1
|
Downey AE, Cordell K, Snowden LR, Accurso EC. Characterizing Medical Complications in Publicly Insured Youth With Eating Disorders. J Adolesc Health 2024; 74:1118-1124. [PMID: 38323960 DOI: 10.1016/j.jadohealth.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE The present study describes the occurrence of eating disorder (ED)-related medical diagnoses in a publicly insured sample of youth with EDs. The study also compares ED medical diagnoses with other psychiatric disorders and identifies high-risk demographic groups. Improved screening practices are needed in public mental health systems where treatment is critical for youth with EDs. METHODS Medicaid claims data were obtained from the state of California, including beneficiaries ages 7-18 who had at least one service episode between January 1, 2014, and December 31, 2016. From this population we extracted demographic and claims data for those youth who received an ED diagnosis during the 3-year period as a primary or secondary diagnosis (n = 8,075). Random subsamples of youth with moderate/severe mental illness were drawn for comparison: primary or secondary diagnosis of mood/anxiety disorder (N = 8,000) or psychotic disorder (n = 8,000) were also extracted. Medical diagnoses were compared within youth with EDs (across diagnostic categories) and across psychiatric diagnoses (EDs, mood/anxiety disorders, psychotic disorders). Logistic regression analyses were used to adjust for demographic characteristics. RESULTS Three-quarters of youth with EDs received no diagnosis of an ED-related medical complication. Bradycardia was the most prevalent diagnosis suggestive of medical instability. Odds of medical diagnosis were greater for ED than other psychiatric disorders but varied with age and gender. Across all diagnoses, Latinx youth were less likely to receive ED-related diagnoses suggesting medical instability. DISCUSSION Most publicly insured youth with EDs received no ED-related medical diagnosis, underscoring the structural barriers to receiving expert medical care.
Collapse
Affiliation(s)
- Amanda E Downey
- Department of Pediatrics, University of California, San Francisco, San Francisco, California; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California.
| | - Kate Cordell
- Center for Innovation in Population Health, University of Kentucky, Kentucky; Social Policy Institute, San Diego State University, San Diego, California
| | - Lonnie R Snowden
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| |
Collapse
|
2
|
Castellini G, Cassioli E, Rossi E, Marchesoni G, Cerini G, Pastore E, De Bonfioli Cavalcabo' N, Rotella F, Mezzani B, Alterini B, Lucarelli S, Magazzini S, Corazzesi P, Caini S, Ricca V. Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it? Psychiatry Res 2023; 328:115427. [PMID: 37647700 DOI: 10.1016/j.psychres.2023.115427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.
Collapse
Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Lucarelli
- Eating Disorders Unit, Central Tuscany Local Health Authority, Florence, Italy
| | - Simone Magazzini
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Patrizia Corazzesi
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
3
|
Bryant E, Koemel N, Martenstyn J, Marks P, Hickie I, Maguire S. Mortality and mental health funding-do the dollars add up? Eating disorder research funding in Australia from 2009 to 2021: a portfolio analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100786. [PMID: 37693868 PMCID: PMC10485676 DOI: 10.1016/j.lanwpc.2023.100786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 09/12/2023]
Abstract
Background Eating Disorders (EDs) are among the deadliest of the mental disorders and carry a sizeable public health burden, however their research and treatment is consistently underfunded, contributing to protracted illness and ongoing paucity of treatment innovation. Methods We compare absolute levels and growth rates of Australian mental health research funding by illness group for the years 2009-2021, with a specific focus on eating disorders analysed at the portfolio level. Findings Actual and adjusted data obtained from Australia's three national medical research funding bodies (NHMRC, ARC and MRFF) shows eating disorders receive a disproportionately low allocation of mental health research funding despite having amongst the highest mortality rates. Forty-one category one research grants totalling $AUD28.1 million were funded for eating disorders over the period. When adjusted for inflation, this equates to $2.05 per affected individual, compared with $19.56 for depression, $32.11 for autism, and $176.19 for schizophrenia. Half of all research funded for eating disorders was 'basic' research (e.g., illness underpinning), with little investment in the development of innovative treatment models, novel therapeutics or translation, well reflected by recovery rates of less than 50% in individuals with Anorexia Nervosa. Interpretation Significant discrepancy remains between research funding dollars and disease burden associated with the mental health disorders. The extent to which eating disorders are underfunded may in part be attributable to inaccuracies in epidemiological and burden of disease data. Funding This work was in-part funded by the Australian Government Department of Health and the National Eating Disorder Research & Translation Strategy. The funder was not directly involved in informing the development of the current study.
Collapse
Affiliation(s)
- E. Bryant
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| | - N. Koemel
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - J.A. Martenstyn
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
- School of Psychology, Faculty of Science, University of Sydney, Australia
| | - P. Marks
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| | - I. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - S. Maguire
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| |
Collapse
|
4
|
Parker MN, Lavender JM, Schvey NA, Tanofsky-Kraff M. Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents. Adolesc Health Med Ther 2023; 14:63-85. [PMID: 36860931 PMCID: PMC9969870 DOI: 10.2147/ahmt.s220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).
