Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany.
Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
Prev Med. 2019 Jun;123:324-332. doi: 10.1016/j.ypmed.2019.04.008. Epub 2019 Apr 17.
Eating disorders are difficult to treat and often associated with morbidity and mortality. Universal prevention approaches are increasingly focusing on enhancing skills, but few eating disorder programs are available for under-15-year-olds. This study aimed to develop and examine a school-based universal prevention program ('MaiStep') for adolescent boys and girls. A three-arm randomized controlled trial with baseline, post-intervention and 12-month follow-up was conducted with 1654 adolescents (M = 13.35, SD 0.76). 'MaiStep' was delivered by psychologists in the first intervention group (IG1) and teachers in the second intervention group (IG2), and compared to an active control group (ACG). Primary outcomes were eating disorder-related risk factors measured with scales of the Eating Disorder Inventory-2 (e.g. 'drive for thinness', 'interoceptive awareness'), cognitions and affect related to the body (Body Shape Questionnaire, BSQ-8), and behaviors (Body Image Avoidance Questionnaire, BIAQ). The total sample (N1) was divided into a healthy subsample (N2) and a sample fulfilling DSM-5 criteria for a subthreshold eating disorder (N3) measured with the self-report Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S). Significant improvements in 'interoceptive awareness' (EDI-2) and lower BIAQ scores emerged in N1 at post-intervention and at 12-month follow-up (F(4; 3038) = 3.068, p = .016, η = 0.004 and F(4; 2900) = 2.993, p = .018, η = 0.004) and in N2 at post-intervention and at 12-month follow-up (F(4; 2812) = 3.147, p = .014, η = 0.004 and F(4; 2684) = 3.674, p = .005, η = 0.005). The healthy subsample N2 additionally showed significantly lower scores on 'drive for thinness' (EDI-2) and on the BSQ-8c at post-intervention (F(2; 1446) = 3.091, p = .046, η = 0.004 and F(2; 1453) = 3.505, p = .030, η = 0.005) but not at 12-month follow-up. No significant results emerged for N3. The positive findings of improved 'interoceptive awareness' (EDI-2) and reduced body image avoidance (BIAQ) indicate that broad disseminated universal prevention under the age of 15 is possible. Trial registration MaiStep is registered at the German Clinical Trials Register (DRKS00005050).
饮食失调症难以治疗，常伴有发病率和死亡率。普及预防方法越来越注重提高技能，但针对 15 岁以下儿童的饮食失调症项目却很少。本研究旨在为青少年男女制定并检验一个基于学校的普遍预防项目（“MaiStep”）。这是一项具有基线、干预后和 12 个月随访的三臂随机对照试验，共有 1654 名青少年参与（M=13.35，SD 0.76）。“MaiStep”由第一干预组（IG1）的心理学家和第二干预组（IG2）的教师实施，并与积极对照组（ACG）进行比较。主要结果是通过饮食失调症清单-2 量表（如“对苗条的渴望”、“内部感知”）、与身体相关的认知和情感（身体形状问卷，BSQ-8）以及行为（身体形象回避问卷，BIAQ）测量的与饮食失调相关的风险因素。总样本（N1）分为健康子样本（N2）和符合 DSM-5 亚阈值饮食失调症标准的样本（N3），通过自我报告的厌食和贪食综合征结构性清单（SIAB-S）进行测量。在 N1 中，干预后和 12 个月随访时，“内部感知”（EDI-2）和 BIAQ 评分的显著改善出现（F（4；3038）=3.068，p=0.016，η²=0.004 和 F（4；2900）=2.993，p=0.018，η²=0.004），在 N2 中，干预后和 12 个月随访时也出现了显著改善（F（4；2812）=3.147，p=0.014，η²=0.004 和 F（4；2684）=3.674，p=0.005，η²=0.005）。健康子样本 N2 还显示，在干预后，“对苗条的渴望”（EDI-2）和 BSQ-8c 的评分显著降低（F（2；1446）=3.091，p=0.046，η²=0.004 和 F（2；1453）=3.505，p=0.030，η²=0.005），但在 12 个月随访时没有显著变化。在 N3 中没有出现显著结果。“内部感知”（EDI-2）改善和身体形象回避减少（BIAQ）的积极发现表明，在 15 岁以下进行广泛传播的普遍预防是可能的。试验注册 MaiStep 已在德国临床试验注册处（DRKS00005050）注册。
