Wallis Andrew, Miskovic-Wheatley Jane, Madden Sloane, Rhodes Paul, Crosby Ross D, Cao Li, Touyz Stephen
Eating Disorder Service, The Sydney Children's Hospital Network, Westmead Campus, Sydney, Australia.
School of Psychology, The University of Sydney, Sydney, Australia.
J Eat Disord. 2017 Dec 13;5:55. doi: 10.1186/s40337-017-0184-9. eCollection 2017.
The aim of this research was to investigate the relationship between family functioning, adolescent-parent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT). Understanding how families respond to treatment is important because the family will be the ongoing context for psychosocial development in the longer term. The relationship between family functioning and outcome is also an important variable because it is potentially modifiable during treatment and this may improve outcome.
Fifty-seven female adolescents treated with FBT in a randomised controlled trial were assessed at baseline, FBT session 20 and 12-months post FBT session 20. Data on family functioning and adolescent-parent attachment was collected from patients and their parents at each time point. A series of regression analyses were used to determine the relationship between family functioning and comorbidity at baseline, and the relationship with remission status over time. Repeat measure mixed-effects models were used to assess changes in family functioning and attachment quality over time.
Greater adolescent perceived family functioning impairment was positively related to psychiatric comorbidity at the start of treatment. Conversely, better family functioning predicted higher self-esteem and stronger attachment quality. Adolescent's reporting better general family functioning, communication and problem solving were more likely to be remitted at session 20, but not at 12-month follow-up. There was no overall improvement in family functioning for any respondent either during treatment or at follow-up, and no significant relationship between change and remission at either session 20 or follow-up.
The adolescent's perspective on family functioning at the start of treatment impacts on a positive outcome. Addressing family issues earlier in FBT may be important for some patients. Further research is needed in this area to determine how these findings could be integrated into the current FBT model.
Australian Clinical Trials Register number: ACTRN012607000009415 (www.anzctr.org.au).
本研究旨在探讨家庭功能、青少年与父母的依恋关系以及缓解情况之间的关系，以及接受基于家庭治疗（FBT）的重度神经性厌食症青少年在这些变量随时间的变化情况。了解家庭对治疗的反应很重要，因为从长远来看，家庭将是心理社会发展的持续背景。家庭功能与治疗结果之间的关系也是一个重要变量，因为它在治疗期间可能是可改变的，这可能会改善治疗结果。
在一项随机对照试验中，对57名接受FBT治疗的女性青少年在基线、FBT第20次治疗时以及FBT第20次治疗后12个月进行评估。在每个时间点从患者及其父母那里收集有关家庭功能和青少年与父母依恋关系的数据。使用一系列回归分析来确定基线时家庭功能与共病之间的关系，以及随时间与缓解状态的关系。使用重复测量混合效应模型来评估家庭功能和依恋质量随时间的变化。
青少年感知到的家庭功能损害越大，在治疗开始时与精神疾病共病呈正相关。相反，更好的家庭功能预示着更高的自尊和更强的依恋质量。报告家庭总体功能、沟通和解决问题能力更好的青少年在第20次治疗时更有可能缓解，但在12个月随访时并非如此。在治疗期间或随访期间，任何受访者的家庭功能都没有总体改善，在第20次治疗或随访时，变化与缓解之间也没有显著关系。
青少年在治疗开始时对家庭功能的看法会影响积极的治疗结果。在FBT中更早地解决家庭问题对一些患者可能很重要。该领域需要进一步研究，以确定如何将这些发现纳入当前的FBT模式。
澳大利亚临床试验注册编号：ACTRN012607000009415（www.anzctr.org.au）。