Collapse
Affiliation(s)
- Megan N Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA,The Metis Foundation, San Antonio, TX, USA,Correspondence: Jason M Lavender, Military Cardiovascular Outcomes Research Program, 4301 Jones Bridge Road, Building 17, Suite 2A, Bethesda, MD, 20814, USA, Email
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA
| |
Collapse
|
5
|
Couturier J, Gayowsky A, Findlay S, Webb C, Sami S, Chan AKC, Chanchlani R, Kurdyak P. A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence. Int J Eat Disord 2022; 55:1316-1330. [PMID: 35920409 DOI: 10.1002/eat.23789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined a 2-year period following an eating disorder (ED) diagnosis in order to determine patterns of health care utilization. METHOD We conducted a retrospective cohort study of children (n = 1560) diagnosed with an ED between 2000 and 2017. The ED diagnosis was made at a tertiary level hospital for children and adolescents presenting for outpatient assessment by specialist adolescent medicine physicians and recorded in a program database over this period of time. We then created three sex- and age-matched comparison cohorts using provincial health administrative databases including: a general population cohort, a diabetes cohort (to compare nonmental health care utilization) and a mood disorder cohort (to compare mental health care utilization). Outcomes included hospitalizations, emergency department visits, as well as general practitioner, psychiatrist, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcomes) were calculated. RESULTS Compared to the general population cohort, the ED cohort had higher odds and rates of all types of health care utilization. Compared to the diabetes cohort, the ED cohort had higher odds of nonmental health-related admissions (OR 1.45, 95% CI 1.09-1.95) and higher rates of nonmental health-related emergency department visits (RR 1.59, 95% CI 1.18-2.13). Compared to the mood disorder cohort, the ED cohort had higher rates of pediatrician visits, which were mental health-related (RR 14.88, 95% CI 10.64-20.82), however most other types of mental health service utilization were lower. DISCUSSION These patterns indicate that the service needs of young people diagnosed with EDs are higher than those with diabetes with respect to nonmental health admissions and emergency department visits, while in terms of mental health service utilization, there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits. These findings must be interpreted in the context of under-detection and under-treatment of EDs. PUBLIC SIGNIFICANCE STATEMENT Our study found that the health service needs of young people with EDs are higher than those with diabetes with respect to admissions and emergency department visits, while there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits.
Collapse
Affiliation(s)
- Jennifer Couturier
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sheri Findlay
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Webb
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sadaf Sami
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Irish M, Dalton B, Potts L, McCombie C, Shearer J, Au K, Kern N, Clark-Stone S, Connan F, Johnston AL, Lazarova S, Macdonald S, Newell C, Pathan T, Wales J, Cashmore R, Marshall S, Arcelus J, Robinson P, Himmerich H, Lawrence VC, Treasure J, Byford S, Landau S, Schmidt U. The clinical effectiveness and cost-effectiveness of a 'stepping into day treatment' approach versus inpatient treatment as usual for anorexia nervosa in adult specialist eating disorder services (DAISIES trial): a study protocol of a randomised controlled multi-centre open-label parallel group non-inferiority trial. Trials 2022; 23:500. [PMID: 35710394 PMCID: PMC9201798 DOI: 10.1186/s13063-022-06386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Anorexia nervosa (AN) is a serious and disabling mental disorder with a high disease burden. In a proportion of cases, intensive hospital-based treatments, i.e. inpatient or day patient treatment, are required, with day patient treatment often being used as a ‘step-down’ treatment after a period of inpatient treatment. Demand for such treatment approaches has seen a sharp rise. Despite this, the relative merits of these approaches for patients, their families, and the NHS and wider society are relatively unknown. This paper describes the rationale for, and protocol of, a two-arm multi-centre open-label parallel group non-inferiority randomised controlled trial, evaluating the effectiveness and cost-effectiveness of these two intensive treatments for adults with severe AN: inpatient treatment as usual and a stepped care day patient approach (the combination of day patient treatment with the option of initial inpatient treatment for medical stabilisation). The main aim of this trial is to establish whether, in adults with severe AN, a stepped care day patient approach is non-inferior to inpatient treatment as usual in relation to improving body mass index (BMI) at 12 months post-randomisation. Methods 386 patients with a Diagnostic and Statistical Manual 5th edition diagnosis of severe AN or related disorder, with a BMI of ≤16 kg/m2 and in need of intensive treatment will be randomly allocated to either inpatient treatment as usual or a stepped care day patient approach. Patients in both groups will receive treatment until they reach a healthy weight or get as close to this point as possible. Assessments will be conducted at baseline (prior to randomisation), and at 6 and 12 months post-randomisation, with additional monthly symptom monitoring. The primary outcome will be BMI at the 12-month post-randomisation assessment. Other outcomes will include psychosocial adjustment; treatment motivation, expectations and experiences; cost-effectiveness; and carer burden. Discussion The results of this study will provide a rigorous evaluation of two intensive treatment approaches which will inform future national and international treatment guidelines and service provision. Trial registration ISRCTN ISRCTN10166784. Registered 28 February 2020. ISRCTN is a primary registry of the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) network and includes all items from the WHO Trial Registration Data Set.
