开始家庭为基础的青少年神经性厌食症治疗前照护者负担的预测因素，以及与治疗期间体重增加的关系。
Predictors of caregiver burden before starting family-based treatment for adolescent anorexia nervosa and associations with weight gain during treatment.
机构信息
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
出版信息
Eat Weight Disord. 2023 Feb 21;28(1):21. doi: 10.1007/s40519-023-01553-4.
PURPOSE
Caregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT.
METHODS
Participants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions.
RESULTS
Caregiver anxiety (p < 0.001), family history of EDs (p = 0.028), adolescent mental health treatment history (p = 0.024), and ED symptoms (p = 0.042) predicted caregiver burden before starting FBT. Pre-treatment caregiver burden was not associated with %TGW gain at 3 or 6 months. Males demonstrated less %TGW gain than females at 3 months (p = 0.010) and 6 months (p = 0.012).
CONCLUSION
Proactively evaluating caregiver burden before starting FBT is suggested. Providing recommendations and/or referrals for identified caregiver vulnerabilities could indirectly impact FBT progress. Males in FBT could require longer courses of treatment and extra vigilance to this demographic is suggested.
LEVEL OF EVIDENCE
Level III, case-control analytic study.
目的
在基于家庭的治疗（FBT）治疗神经性厌食症（AN）中，照顾者起着关键作用。在饮食失调（ED）中经常会出现照顾者负担过重的情况，并且可能会影响 FBT 的结果。本研究探讨了开始 FBT 前与照顾者负担相关的因素，以及治疗前的照顾者负担是否与 FBT 期间的体重增加有关。
方法
参与者包括 114 名患有 AN 或非典型 AN 的青少年（平均年龄 15.6 岁，标准差 1.4 岁）和主要照顾者（87.6%为母亲），他们在美国接受了 FBT。在开始治疗之前，参与者完成了照顾者负担的自我报告量表（通过饮食失调症状影响量表）、照顾者焦虑、照顾者抑郁和 ED 症状。通过回顾性图表审查获得 FBT 第 1 次、第 3 次和开始治疗后 6 个月的临床特征和目标体重百分比（%TGW）。分层回归分析了 FBT 开始前照顾者负担的预测因素。通过分层回归分析评估了治疗前照顾者负担与开始治疗后 3 个月和 6 个月的%TGW 增加之间的关系。
结果
照顾者焦虑（p<0.001）、ED 家族史（p=0.028）、青少年心理健康治疗史（p=0.024）和 ED 症状（p=0.042）预测了 FBT 开始前的照顾者负担。治疗前照顾者负担与 3 个月或 6 个月时的%TGW 增加无关。男性在 3 个月（p=0.010）和 6 个月（p=0.012）时的%TGW 增加少于女性。
结论
建议在开始 FBT 之前主动评估照顾者的负担。为已确定的照顾者脆弱性提供建议和/或转介，可能会间接影响 FBT 的进展。在 FBT 中，男性可能需要更长时间的治疗，并且建议对这一人群进行额外的关注。
证据水平
三级，病例对照分析研究。
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