K, Russell J, Russell H, Salter F, Sawyer S, Shelton B, Singh U, Smith S, Smith E, Spielman K, Squire S, Thomson J, Tiggemann M, Touyz S, Utpala R, Vartanian L, Wallis A, Ward W, Wells S, Wertheim E, Wilksch S, Williams M, Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord 2022; 10:78. [PMID: 35672777 PMCID: PMC9175461 DOI: 10.1186/s40337-022-00597-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. METHODS This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. RESULTS Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. CONCLUSIONS A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karen Spielman
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, New South Wales Health, Sydney, Australia
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Wade T, Byrne S, Fursland A, Steele A, Wilksch S, Anderson J, Zhou Y, Datta N, Matheson B, Lock J. Is guided self-help family-based treatment for parents of adolescents with anorexia nervosa on treatment waitlists feasible? A pilot trial. Int J Eat Disord 2022; 55:832-837. [PMID: 35470910 DOI: 10.1002/eat.23720] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of the study was to assess the feasibility (recruitment and retention) of an online 12-session guided self-help family-based treatment (GSH-FBT) for families on the waitlist for face-to-face FBT utilizing trainee psychologists to assist carers of children with anorexia nervosa (AN) or atypical AN. METHOD The primary outcomes were feasibility of GSH-FBT for families on the waitlist and secondary exploratory outcomes examined improvement of child and parental function. RESULTS Of 187 eligible families on the waitlist, 24 (13%) expressed interest in the study; 16 (67%) of these families completed baseline, 13 (54%) completed GSH-FBT over a 6-month recruitment period. Children (mean age = 13.92, SD = .86; mean body mass index [BMI] centile = 29.47, SD = 24.80) had an average weight gain of 6 kg (BMI centile effect size = 2.61, 95% CI: 1.77-3.44) and a decrease in eating disorder behaviors (effect size = 1.11, 95% CI: .27-1.95). Improvements also occurred for general mood and behaviors in the child, and the impact of eating disorder symptoms on their functioning. Parents reported improvements in knowledge, skills, and confidence in managing AN. DISCUSSION Use of this low-cost intervention while families are on the waitlist for FBT is engaging and useful but strategies to improve initial recruitment are needed. PUBLIC SIGNIFICANCE STATEMENT Although most eligible families did not enroll in an online 12-session guided self-help family-based treatment for families on the waitlist for face-to-face FBT for anorexia nervosa, families who participated found it engaging. The children experienced improvements in BMI centile, eating and behavior. Parents reported increased confidence, knowledge, and skills. We need to examine how families can be encouraged to participate on online training when on waitlists for treatment.
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Affiliation(s)
- Tracey Wade
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia
| | - Susan Byrne
- Swan Centre, Perth, Western Australia, Australia
| | | | - Anna Steele
- Advanced Psychology Services, Adelaide, South Australia, Australia
| | - Simon Wilksch
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia.,Advanced Psychology Services, Adelaide, South Australia, Australia
| | - Jemma Anderson
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Yuan Zhou
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia
| | - Nandini Datta
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - Brittany Matheson
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - James Lock
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
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Abstract
Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [g = 0.29, 95% confidence interval (CI) 0.18-0.40] and the proportion of intervention completers [log odds ratio (OR) = 0.50, 95% CI 0.34-0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.
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Affiliation(s)
- Peter Musiat
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine Johnson
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | | | - Simon Wilksch
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Tracey Wade
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
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Abstract
OBJECTIVE The current study examined the relation among shape and weight concerns, domain-specific self-esteem, dietary restraint, and depression. METHOD Women with anorexia nervosa (AN; n = 19), restrained eaters (n = 20), and unrestrained eaters (n = 21) completed measures of shape and weight concerns, depression, and self-esteem. RESULTS Women with AN had significantly higher shape and weight concerns and lower self-esteem than restrained eaters. However, once depression was controlled, these significant differences disappeared on all but the morality self-esteem subscale. Unrestrained eaters had significantly lower shape and weight concerns and higher self-esteem than restrained participants both before and after depression was controlled. DISCUSSION Shape and weight concerns and low self-esteem are associated with dietary restriction. However, results from the current study suggest these two variables may not be the primary driving forces behind extreme dietary restriction.
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Affiliation(s)
- Simon Wilksch
- School of Psychology, Flinders University, Adelaide, Australia.
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