Collapse
Affiliation(s)
- Madeleine Irish
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Laura Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - James Shearer
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nikola Kern
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Clark-Stone
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | | | - Ciarán Newell
- Dorset HealthCare University NHS Foundation Trust, Poole, UK
| | - Tayeem Pathan
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Jackie Wales
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Rebecca Cashmore
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Sandra Marshall
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK
| | - Paul Robinson
- Division of Medicine, University College London, 5 University Street, London, WC1E, 6JF, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Vanessa C Lawrence
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| |
Collapse
|
7
|
Cost-of-illness for non-underweight binge-eating disorders. Eat Weight Disord 2022; 27:1377-1384. [PMID: 34327651 PMCID: PMC9079013 DOI: 10.1007/s40519-021-01277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study examined economic costs associated with untreated eating disorders (EDs) characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, reporting a limited societal perspective of economic impact as some costs were not included. METHODS One hundred and twenty six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an ED. Costs were calculated using 2017 prices, including an examination of variables associated with costs. RESULTS Estimated societal costs for the year preceding assessment were £3268.47 (€3758.54) per person. In multivariate analyses, no reliable baseline associates of cost were identified. CONCLUSION The economic burden of EDs characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with binge-eating disorders report work impairment and healthcare use that may cost the United Kingdom economy upwards of £3.5 billion (€4bn) per annum. Further studies should consider academic impairment and the economic impact of EDs on families. LEVEL OF EVIDENCE III: evidence obtained from well-designed cohort or case-control analytic studies.
Collapse
|
8
|
Presskreischer R, Steinglass JE, Anderson KE. Eating disorders in the U.S. Medicare population. Int J Eat Disord 2022; 55:362-371. [PMID: 35023194 PMCID: PMC8917996 DOI: 10.1002/eat.23676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The social and economic burden of eating disorders is significant and often financially devastating. Medicare is the largest public insurer in the United States and provides coverage for older adults and some disabled individuals. This study explores prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. METHOD A cross-sectional study was conducted with the nationally representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records. Sociodemographic characteristics and comorbid somatic conditions were compared between individuals with versus without an eating disorder diagnosis. Mean spending was compared overall and separately for inpatient, outpatient, home health, and pharmacy claims. RESULTS The sample included 11,962,287 Medicare enrollees of whom 0.15% had an eating disorder diagnosis. Compared to those without a 2016 eating disorder diagnosis, a greater proportion of individuals with an eating disorder were female (73.8% vs. 54.3%), under age 65 (41.6% vs. 15.5%), and dually eligible for Medicaid due to disability or low-income qualification (48.0% vs. 19.6%). Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias (35.3% vs. 19.9%), arthritis (40.1% vs. 26.6%), and thyroid conditions (32.2% vs. 19.4%). Spending was higher for enrollees with eating disorders compared to those without overall ($29,456 vs. $7,418) and across settings. DISCUSSION The findings establish that eating disorders occur in the Medicare population, and that enrollees with these illnesses have risk factors associated with significant healthcare spending and adverse health outcomes.
Collapse
Affiliation(s)
- Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, New York, USA
| | - Kelly E. Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Gay A, Cabe J, De Chazeron I, Lambert C, Defour M, Bhoowabul V, Charpeaud T, Tremey A, Llorca PM, Pereira B, Brousse G. Repetitive Transcranial Magnetic Stimulation (rTMS) as a Promising Treatment for Craving in Stimulant Drugs and Behavioral Addiction: A Meta-Analysis. J Clin Med 2022; 11:jcm11030624. [PMID: 35160085 PMCID: PMC8836499 DOI: 10.3390/jcm11030624] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023] Open
Abstract
Addiction is a mental disorder with limited available treatment options. The therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) on it, by targeting craving in particular, has been explored with heterogenous results. This meta-analysis uses updated evidence to assess overall rTMS efficacy on craving, differential effects between addiction types clustered into three groups (depressant (alcohol, cannabis, opiate), stimulant (nicotine, cocaine, methamphetamine), and behavioral addiction (gambling, eating disorder)), and stimulation settings. Studies on substance use, gambling, and eating disorders are included, with unrestricted stimulation settings, by searching the PubMed, Embase, PsycINFO, and Cochrane databases up to 30 April 2020. A total of 34 eligible studies (42 units of analysis) were identified. Because of highly significant heterogeneity in primary results, a sensitivity analysis was performed on a remaining sample of 26 studies (30 units of analysis). Analyses performed using random effects model revealed a small effect size favoring active rTMS over shamTMS stimulation in the reduction in craving. We found a significant difference between addiction types, with a persistent small effect only for stimulant and behavioral groups. In these groups we found no difference between the different combinations of target and frequency of stimulation, but a significant correlation between number of sessions and craving reduction. In conclusion, efficacy of rTMS on craving in stimulant and behavioral addiction was highlighted, but recommendations on optimal stimulation settings and its clinical application await further research.
Collapse
Affiliation(s)
- Aurélia Gay
- University Department of Psychiatry and Addiction, CHU St-Etienne, CEDEX 2, 42055 Saint-Étienne, France; (M.D.); (V.B.)
