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Measuring eating disorder outcome: definitions, dropout and patients' perspectives
Örebro University, School of Health and Medical Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Despite a plethora of research, there are serious limitations in our knowledge of outcome in eating disorders. Almost all studies have been compromised by the problem of treatment dropout or non-participation in follow-ups. There exists a lack of consensus in definitions of outcome and choice of outcome measures, and there is a dearth of studies focusing on how patients subjectively perceive recovery. The overall aim of this thesis was to address problems in measuring outcome after treatment for eating disorders, with an emphasis on methodological issues. Specific areas of investigation included non-participation in long-term follow-ups, the role of self-image in treatment dropout, outcome among patients who drop out, patients’ subjective perspectives of recovery, and the impact of different methods of measuring outcome.

Method: Four quantitative studies (I, II, III and V) were conducted within the framework of a large Swedish multi-centre study of eating disorders, which adopted a prospective, longitudinal and naturalistic design. Study IV was a qualitative investigation encompassing interviews with former ex-patients who were considered recovered.

Results: Study I suggested that the reasons for non-participation in research were mainly patient related (69%). Those declining further participation in follow-ups were reported significantly lower levels of obsession-compulsion and anxiety, while those not traceable reported significantly higher levels of hostility at admission. Study II suggested that patients who dropped out from treatment initially presented with less negative self-image and fewer psychological problems compared to those who remained in treatment. Low levels of self-blame discriminated dropouts from completers and remainers, and significantly predicted treatment dropout. Study III found no significant differences between dropouts and completers at follow-up, with the exception that dropouts were more dissatisfied with treatment. However, patterns of treatment response revealed that those who completed treatment made significantly greater changes in terms of reduced eating disorder symptoms, fewer psychological problems and a more positive self-image compared to dropouts. Study IV found that patients who had recovered from an eating disorder tended to describe other dimensions of outcome than those usually reported in follow-ups. Patients tended to view recovery in terms of being able to relate in a relaxed and accepting manner to food, their bodies, themselves as individuals, and their social environment. Some perceived recovery in terms of coping better with emotions, while others experienced themselves as healthier than people generally regarding food and weight. Study V applied some of the most frequently used outcome measures for eating disorders and found marked variations in the number of patients who could be considered in remission. Overall remission rates varied from 24.3% to 77.8%, depending on the outcome measure used.

Discussion: The results suggest that non-participation and dropout are not unitary phenomena. There is also a need for greater consensus on how eating disorder outcome should be measured. This is necessary in order to make comparisons between different outcome studies meaningful, and to elucidate the overall picture of eating disorders outcome.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2008. , p. 75
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 17
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-2119ISBN: 978-91-7668-598-3 (print)OAI: oai:DiVA.org:oru-2119DiVA, id: diva2:135910
Public defence
2008-05-27, Wilandersalen, Universitetssjukhuset, Örebro, 13:00
Opponent
Supervisors
Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-10-18Bibliographically approved
List of papers
1. Reasons for non-participation in follow-up research on eating disorders
Open this publication in new window or tab >>Reasons for non-participation in follow-up research on eating disorders
2006 (English)In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 11, no 3, p. 147-153Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Lack of participation in follow-ups is thought to be a serious bias in outcome research on eating disorders; however, little systematic knowledge exists about the problem. The present study aimed to delineate non-participation in long-term follow-up research, and explore the reasons for non-participation.

METHOD: Eating disorder patients (N=840) entering a naturalistic, longitudinal multi-centre study were divided into participators (N=508) and non-participators (N=332) in 36-month follow-ups. Non-participators were further classified as either active (i.e. refused participation or failed to attend scheduled appointments) or passive non-participators (i.e. could not be traced).

RESULTS: Active non-participators exhibited significantly lower levels of general and eating disorder psychopathology at intake compared to participators, while passive non-participators reported higher levels of hostility.

DISCUSSION: Systematic exploration of non-participation in longitudinal research can help to mitigate the problem of indistinct results due to missing data. Barriers to successful longitudinal research and how to overcome non-participation at endpoint are discussed.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2978 (URN)17075242 (PubMedID)
Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
2. Self-image and treatment drop-out in eating disorders
Open this publication in new window or tab >>Self-image and treatment drop-out in eating disorders
Show others...
2008 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 81, no 1, p. 95-104Article in journal (Refereed) Published
Abstract [en]

Introduction: Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. Method: Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. Results: Patients who dropped out had initially presented with less negative self-image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out. Discussion: Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.

Place, publisher, year, edition, pages
Leicester, UK: British Psychological Society, 2008
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2979 (URN)10.1348/147608307X224547 (DOI)
Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
3. What happened to the ones who dropped out?: Outcome in eating disorder patients who complete or prematurely terminate treatment
Open this publication in new window or tab >>What happened to the ones who dropped out?: Outcome in eating disorder patients who complete or prematurely terminate treatment
Show others...
2009 (English)In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 17, no 2, p. 109-119Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake.

METHOD:

Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored.

RESULTS:

No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts.

DISCUSSION:

Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.

Place, publisher, year, edition, pages
New York: John Wiley & Sons, 2009
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2980 (URN)10.1002/erv.911 (DOI)000264357700004 ()19142975 (PubMedID)2-s2.0-66449117940 (Scopus ID)
Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
4. The patient’s perception of having recovered from an eating disorder
Open this publication in new window or tab >>The patient’s perception of having recovered from an eating disorder
2008 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 29, no 8-9, p. 926-944Article in journal (Refereed) Published
Abstract [en]

Our aim in this study was to describe how patients perceive having recovered from eating disorders. A qualitative method with a phenomenographic approach was used to identify various ways of experiencing recovery. Four categories emerged, describing how the subjects now relate in a relaxed and accepting manner to food, the body, themselves as individuals, and their social environment. Some perceived recovery as coping with emotions, while others experienced themselves as healthier than people in general regarding food and weight. Different aspects were emphasized as important for recovery. As long as patients perceive themselves as recovered, it is not necessary that they fulfill all conceivable criteria for recovery.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2981 (URN)10.1080/07399330802269543 (DOI)
Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
5. The impact of using different outcome measures on remission rates in a three-year follow-up of eating disorders
Open this publication in new window or tab >>The impact of using different outcome measures on remission rates in a three-year follow-up of eating disorders
(English)Manuscript (Other academic)
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2982 (URN)
Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-10-18Bibliographically approved

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