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饮食失调的住院治疗与日间项目治疗:治疗后结果及预测因素的比较

Residential versus day program treatment for eating disorders: A comparison of post-treatment outcomes and predictors.

作者信息

Day Sinead, Mitchison Deborah, Mannan Haider, Tannous W Kathy, Conti Janet, Dearden Amanda, Doyle Aunty Kerrie, Gill Katherine, Hannigan Amy, Houlihan Catherine, Ramjan Lucie, Rankin Rebekah, Valentine Natalie, Hay Phillipa

机构信息

Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.

Graduate School of Health, University of Technology Sydney, Building 20, 100 Broadway, Ultimo, NSW 2148, Australia.

出版信息

J Affect Disord. 2025 Feb 15;371:177-186. doi: 10.1016/j.jad.2024.11.054. Epub 2024 Nov 20.

Abstract

Both residential and day programs for eating disorders provide options for a step-up from standard outpatient care. However, there have not been any direct comparisons of their effectiveness and limited research on predictors of better outcomes from either setting. This study aimed to compare clinical outcomes and predictors from a transdiagnostic residential and day program for eating disorders. Measures of eating disorder symptoms, body mass index (BMI), anxiety, and depression were completed by 106 participants (n = 82 residential, n = 24 day program) at pre-treatment, after four weeks, and at discharge. Greater improvement from pre- to post-treatment was evident from residential, compared to day program, treatment (all ps ≤ .005, medium effect sizes). After accounting for age, baseline BMI, and treatment duration, lower baseline eating disorder symptoms (β = 0.84, p < .001) and greater early change in eating disorder symptoms (β = -0.88, p < .001) each predicted less severe eating psychopathology at discharge. Longer treatment duration predicted better post-treatment outcomes for the day program, but was less predictive of residential outcomes (β = 0.64, p < .001). Post-treatment outcomes were not predicted by age or baseline BMI, anxiety, or depression. As symptom severity did not differ at baseline, results support residential treatment over day programs for individuals with more severe eating disorder presentations. Future research should examine whether day programs are equally effective as residential treatment at lower baseline symptom severity and compare residential care with more intensive settings such as inpatient services.

摘要

针对饮食失调的住院和日间项目都提供了比标准门诊护理更进一步的选择。然而,尚未对它们的有效性进行任何直接比较,且对这两种环境下更好治疗效果的预测因素的研究也很有限。本研究旨在比较一个针对饮食失调的跨诊断住院和日间项目的临床结果及预测因素。106名参与者(n = 82名住院患者,n = 24名日间项目患者)在治疗前、四周后及出院时完成了饮食失调症状、体重指数(BMI)、焦虑和抑郁的测量。与日间项目治疗相比,住院治疗从治疗前到治疗后的改善更明显(所有p值≤.005,中等效应量)。在考虑年龄、基线BMI和治疗时长后,较低的基线饮食失调症状(β = 0.84,p <.001)和饮食失调症状的更大早期变化(β = -0.88,p <.001)各自预测出院时饮食心理病理学症状较轻。较长的治疗时长预测了日间项目更好的治疗后结果,但对住院治疗结果的预测性较低(β = 0.64,p <.001)。治疗后结果不受年龄、基线BMI、焦虑或抑郁的预测。由于基线时症状严重程度无差异,结果支持对饮食失调表现更严重的个体采用住院治疗而非日间项目。未来研究应考察在较低基线症状严重程度时,日间项目是否与住院治疗同样有效,并将住院护理与如住院服务等更强化的环境进行比较。

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