- TAPE Laboratory, EA7423, Jean Monnet University, 42100 Saint-Étienne, France
- Correspondence: ; Tel.: +33-04-77828850
| | - Julien Cabe
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| | - Ingrid De Chazeron
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| | - Céline Lambert
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.L.); (B.P.)
| | - Maxime Defour
- University Department of Psychiatry and Addiction, CHU St-Etienne, CEDEX 2, 42055 Saint-Étienne, France; (M.D.); (V.B.)
| | - Vikesh Bhoowabul
- University Department of Psychiatry and Addiction, CHU St-Etienne, CEDEX 2, 42055 Saint-Étienne, France; (M.D.); (V.B.)
| | - Thomas Charpeaud
- Service d’Addictologie et Pathologies Duelles, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (T.C.); (A.T.)
| | - Aurore Tremey
- Service d’Addictologie et Pathologies Duelles, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (T.C.); (A.T.)
| | - Pierre-Michel Llorca
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.L.); (B.P.)
| | - Georges Brousse
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (J.C.); (I.D.C.); (P.-M.L.); (G.B.)
| |
Collapse
|
10
|
Wolter V, Hammerle F, Buerger A, Ernst V. Prevention of eating disorders-Efficacy and cost-benefit of a school-based program ("MaiStep") in a randomized controlled trial (RCT). Int J Eat Disord 2021; 54:1855-1864. [PMID: 34498304 DOI: 10.1002/eat.23599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Given the severity of eating disorders, effective and easily implementable prevention programs which reduce incidence rates and in addition have health-economic benefits are essential. The majority of research on prevention programs focuses on questionnaire-based efficacy or the reduction of eating disorder symptoms while neglecting the health-economic perspective. By contrast, the present study focuses on both an efficacy analysis considering diagnostic criteria (DSM-5) and on evaluating the cost-benefit of a universal prevention program for eating disorders ("MaiStep"). METHOD A three-arm randomized controlled trial with baseline, posttreatment and 12-month follow-up was conducted with 1,654 adolescents (M = 13.35, SD = 0.76), comprising two intervention groups (MaiStep delivered by psychologists or teachers, IG-T) and an active control group (ACG). The primary outcome was DSM-5 eating disorder diagnosis measured with the SIAB-S. Furthermore, the costs of the prevention program and the savings in health care costs were calculated. RESULTS A significant difference in eating disorder diagnosis was found between the IG-T and the ACG for posttreatment (χ2 (1= 7.352, p = .007), Relative Risk (RR) = .53 and 12-month follow-up (χ2 (1= 5.203, p = .023), RR = .61. MaiStep proved to be cost-effective (tcbr = 6.75), saving about 560,000 € (standardized per 1,000 students = 601,388.19 €). DISCUSSION Universal prevention can both reduce incidence rates of eating disorders and be cost-beneficial for health care systems. Future research should analyze prevention programs regarding efficacy and cost-benefit to enable comparability and derive guidelines for political decision-makers. TRIAL REGISTRATION NUMBER MaiStep is registered at the German Clinical Trials Register (DRKS00005050).
Collapse
Affiliation(s)
- Vanessa Wolter
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arne Buerger
- German Centre of Prevention Research in Mental Health, University of Wuerzburg, Wuerzburg, Germany.,Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Verena Ernst
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
11
|
Thiebaut S, Millaud F, Lemaire P, Ryst A, Girod C, Seneque M, Dupuis-Maurin K, Sahuc N, Courtet P, Guillaume S. [Feasibility of a psychoeducation group for patients with anorexia nervosa: An open study]. Encephale 2021; 48:430-435. [PMID: 34238567 DOI: 10.1016/j.encep.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Management of anorexia nervosa is difficult and few treatments have shown their effectiveness, justifying the exploration of new therapeutic approaches. Available evidence suggests an interest of psychoeducational groups in a significant number of psychiatric disorders. In patients suffering from anorexia, to date there are few groups or interventions available. We aimed to assess the feasibility and acceptability of a psycho-educational program promoting information about the disease and presenting techniques that can help to cope with anorexia and the functional impact it causes. The exploratory secondary objectives were to evaluate if such a group is associated with clinical improvement. METHOD Twenty-seven patients suffering from anorexia nervosa, in three groups, received eight weekly interventions in addition to their usual care. The study was open-label and non-randomized. Patients were assessed three times (baseline, at the end of the group and three months later). The assessments were both qualitative (Eating Disorder Examination questionnaire, The Anorexia Nervosa Stage of Change Questionnaire, the Eating Disorders Quality of Life questionnaire, Work and Social Adjustment Scale) and qualitative. RESULTS Seventy-eight percent of participants attended more than 75 % of the sessions. Seventy percent of participants found the group useful, and 95 % said it helped them improve their knowledge of the disease and its consequences. The average BMI of participants changed significantly with an average increase of 2.5kg between baseline and the three month assessment. There was an improvement of the eating disorders features in EDE-Q for the total score and for all subscores. The improvement in the total score was significant at the end of the group sessions, while the improvement in the sub scores became significant at three months. There was also a significant mood improvement at the end of the group. Finally, there was a significant improvement in daily functioning with a decrease in Work and Social Adjustment Scale scores and an improvement in quality of life. On qualitative assessment, patients were satisfied with the care proposal. They were able to appreciate the support and sharing of experience provided by the group formula. Most of them reported changes in their daily lives, either in their relationship to care and illness, or in their relationships with their loved ones, their leisure/work, their mood or their eating behavior. CONCLUSION Both qualitative and quantitative results suggest that this group psychoeducation program is feasible and well accepted by patients in addition to usual management. Although the methodology does not allow any conclusions, the clinical improvements observed during the group are encouraging with regard to the safety of this type of intervention and its possible effectiveness and argue for a controlled study.
