Jones Nickolas M, Baker Jessica H, Urban Bek, Freestone David, Doyle Angela Celio, Bohon Cara, Steinberg Dori M
Equip Health, Inc., CA, Carlsbad, USA.
University of California, Irvine, CA, USA.
J Eat Disord. 2023 Sep 22;11(1):167. doi: 10.1186/s40337-023-00869-x.
Caregiver self-efficacy is thought to be a key component for successful family-based treatment (FBT) for individuals with eating disorders. As such, interventions aimed at enhancing caregiver self-efficacy, often measured via the Parents Versus Anorexia scale, have been a focal point of FBT literature. However, studies looking at the relationship between caregiver self-efficacy and treatment outcomes have been mixed. We aimed to better understand the influence of caregiver self-efficacy on eating disorder treatment outcomes during FBT.
Caregiver self-efficacy was measured using the Parents Versus Eating Disorders (PVED) scale, an adapted version of the Parents Versus Anorexia scale, in a sample of 1051 patients with an eating disorder and 1528 caregivers (patients can have more than one caregiver) receiving virtual FBT. Across two multilevel models, we tested how caregiver self-efficacy changed over time and its association with changes in eating disorder symptoms and weight over the first 16 weeks of treatment.
Over treatment, PVED scores increased (b = 0.79, SE = 0.04, CI [0.72, 0.86]) and starting PVED scores were predictive of improved eating disorder symptoms (b = - 0.73, SE = 0.22, CI [- 1.15, - 0.30]), but not weight (b = - 0.96, SE = 0.59, CI [- 2.10, 0.19]). We also found that PVED change-from-baseline scores were predictive of weight (b = - 0.48, SE = 0.03, CI [- 0.53, - 0.43]) such that patient weight was lower when caregiver reports of PVED were higher. Likewise, the association between caregiver change in PVED scores and weight varied as a function of treatment time (b = 0.27, SE = 0.01, CI [0.24, 0.29]). Results were consistent when isolating patients with anorexia nervosa.
Caregiver self-efficacy during FBT improved over time but was not robustly associated with treatment outcomes. This may, in part, be due to psychometric properties of the PVED scale. We describe these issues and illustrate the need for development of a new measure of self-efficacy for caregivers supporting their loved ones through eating disorder treatment.
照顾者自我效能感被认为是对饮食失调患者成功进行家庭治疗（FBT）的关键组成部分。因此，旨在提高照顾者自我效能感（通常通过“父母对抗厌食症”量表来衡量）的干预措施一直是FBT文献的焦点。然而，关于照顾者自我效能感与治疗结果之间关系的研究结果不一。我们旨在更好地了解在FBT期间照顾者自我效能感对饮食失调治疗结果的影响。
在1051名饮食失调患者和1528名接受虚拟FBT的照顾者（患者可能有不止一名照顾者）的样本中，使用“父母对抗饮食失调”（PVED）量表（“父母对抗厌食症”量表的改编版）来测量照顾者自我效能感。在两个多层次模型中，我们测试了照顾者自我效能感如何随时间变化，以及它与治疗前16周内饮食失调症状和体重变化的关联。
在治疗过程中，PVED得分增加（b = 0.79，标准误 = 0.04，置信区间[0.72, 0.86]），起始PVED得分可预测饮食失调症状的改善（b = -0.73，标准误 = 0.22，置信区间[-1.15, -0.30]），但与体重无关（b = -0.96，标准误 = 0.59，置信区间[-2.10, 0.19]）。我们还发现，PVED相对于基线的变化得分可预测体重（b = -0.48，标准误 = 0.03，置信区间[-0.53, -0.43]），即当照顾者报告的PVED得分较高时，患者体重较低。同样，照顾者PVED得分的变化与体重之间的关联随治疗时间而变化（b = 计算得出的值，标准误 = 0.01，置信区间[0.24, 0.29]）。在单独分析神经性厌食症患者时，结果一致。
FBT期间照顾者的自我效能感随时间有所提高，但与治疗结果的关联并不稳固。这可能部分归因于PVED量表的心理测量特性。我们描述了这些问题，并说明了需要开发一种新的自我效能感测量方法，用于支持亲人接受饮食失调治疗的照顾者。
