Pre-treatment predictors of attrition in a randomised controlled trial of psychological therapy for severe and enduring anorexia nervosa

BMC Psychiatry

Stephen Touyz¹  Ross D Crosby²  Hubert Lacey⁵  Daniel le Grange⁶  Phillipa J Hay³  Ghada B Abd Elbaky⁴ 

[1] School of Psychology, University of Sydney, Sydney, Australia;Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA;School of Medicine, James Cook University, Townsville, Australia;NSW Institute of Psychiatry Fellow, University of Western Sydney, School of Medicine, Sydney, Australia;Eating Disorders Research Team, St George’s University of London, London, UK;Department of Psychiatry and Behavioural Neuroscience, The University of Chicago, Chicago, IL, USA

关键词: Treatment;    Dropout;    Eating disorders;    Premature termination of treatment;    Attrition;    Anorexia nervosa;   

Others  :  1123720
DOI  :  10.1186/1471-244X-14-69

 received in 2013-11-25, accepted in 2014-03-04,  发布年份 2014

【 摘 要 】

Background

Attrition is common in the treatment of anorexia nervosa and its causes are complex and incompletely understood. In particular, its relationship with adaptive function and motivational stage of change has been little studied. This study aimed to (1) investigate and (2) compare the strength of associations between adaptive function, stage of change and other previously found factors such as illness sub-type and treatment attrition in women with severe and enduring anorexia nervosa (SE-AN).

Methods

Participants were 63 adult women with SE-AN of at least 7 years duration who were enrolled in a multi-site randomized controlled trial conducted from July 2007 through June 2011. Treatment comprised 30 outpatient visits over 8 months of either Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN) or Specialist Supportive Clinical Management (SSCM) both of which were modified for severe and enduring illness. Assessments were done at baseline, end of treatment, and 6 and 12 month post treatment follow-up. Demographic variables, duration of illness, specific and generic health related quality of life (QoL), eating disorder (ED) and mood disorder symptoms, social adjustment, body mass index (BMI), and motivation for change were assessed with interview and self-report questionnaires. Treatment attrition was defined as leaving therapy after either premature termination according to trial protocol or self-instigated discharge. Binary logistic regression was used to investigate relative strength of associations.

Results

Those who did not complete treatment were significantly more likely to have the purging sub-type of anorexia nervosa and poorer ED related QoL. There were no significant differences between attrition and which therapy was received, educational level, and global ED psychopathology, stage of change, BMI, social adjustment, duration of illness or level of depression. The strongest predictors on multivariable analysis were ED QoL and AN-purging subtype.

Conclusion

This study supported previous findings of associations between attrition and purging subtype. Furthermore, we found associations between a potentially important cycle of attrition, and poorer EDQoL, which has not been previously reported. Contrary to expectations we did not find an association with BMI, severity of ED symptoms, low level of motivation to change ED features, or level of education.