Collapse
Affiliation(s)
- S Thiebaut
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France
| | - F Millaud
- Unité d'hospitalisation Farandole sur le pôle 30I03 au CH du Mas Careiron, chemin du paradis, 30700 UZES, France
| | - P Lemaire
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Clinique de l'anxiété, IACCA (Institut d'accompagnement cognitivo-comportemental de l'anxiété), Centre Hospitalier "Le Mas Careiron", chemin du Paradis, 30700 Uzès, France
| | - A Ryst
- Centre de psychiatrie ambulatoire de cenon, 50, bis avenue Jean Jaurès, 33150 Cenon, France
| | - C Girod
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France
| | - M Seneque
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Inserm, U1061, Université de Montpellier, Montpellier, France
| | - K Dupuis-Maurin
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France
| | - N Sahuc
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Clinique du Chateau, 11, bis rue de la porte jaune, 92380 Garches, France
| | - P Courtet
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Inserm, U1061, Université de Montpellier, Montpellier, France
| | - S Guillaume
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Inserm, U1061, Université de Montpellier, Montpellier, France.
| |
Collapse
|
12
|
Tannous WK, Hay P, Girosi F, Heriseanu AI, Ahmed MU, Touyz S. The economic cost of bulimia nervosa and binge eating disorder: a population-based study. Psychol Med 2021; 52:1-15. [PMID: 33998425 DOI: 10.1017/s0033291721000775] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. METHOD Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. RESULTS The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively. CONCLUSIONS The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.
Collapse
Affiliation(s)
- Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Federico Girosi
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Andreea I Heriseanu
- School of Psychology and InsideOut Institute, University of Sydney, Camperdown, NSW, Australia
| | - Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Stephen Touyz
- School of Psychology and InsideOut Institute, University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
13
|
Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, Myers EM, Richmond TK, Samnaliev M, Velasquez K, Weissman RS, Pezzullo L. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord 2021; 54:851-868. [PMID: 33655603 DOI: 10.1002/eat.23486] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate one-year costs of eating disorders in the United States (U.S.) from a societal perspective, including the costs to the U.S. health system, individual and family productivity costs, lost wellbeing, and other societal economic costs, by setting and payer. Findings will inform needed policy action to mitigate the impact of eating disorders in the U.S. METHOD Costs of eating disorders were estimated using a bottom-up cost-of-illness methodology, based on the estimated one-year prevalence of eating disorders. Intangible costs of reduced wellbeing were also estimated using disability-adjusted life years. RESULTS Total economic costs associated with eating disorders were estimated to be $64.7 billion (95% CI: $63.5-$66.0 billion) in fiscal year 2018-2019, equivalent to $11,808 per affected person (95% CI: $11,754-$11,863 per affected person). Otherwise Specified Feeding or Eating Disorder accounted for 35% of total economic costs, followed by Binge Eating Disorder (30%), Bulimia Nervosa (18%) and Anorexia Nervosa (17%). The substantial reduction in wellbeing associated with eating disorders was further valued at $326.5 billion (95% CI: $316.8-$336.2 billion). DISCUSSION The impact of eating disorders in the U.S. is substantial when considering both economic costs and reduced wellbeing (nearly $400 billion in fiscal year 2018-2019). Study findings underscore the urgency of identifying effective policy actions to reduce the impact of eating disorders, such as through primary prevention and screening to identify people with emerging or early eating disorders in primary care, schools, and workplaces and ensuring access to early evidence-based treatment.
Collapse
Affiliation(s)
- Jared Streatfeild
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - Josiah Hickson
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - S Bryn Austin
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Rebecca Hutcheson
- Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA.,School of Public Health, University of Washington, Seattle, Washington, USA
| | - Johanna S Kandel
- Alliance for Eating Disorders Awareness, West Palm Beach, Florida, USA
| | - Jillian G Lampert
- The Emily Program, St Paul, Minnesota, USA.,REDC Consortium (REDC), New York, New York, USA
| | | | - Tracy K Richmond
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Mihail Samnaliev
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | | | - Ruth S Weissman
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Lynne Pezzullo
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
14
|
Brunet J, Del Duchetto F, Wurz A. Physical activity behaviors and attitudes among women with an eating disorder: a qualitative study. J Eat Disord 2021; 9:20. [PMID: 33568228 PMCID: PMC7877068 DOI: 10.1186/s40337-021-00377-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA) is an integral part of healthcare for the general population and individuals with psychiatric disorders. However, PA is significantly more complex for and related to both healthy (e.g., reduced anxiety and depressive symptoms) and unhealthy outcomes (e.g., intrusive, repetitive thoughts that lead to abnormally high levels of PA) among women with an eating disorder (ED). Consequently, many healthcare professionals recommend abstinence from PA during ED treatment. Despite this, women may remain engaged in PA during ED treatment or resume PA shortly thereafter. Little has been done to understand women's PA behaviors and attitudes and to explore how they integrate PA into their lives during and after ED treatment. Thus, this study sought to explore PA behaviors and attitudes among women with an ED. METHODS Nine women who self-reported receiving an ED diagnosis participated in semi-structured interviews, which were transcribed and analysed thematically. RESULTS Six interrelated themes were constructed to represent participants' PA experiences: PA as a lifestyle, PA can be beneficial, How I feel when I can't do PA, Being cautious about PA, Reactions to healthcare professionals' practice of recommending abstinence from PA during ED treatment, and PA programming thoughts. CONCLUSIONS Overcoming dysfunctional PA behaviors (e.g., engaging in abnormally high levels of PA) and attitudes (e.g., associating PA with caloric expenditure) can be a long and complicated journey for women with an ED. Nevertheless, women with an ED want PA to be integrated into their ED treatment protocol for two key reasons, namely to accrue the benefits associated with PA and to learn how to engage in PA in adaptive and healthy ways.
