针对患有饮食失调症及并发心理健康问题的青少年的家庭式居家治疗：一项混合方法试验的基本原理与研究设计

Family-based treatment at home in adolescents with eating disorders and co-occurring mental health conditions: rationale and study design of a mixed methods trial.

作者信息

Schapink Andrea A H, van der Velde Jildou, Winkelhorst Katie, Kaijadoe Shireen, Elgersma Hermien H J, Grange Daniel Le, Knipschild Rik, Klip Helen

机构信息

Karakter, Child and Adolescent Psychiatry, Nijmegen, The Netherlands.

Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.

出版信息

BMC Psychiatry. 2025 Apr 8;25(1):346. doi: 10.1186/s12888-025-06672-z.

DOI:10.1186/s12888-025-06672-z

PMID:40200161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11980117/

Abstract

BACKGROUND

The significant impact of eating disorders on adolescents necessitates the evaluation of current treatments. Family-based Treatment (FBT) is the standard treatment but has modest remission rates, highlighting the need for improvements. Assessing its effectiveness in adolescents with co-occurring mental health conditions is also crucial. In the Netherlands, there is a growing focus on home-based treatment. This study aims to enhance remission rates in FBT by adapting it for use in a home setting (FBT-H).

OBJECTIVE

This mixed-method study combines single case studies with qualitative research. The primary objective is to assess the effects and experiences of FBT-H in adolescents with eating disorders and co-occurring mental health conditions across variables such as weight, eating disorder symptoms, anxiety, mood, well-being, quality of life, and family dynamics. Additionally, it explores the experiences of adolescents, parents, and practitioners with FBT-H.

METHODS

Adolescents (12-18 years old) with anorexia nervosa (AN) or other specified feeding or eating disorders (OSFED), alongside co-occurring mental health conditions, will participate in FBT-H, attending about two home sessions per week for 6-12 months. Ten patients will be monitored with intensive measurements over one year. Baseline assessments include somatic screening, clinical interviews, and evaluations of mood, anxiety, and family dynamics. The primary outcome is weight change from baseline to one year post treatment, and secondary outcomes (e.g., eating disorder symptoms, quality of life, parent-child relationships, and caregiving burden) are assessed at baseline and then every three months. General well-being and therapeutic relationships are tracked weekly. One-year post treatment, somatic health, and mood/anxiety symptoms will be reassessed alongside qualitative interviews with adolescents, parents, and practitioners.

DISCUSSION

The FBT-H study has the potential to yield significant findings for providing effective treatments for adolescents with eating disorders and co-occurring mental health conditions. By examining a range of variables beyond weight and eating disorder symptoms, this study aims to provide comprehensive insights into the potential benefits and limitations of this home treatment.

REGISTRATION

The study was approved by the Dutch Medical Ethics Committee 'METC Oost Nederland' (Dossier Number: 2023-16217).

CLINICAL TRIAL REGISTRATION

NCT06792227, ClinicalTrials.gov, registered on 25 January 2025.

TRIAL REGISTRATION

Clinical Trial Number: NCT06792227.

摘要

背景

饮食失调对青少年有重大影响，因此有必要对当前的治疗方法进行评估。基于家庭的治疗（FBT）是标准治疗方法，但缓解率一般，这凸显了改进的必要性。评估其对同时患有心理健康问题的青少年的有效性也至关重要。在荷兰，越来越关注居家治疗。本研究旨在通过调整FBT使其适用于居家环境（FBT-H）来提高缓解率。

目的

这项混合方法研究将单病例研究与定性研究相结合。主要目的是评估FBT-H对患有饮食失调以及同时患有心理健康问题的青少年在体重、饮食失调症状、焦虑、情绪、幸福感、生活质量和家庭动态等变量方面的效果和体验。此外，还将探索青少年、父母和从业者对FBT-H的体验。

方法

患有神经性厌食症（AN）或其他特定的喂养或饮食失调（OSFED）以及同时患有心理健康问题的12至18岁青少年将参与FBT-H，每周参加约两次居家治疗课程，为期6至12个月。将对10名患者进行为期一年的密集监测。基线评估包括身体检查、临床访谈以及对情绪、焦虑和家庭动态的评估。主要结局是从基线到治疗后一年的体重变化，次要结局（如饮食失调症状、生活质量、亲子关系和照顾负担）在基线时进行评估，然后每三个月评估一次。每周跟踪总体幸福感和治疗关系。治疗后一年，将重新评估身体健康以及情绪/焦虑症状，并对青少年、父母和从业者进行定性访谈。