School of Psychology, Deakin University, Geelong, Victoria, Australia.
Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia.
Int J Eat Disord. 2024 May;57(5):1034-1048. doi: 10.1002/eat.24078. Epub 2023 Oct 27.
Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs.
Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused).
Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified.
It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality.
Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.
数字干预措施有望成为治疗饮食失调症（ED）的有效预防或自我管理选择。然而，由于缺乏对结果预测因素、调节因素和中介因素的综合分析，目前尚不清楚它们在这一人群中的作用机制、针对哪些人群以及如何发挥作用。本系统评价综合了关于 ED 数字干预反应的预测因素、中介因素和调节因素的实证研究。
检索了 6 个数据库（PROSPERO CRD42022295565），以评估针对 ED 的数字预防或治疗计划的反应（即参与、退出、参与度和症状水平变化）的预测因素、调节因素或中介因素的研究。变量被分为几个总体类别（人口统计学、症状严重程度、心理等），并在没有正式诊断为 ED 的样本（通常是预防为重点）和有正式诊断为 ED 的样本（通常是治疗为重点）中进行了定性综合。
共纳入 86 项研究。对于招募无正式诊断样本的研究（n=70 项研究），大多数探索的预测因素与结果无关，但参与者年龄、基线症状严重程度、改变信心、动机和计划参与度显示出初步的预后潜力。没有发现可靠的调节因素或中介因素。仅出现了少数招募有正式诊断样本的研究（n=16），也没有发现可靠的预测因素、调节因素或中介因素。
目前尚不清楚数字程序针对 ED 如何作用、针对哪些人群以及在什么情况下发挥作用。我们为未来的研究提供了一些建议，旨在提高对客户特征和预示干预成功的干预要素的理解，从而为这种干预模式提供支持。
数字干预措施已显示出作为 ED 有效、可扩展和可及的干预选择的潜力。然而，反应各不相同，因此需要深入了解 ED 数字干预的结果预测因素、调节因素和中介因素。这些知识对于实现安全有效的治疗匹配以及为有效数字干预的未来发展提供信息非常重要。