Collapse
Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, Ottawa, Ontario, K1N 6N5, Canada. .,Cancer Therapeutics Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada. .,Institut du savoir Montfort, Hôpital Montfort, 713 Montreal Road, Ottawa, Ontario, K1K 0T2, Canada.
| | - Francis Del Duchetto
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, Ottawa, Ontario, K1N 6N5, Canada.,Present address: Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3, Canada
| | - Amanda Wurz
- Faculty of Kinesiology, University of Calgary, 2500 University Drive, Calgary, Alberta, T2N 1N4, Canada
| |
Collapse
|
15
|
Tseng MCM, Tu CY, Chang YT. Healthcare use and costs of adults with anorexia nervosa and bulimia nervosa in Taiwan. Int J Eat Disord 2021; 54:69-80. [PMID: 33210331 DOI: 10.1002/eat.23419] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to examine the health service use and healthcare costs of adults with anorexia nervosa (AN) and bulimia nervosa (BN) in Taiwan. METHOD AN and BN cases between 2002-2013 were extracted from a national health insurance database. For each AN and BN case, we randomly selected 10 controls with no eating disorder, matched for sex, age, urbanization of residence, and year of medical visit. The percentage and frequency of health services use and costs in the year preceding and after the diagnosis of AN/BN were compared between groups. We used generalized linear models with gamma distribution and log link function to determine the effects of age, sex, and psychiatric comorbidities on the total cost adjusting for physical comorbidities and to calculate the mean cost difference between groups by using marginal and incremental effects. RESULTS Both individuals with AN and BN had significantly elevated healthcare utilization and costs compared to controls during the baseline and one-year period after diagnosis. Patients with AN had more than three times higher total costs (US $792) and patients with BN had two times higher total costs (US $320) than individuals without eating disorders. Comorbidity of depressive disorder and older age significantly increased healthcare costs among both individuals with AN and BN. DISCUSSION There are high medical and economic burdens of care for individuals with AN and BN. Early diagnosis and integrated care for eating disorders are important tasks to reduce disease burden in Taiwan.
Collapse
Affiliation(s)
- Mei-Chih Meg Tseng
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin, Taiwan
| | - Yuan-Ting Chang
- National Taiwan University Health Data Research Center, Taipei, Taiwan
| |
Collapse
|
16
|
Yan CL, Kao LT, Yeh MK, Chien WC, Yeh CB. Healthcare utilisation for eating disorders among patients with depression: a cross-sectional study in Taiwan. BMJ Open 2019; 9:e032108. [PMID: 31888926 PMCID: PMC6937097 DOI: 10.1136/bmjopen-2019-032108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED. DESIGN A cross-sectional study. SETTING This population-based study used claims data from Taiwan's National Health Insurance Research database between 2001 and 2012. PARTICIPANTS The study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED. OUTCOME MEASURES We tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups. RESULTS Patients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED. CONCLUSION Depression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.
Collapse
Affiliation(s)
- Chiu-Lan Yan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry and Keelung branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
17
|
Regionale Inanspruchnahme des Versorgungssystems und Behandlungsprävalenz bei Essstörungen. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0290-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
18
|
Cimino S, Simonelli A, Parolin M, Ballarotto G, Carbone P, Cerniglia L. A Theoretical and Empirical Linkage between Road Accidents and Binge Eating Behaviors in Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020355. [PMID: 29462976 PMCID: PMC5858424 DOI: 10.3390/ijerph15020355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 01/13/2023]
Abstract
This study aimed at identifying specific clusters of maladaptive emotional–behavioral symptoms in adolescent victims of motorbike collisions considering their scores on alexithymia and impulsivity in addition to examining the prevalence of clinical binge eating behaviors (respectively through the Youth Self-Report (YSR), Toronto Alexithymia Scale-20 (TAS-20), Barratt Impulsiveness Scale-11 (BIS-11), and Binge Eating Scale (BES)). Emotional–behavioral profiles, difficulties in identifying and describing feelings, impulsivity, and binge eating behaviors have been assessed in 159 adolescents addressing emergency departments following motorbike collisions. Our results showed a cluster of adolescents with clinical binge eating behaviors, high rates of motorbike accidents, and high levels of internalizing and externalizing problems, alexithymia, and impulsivity (23.3% of the sample); a second cluster of adolescents with clinical binge eating behaviors, a moderate number of collisions, and moderate levels of emotional and behavioral problems on the above four dimensions (25.8% of the sample); and a third cluster of youth without clinical binge eating behaviors, with a moderate number of accidents, and with low scores on the four dimensions (50.9% of the sample). Adolescents of Cluster 1 showed a higher likelihood to be involved in motorbike collisions than the youth in Clusters 2 and 3 (p < 0.0001). We suggest that adolescents’ motor collisions could be associated with their difficulties in emotion regulation and with their impaired psychological profiles, which could also underpin their disordered eating. The identification of specific clusters of psychopathological symptoms among this population could be useful for the construction of prevention and intervention programs aimed at reducing motor collision recidivism and alleviating co-occurring psychopathologies.
