1. Depression, Worry, and Psychosocial Functioning
Predict Eating Disorder Treatment Outcomes in a
Residential and Partial Hospitalization Setting
Laura Fewell, BA, McCallum Place Eating Disorder Centers, Cheri A. Levinson, PhD, University of Louisville, and Lynn Stark, DNP, McCallum Place Eating Disorder Centers
Background
Methods
Measures
Eating disorders (EDs) affect up to 13.1% of the U.S. population by age 20 (Stice et al, 2013)
Many people with EDs have other comorbidities
Nearly two-thirds have an anxiety disorder (Kaye et al, 2004)
Approximately half have a depressive disorder (Pearlstein, 2002)
Intensive treatment is often needed for serious EDs
Inpatient
Residential
Partial Hospitalization
• Yet findings on the effectiveness of such
centers vary (Fichter et al, 2006)
Identifying factors that influence ED outcomes is necessary for improving treatment approaches
Participants:
439 female (94%) and male (6%) patients
• Ages (M = 23.92; SD = 9.67)
• Primarily European American (N = 412; 94%)
• Receiving intensive ED treatment
• 62.9% diagnosed with AN
Procedure:
Patients completed measures at admission, discharge, and one year follow up
BMI was collected at admission, discharge and
(self-reported) at one year follow up
Eating Disorder Examination Questionnaire (EDE-Q; Fairburn, 2008)
Self-report questionnaire designed to assess ED behaviors and thoughts
Clinical Impairment Assessment (CIA; Bohn & Fairburn, 2008)
16-item measure of psychological and social impairment related to an ED
• Ex: “To what extent have your…eating habits…
made it difficult to eat out with others?”
Beck Depression Inventory II (BDI-II; Beck et al, 1996)
21-item measure of depression
Penn State Worry Questionnaire (PSWQ; Meyer et al, 1990)
Measures trait assessment of pathological worry
• Ex: “My worries overwhelm me.”
World Health Disability Assessment Schedule 2.0 (WHODAS; Ustün et al, 2010)
36-item, self-report measure of psychosocial functioning
Global score comprised of six domains of abilities “Ex: “How much difficulty did you have in
maintaining a friendship?
Body Mass Index (BMI)
Objectives
Research Questions:
Do patients improve after intensive ED treatment?
• Do patients maintain improvement one year
after discharge?
Do depression, worry, and psychosocial functioning predict ED symptomatology, impairment, or body mass index (BMI) [in AN] at one year follow up?
Hypotheses:
ED symptomatology and impairment will be significantly lower at discharge and one year follow up than at treatment admission
BMI in AN will be significantly higher at discharge and one year follow up than at treatment admission
Higher levels of depression will predict higher ED symptomatology and impairment at one year follow up
Higher levels of worry will predict higher ED symptomatology and impairment at one year follow up
Lower levels of psychosocial functioning will predict higher ED symptomatology and impairment at one year follow up
Results
Change over time:
ED symptomatology and impairment were lower and BMI in AN was higher at discharge and one year follow up than admission
Predictors of Outcomes:
Depression and worry predicted both ED symptomatology and impairment at one year follow up
Psychosocial functioning predicted ED symptomatology (b =-.61, p <.001) and impairment (b =-.41, p <.001), but the direction was negative
Depression (p =.09) and worry (p =.83) did not predict BMI in AN at one year follow up
Regression 1: One Year Follow Up ED Symptoms β
Part r
Worry
.25**
.26**
Depression
.20**
Psychosocial Functioning
-.61**
-.52**
Admission EDE-Q
.57**
.48**
Regression 2: One Year Follow Up Impairment β
Part r
Worry
.34**
.27**
Depression
.19*
.13*
Psychosocial Functioning
.-41**
-.31**
Admission CIA
.32**
.21**
Discussion
Patients showed significant improvement after undergoing intensive ED treatment
Depression, worry, and psychosocial functioning predicted ED impairment and symptoms at one year follow up
Clinicians should consider treating depression, worry, and psychosocial functioning when treating EDs
** p < .001; * p < .05