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饮食失调住院治疗的纵向影响:症状轨迹及功能结局的预测因素

Longitudinal Effects of Residential Treatment for Eating Disorders: Symptom Trajectories and Predictors of Functional Outcomes.

作者信息

Day Sinead, Mitchison Deborah, Tannous W Kathy, Conti Janet, Gill Katherine, Le Long, Mannan Haider, Mihalopoulos Cathrine, Ramjan Lucie, Rankin Rebekah, Hay Phillipa

机构信息

Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.

Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.

出版信息

Int J Eat Disord. 2025 Jul;58(7):1367-1380. doi: 10.1002/eat.24448. Epub 2025 Apr 24.

Abstract

OBJECTIVE

Residential treatment for eating disorders addresses the gap between inpatient and outpatient care, but evidence for longer-term and functional outcomes remains limited. The current study examined both clinical and functional outcomes from admission to a 6-month follow-up from Australia's first residential service for eating disorders.

METHOD

Measures of eating disorder symptoms, body mass index (BMI), anxiety, depression, general and eating disorder-specific health-related quality of life (HRQoL), and functional disability were completed at pretreatment, posttreatment, and 3- and 6-month follow-ups by 81 individuals with eating disorders (M  = 25.78 years).

RESULTS

Linear mixed effects modeling found that change in outcomes over time was best modeled by a cubic growth curve, such that participants showed a steep improvement from pretreatment to posttreatment followed by a worsening of symptoms by 3 months post-discharge, which tapered off by 6 months post-discharge. Pairwise comparisons indicated significant improvement between pretreatment and posttreatment for all outcomes, and between pretreatment and 6 months post-discharge for all outcomes except mental HRQoL. Treatment gains were maintained after discharge for shape and weight concerns, anxiety, general and eating disorder-specific HRQoL, and functional disability. Greater in-treatment improvement in eating disorder symptoms predicted steeper in-treatment improvement and posttreatment deterioration in eating disorder-specific HRQoL, mental HRQoL, and functional disability. Greater post-discharge mental health support predicted steeper improvement in functional disability.

DISCUSSION

Results support the longitudinal effectiveness of residential treatment for clinical and functional outcomes. However, not all outcomes may maintain the degree of improvement seen at discharge, highlighting the importance of appropriate step-down care.

TRIAL REGISTRATION

Registration number: ACTRN12621001651875.

摘要

目的

饮食失调的住院治疗弥补了住院护理和门诊护理之间的差距,但长期和功能结局的证据仍然有限。本研究调查了澳大利亚首个饮食失调住院服务机构从入院到6个月随访期间的临床和功能结局。

方法

81名饮食失调患者(平均年龄25.78岁)在治疗前、治疗后、3个月和6个月随访时完成了饮食失调症状、体重指数(BMI)、焦虑、抑郁、一般和饮食失调特异性健康相关生活质量(HRQoL)以及功能残疾的测量。

结果

线性混合效应模型发现,随着时间推移,结局变化最好用三次生长曲线来模拟,即参与者从治疗前到治疗后显示出急剧改善,随后在出院后3个月症状恶化,到出院后6个月逐渐减轻。两两比较表明,所有结局在治疗前和治疗后之间以及除心理HRQoL外的所有结局在治疗前和出院后6个月之间均有显著改善。出院后,对体型和体重的关注、焦虑、一般和饮食失调特异性HRQoL以及功能残疾方面的治疗效果得以维持。饮食失调症状在治疗期间改善越大,饮食失调特异性HRQoL、心理HRQoL和功能残疾在治疗期间的改善越显著,出院后恶化越严重。出院后心理健康支持越多,功能残疾改善越显著。

讨论

结果支持住院治疗在临床和功能结局方面的纵向有效性。然而,并非所有结局都能维持出院时的改善程度,这凸显了适当的逐步护理的重要性。

试验注册

注册号:ACTRN12621001651875。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c6ca/12232342/d10d35638ec1/EAT-58-1367-g001.jpg

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