Collapse
Affiliation(s)
- Silvia Cimino
- Department of Dynamic and Clinical Psychology, University of Rome "Sapienza", Rome 00100, Italy.
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Padua 35100, Italy.
| | - Micol Parolin
- Department of Developmental and Social Psychology, University of Padua, Padua 35100, Italy.
| | - Giulia Ballarotto
- Department of Dynamic and Clinical Psychology, University of Rome "Sapienza", Rome 00100, Italy.
| | - Paola Carbone
- Department of Dynamic and Clinical Psychology, University of Rome "Sapienza", Rome 00100, Italy.
| | - Luca Cerniglia
- Department of Psychology, International Telematic University, Rome 00100, Italy.
| |
Collapse
|
19
|
Patterns of medical utilization before the first hospitalization for women with anorexia nervosa in Taiwan. J Psychosom Res 2017; 102:1-7. [PMID: 28992891 DOI: 10.1016/j.jpsychores.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan. METHOD We selected female anorexia nervosa patients (n=239) and control participants hospitalized for peptic ulcers (n=478) or appendectomy (n=478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed. RESULTS Compared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6±45.0 visits; peptic ulcers, 45.3±37.3 visits; appendectomy, 32.5±26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency. CONCLUSIONS We posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted.
Collapse
|
20
|
Murray SB, Pila E, Griffiths S, Le Grange D. When illness severity and research dollars do not align: are we overlooking eating disorders? World Psychiatry 2017; 16:321. [PMID: 28941116 PMCID: PMC5608830 DOI: 10.1002/wps.20465] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stuart B. Murray
- Department of Psychiatry and Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCAUSA
| | - Eva Pila
- Department of Kinesiology and Physical EducationUniversity of TorontoTorontoONCanada
| | - Scott Griffiths
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVICAustralia
| | - Daniel Le Grange
- Department of Psychiatry and Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCAUSA
| |
Collapse
|
21
|
Cook BJ, Wonderlich SA, Mitchell JE, Thompson R, Sherman R, McCallum K. Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Med Sci Sports Exerc 2017; 48:1408-14. [PMID: 26909533 DOI: 10.1249/mss.0000000000000912] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Although exercise is an effective intervention for many psychological health issues, it has often been overlooked as a potential adjunct to eating disorder (ED) treatment. Thus, our objective was to summarize the literature by synthesizing themes identified in clinical studies and explicit guidelines or recommendations for the use or management of exercise in ED interventions into a proposed set of guidelines for the use of exercise in ED treatment. METHODS A literature search in exercise science, health psychology, and the ED literature was conducted. The focus was to obtain articles that reported on therapeutic effects and/or guidelines for the therapeutic use of exercise in individuals with ED. RESULTS Our review identified 11 core themes describing techniques that have been successful in using exercise therapeutically in ED treatment. These 11 guidelines are as follows: employ a team of relevant experts, monitor medical status, screen for exercise-related psychopathology, create a written contract of how therapeutic exercise will be used, include a psychoeducational component, focus on positive reinforcement, create a graded exercise program, begin with mild-intensity exercise, tailor the mode of exercise to the needs of the individual, include a nutritional component, and debrief after exercise sessions. CONCLUSION Our review identifies specific guidelines that may enhance ED treatment outcomes. It is the first to summarize divergent literature and synthesizes previous successes that may guide the use of therapeutic exercise in some, but not all ED patients. This review provides a practical set of guidelines for the clinical management and therapeutic use of exercise in ED treatment by focusing on empowering individuals with exercise as a tool for healthy living.
Collapse
Affiliation(s)
- Brian J Cook
- 1California State University Monterey Bay, Seaside, CA; 2Neuropsychiatric Research Institute, Fargo, ND; 3University of North Dakota School of Medicine and Health Sciences, Fargo, ND; 4Indiana University, Bloomington, IN; 5Bloomington, IN; and 6The Victory Program at McCallum Place, St. Louis, MO
| | | | | | | | | | | |
Collapse
|
22
|
Cook B, Leininger L. The ethics of exercise in eating disorders: Can an ethical principles approach guide the next generation of research and clinical practice? JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:295-298. [PMID: 30356587 PMCID: PMC6189014 DOI: 10.1016/j.jshs.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/09/2017] [Accepted: 01/27/2017] [Indexed: 06/08/2023]
|
23
|
Identification and Management of Eating Disorders in Integrated Primary Care: Recommendations for Psychologists in Integrated Care Settings. J Clin Psychol Med Settings 2017; 24:163-177. [DOI: 10.1007/s10880-017-9497-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
24
|
Guarda AS, Schreyer CC, Fischer LK, Hansen JL, Coughlin JW, Kaminsky MJ, Attia E, Redgrave GW. Intensive treatment for adults with anorexia nervosa: The cost of weight restoration. Int J Eat Disord 2017; 50:302-306. [PMID: 28130794 DOI: 10.1002/eat.22668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Weight restoration in anorexia nervosa (AN) is associated with lower relapse risk; however rate of weight gain and percent of patients achieving weight restoration (BMI ≥ 19 at discharge) vary among treatment programs. We compared both cost/pound of weight gained and cost of weight restoration in a hospital-based inpatient (IP)-partial hospitalization (PH) eating disorders program to estimates of these costs for residential treatment. METHOD All adult first admissions to the IP-PH program with AN (N = 314) from 2003 to 2015 were included. Cost of care was based on hospital charges, rates of weight gain, and weight restoration data. Results were compared with residential treatment costs extracted from a national insurance claims database and published weight gain data. RESULTS Average charge/day in the IP-PH program was $2295 for IP and $1567 for PH, yielding an average cost/pound gained of $4089 and $7050, respectively, with 70% of patients achieving weight restoration. Based on published mean weight gain data and conservative cost/day estimates, residential treatment is associated with higher cost/pound, and both higher cost and lower likelihood of weight restoration for most patients. DISCUSSION The key metrics used in this study are recommended for comparing the cost-effectiveness of intensive treatment programs for patients with AN.