【 授权许可】

   
2014 Abd Elbaky et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Fassino S, Pierò A, Tomba E, Abbate-Daga G: Factors associated with dropout from treatment for eating disorders: comprehensive literatures review. BMC Psychiatry 2009, 9:1471. 67.
• [2]Wallier J, Vibert S, Berthoz S, Huas C, Hubert T, Godart N: Dropout from inpatient treatment for anorexia nervosa: critical review of the literature. Int J Eat Disord 2009, 42(suppl 7):636-647.
• [3]Abd Elbaky G, Hay P, Touyz S: A systematic review of factors associated with treatment attrition in anorexia nervosa. OA Evid Based Med 2013, 01;18(1):8.
• [4]Eivors A, Button E, Warner S, Turner K: Understanding the experience of drop-out from treatment for anorexia nervosa. Eur Eat Disord Rev 2003, 11(suppl 2):90-107.
• [5]Tasca GA, Taylor D, Bissada H, Ritchie K, Balfour L: Attachment predicts treatment completion in an eating disorders partial hospital program among women with anorexia nervosa. J Pers Assess 2004, 83(suppl 3):201-212.
• [6]Lock J, Couturier J, Bryson S, Agras S: Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial. Int J Eat Disord 2006, 39(suppl 8):639-647.
• [7]Stein KF, Wing J, Lewis A, Raghunathan T: An eating disorder randomized clinical trial and attrition: profiles and determinants of dropout. Int J Eat Disord 2011, 44:356-368.
• [8]Nozaki T, Motoyama S, Arimura T, Morita C, Koreeda-Arimura C, Kawai K, Takii M, Kubo C: Psychopathological features of anorectic patients who dropped out of inpatient treatment as assessed by the Minnesota multiphasic personality inventory. Bio Psycho Soc Med 2007, 1:15.
• [9]Björck C, Bjork T, Clinton D, Sohlberg S, Norring C: Self-image and treatment drop-out in eating disorders. Psychol Psychother Theory Res Pract 2008, 81:95-104.
• [10]Neeren Amy M, Butryn Meghan L, Lowe Michael R, O’Planick AP, Bunnell Doug W, Ice Susan M: Does attrition during follow up bias in studies of eating disorders? Eat Behav 2010, 11:40-44.
• [11]Vandereycken W, Vansteenkiste M: Let eating disorder patients decide: providing choice may reduce early drop-out from inpatient treatment. Eur Eat Disord Rev 2009, 17:177-183.
• [12]Huas C, Godart N, Foulon C, Pham-Scottez A, Divac S, Fedorowicz V, Peyracque E, Rouillon F: Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample. Psychiatry Res 2011, 185:421-426.
• [13]Nordbaø RHS, Espeset EMS, Gulliksen KS, Skårderud F, Geller J, Holte A: Reluctance to recover in anorexia nervosa. Eur Eat Disord Rev 2012, 20:60-67.
• [14]Rodríguez-Cano T, Beato-Fernandez L, Moreno LR, Vaz Leal FJ: Influence of attitudes towards change and self-directness on dropout in eating disorders: a 2-year follow-up study. Eur Eat Disord Rev 2012, 20:23-28.
• [15]Pham-Scottez A, Huas C, Perez-Diaz F, Nordon C, Divac S, Dardennes R, Speranza M, Rouillon F: Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors. J Nerv Ment Dis 2012, 200:807-813.
• [16]Sly R, Morgan JF, Mountford VA, Lacey JH: Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eat Behav 2013, 14:119-123.
• [17]Vitousek K, Watson S, Wilson GT: Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 1998, 18:391-420.
• [18]Bachner-Melman R, Zohar AH, Ebstein RP: An examination of cognitive versus behavioural components of recovery from anorexia nervosa. J Nerv Ment Dis 2006, 194:697-703.
• [19]Touyz S, Le Grange D, Lacey H, Hay P, Crosby R: Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med 2013, 1:1-11.
• [20]APA: Diagnostic and Statistical Manual of Mental Disorders, Edition 4 (DSM-IV), Text Revision. Washington DC: American Psychiatric Association; 2000.
• [21]APA: Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Washington DC: American Psychiatric Association; 2013.
• [22]Fairburn CG, Cooper Z: The Eating Disorder Examination. In Binge Eating: Nature, Assessment and Treatment. 12th edition. Edited by Fairburn CG, Wilson GT. New York: The Guilford Press; 1993:317-331.
• [23]Rieger E, Touyz SW, Beumont PJV: The Anorexia Nervosa Stages of Change Questionnaires (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord 2002, 32:24-38.
• [24]Engel SG, Wittrock DA, Crosby RD, Wonderlich SA, Mitchell JE, Kolotkin RL: Development and Psychometric validation of an eating disorder-specific health –related quality of life instrument. Int J Eat Disord 2006, 39:62-71.
• [25]Ware JE, Kosinski M, Keller SD: A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996, 34:220-233.
• [26]Beck AT, Steer RA, Garbin MK: Manual for the Beck Depression Inventory-II. San Antonia, TX: Psychological Corporation; 1996.
• [27]Weissman MM, Bothwell S: Assessment of social adjustment by patient self-report. Arch Gen Psychiatry 1976, 33:1111-1115.
• [28]Halmi KA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson SW, Kraemer HC: Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry 2005, 62:776-781.
• [29]Masson PC, Perlman CM, Ross SA, Gates AL: Premature termination of treatment in an inpatient eating disorder programme. Eur Eat Disord Rev 2007, 15:275-282.
• [30]Dalle Grave R, Calugi S, Brambilla F, Marchesini G: Personality dimensions and treatment drop-outs among eating disorder patients treated with cognitive behaviour therapy. Psychiatry Res 2008, 158:381-388.
• [31]Mander J, Teufel M, Keifenheim K, Zipfel S, Giel E: Stages of change, treatment outcome and therapeutic alliance win adult in patients with chronic anorexia nervosa. BMC Psychiatry 2013, 13:111. BioMed Central Full Text
• [32]Zipfel S, Wild B, Gross G, Friederich HC, Teufel M, Schellberg D, Giel KE, De Zwann M, Dinkel A, Herpertz S: Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 2014, 83:127-37.
• [33]Schmidt U, Oldershaw A, Jichi F, Sternheim L, Startup H, McIntosh V, Jordan J, Tchanturia K, Wolff G, Rooney M: Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Br J Psychiatry 2012, 201:392-399.