Gumz Antje, Reuter Laurence, Löwe Bernd, Voderholzer Ulrich, Schwennen Bianca, Fehrs Helge, Wünsch-Leiteritz Wally, Brunner Romuald, Kästner Denise, Zapf Antonia, Weigel Angelika
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.
Int J Eat Disord. 2023 Dec;56(12):2315-2327. doi: 10.1002/eat.24069. Epub 2023 Oct 9.
The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis.
To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies.
Within a multicenter, multi-informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN-patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA-checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA-items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]).
We included data from N = 125 female patients with AN (72 adults, 53 adolescents, M = 19.2 years, SD = 4.2, M = 15.7 kg/m , SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, M = 46.0 years, SD = 11.0) and N = 40 PCPs (M = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p = .046/ HR = 0.395, p = .018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = -0.147, p = .037). PCPs and relatives rated PCPs' competence higher than patients did.
It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints.
Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN.
未治疗疾病的持续时间（DUI），即神经性厌食症（AN）症状出现至开始专科治疗之间的间隔，对预后有很大影响。
量化DUI的可改变预测因素，并得出二级预防策略的建议。
在一项多中心、多信息源研究中，通过对接受首次AN专科治疗的患者进行访谈来评估DUI。使用FABIANA检查表（神经性厌食症治疗启动的促进因素和障碍）从AN患者、其亲属和初级保健医生（PCP）的角度评估可改变因素。使用Cox回归计算每个角度下FABIANA项目对DUI的影响（控制变量：年龄、饮食失调病理、医疗保健状况、移民背景、体重指数[BMI]）。
我们纳入了N = 125名患有AN的女性患者的数据（72名成年人，53名青少年，M = 19.2岁，SD = 4.2，M = 15.7kg/m²，SD = 1.9），N = 89名亲属（81.8%为女性，18.2%为男性，M = 46.0岁，SD = 11.0）和N = 40名PCP的数据（M = 49.7岁，SD = 9.0）。平均DUI为12.0个月。观看或阅读有关其他AN患者成功治疗的文章（患者角度）以及与PCP定期预约（PCP角度）与较短的DUI相关（HR = 0.145，p = 0.046/HR = 0.395，p = 0.018）。亲属认为PCP轻视患者困难的患者DUI较长（HR = -0.147，p = 0.037）。PCP和亲属对PCP能力的评价高于患者。
建议（a）将治疗成功案例纳入预防策略，（b）在向专科护理过渡期间告知PCP定期预约的潜在益处，以及（c）培训PCP处理患者投诉。
许多AN患者很晚才寻求治疗。我们的研究表明，促进早期AN治疗的一种有前景的方法是告知患者受影响同伴的成功治疗案例，促进与PCP的定期预约，并激励这些PCP认真对待AN患者的困难。因此，我们的研究为旨在改善AN早期治疗的干预措施提供了重要建议。