Collapse
Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Kaminsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York.,Department of Psychiatry, Weill Cornell Medical College, New York
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
25
|
Pohjolainen V, Räsänen P, Roine RP, Sintonen H, Koponen S, Karlsson H. Cost-effectiveness of anorexia nervosa in QALYs. Nord J Psychiatry 2017; 71:67-71. [PMID: 27643401 DOI: 10.1080/08039488.2016.1224922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The costs of treating eating disorders are often considered high. AIMS The objective was to perform a cost-utility analysis to estimate the cost-effectiveness of treatment of anorexia nervosa (AN). METHODS Thirty-nine patients entering treatment of AN completed the 15D health-related quality-of-life (HRQoL) questionnaire before and 2 years after the start of treatment. Direct hospital costs were obtained. Quality-adjusted life years (QALYs) gained were calculated and cost-utility assessed. RESULTS Patients' baseline HRQoL was severely impaired. During follow-up, mean HRQoL improved statistically significantly. The cost per QALY gained was €5296 (best-case scenario) or €64 440 (base-case scenario) (€11 559 or €71 600 discounted 3%) depending on the assumptions used in the analysis. CONCLUSIONS The cost per QALY was in the same range as that of many other interventions provided in specialized medical care and within the limits usually considered acceptable, indicating that the treatment of AN is cost-effective.
Collapse
Affiliation(s)
- Veera Pohjolainen
- a Department of Psychiatry , Hospital District of Helsinki and Uusimaa , Helsinki , Finland.,b City of Helsinki, Social Services and Health Care , Department of Mental Health and Substance Abuse , Helsinki , Finland.,c Department of Psychiatry , University of Helsinki , Helsinki , Finland
| | - Pirjo Räsänen
- d External Evaluation Unit , Hospital District of Helsinki and Uusimaa , Helsinki , Finland.,e Finnish Office for Health Technology Assessment (FINOHTA) , Helsinki , Finland
| | - Risto P Roine
- d External Evaluation Unit , Hospital District of Helsinki and Uusimaa , Helsinki , Finland.,f Department of Health and Social Management , University of Eastern Finland , Kuopio , Finland
| | - Harri Sintonen
- g Department of Public Health Science , University of Helsinki , Helsinki Finland
| | - Salla Koponen
- a Department of Psychiatry , Hospital District of Helsinki and Uusimaa , Helsinki , Finland.,c Department of Psychiatry , University of Helsinki , Helsinki , Finland
| | - Hasse Karlsson
- h Department of Psychiatry , University of Turku and Hospital District of Southwest Finland , Turku , Finland
| |
Collapse
|
26
|
Aardoom JJ, Dingemans AE, van Ginkel JR, Spinhoven P, Van Furth EF, Van den Akker-van Marle ME. Cost-utility of an internet-based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial. Int J Eat Disord 2016; 49:1068-1076. [PMID: 27441418 DOI: 10.1002/eat.22587] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the cost-utility of the internet-based intervention "Featback" provided with different levels of therapist support, in comparison to a waiting list. METHOD This economic evaluation was conducted from a societal perspective and was part of a randomized controlled trial in which participants (N = 354) with self-reported ED symptoms were randomized to: (1) 8 weeks of Featback, consisting of psychoeducation and a fully automated monitoring- and feedback system, (2) Featback with low-intensity (weekly) therapist support, (3) Featback with high-intensity (three times a week) therapist support, and (4) a waiting list. Participants were assessed at baseline, postintervention, and 3-month follow-up. Cost-utility acceptability curves were constructed. RESULTS No significant differences between the study conditions were found regarding quality-adjusted life-years (P = 0.55) and societal costs (P = 0.45), although the mean costs per participant were lowest in the Featback condition with low-intensity therapist support (€1951), followed by Featback with high-intensity therapist support (€2032), Featback without therapist support (€2102), and the waiting list (€2582). Featback seemed to be cost-effective as compared to the waiting list. No clear preference was found for Featback with or without therapist support. DISCUSSION A fully automated Internet-based intervention for ED symptoms with no, low-, or high-intensity therapist support represented good value for money when compared to a waiting list. This finding may have important implications for clinical practice, as both the unguided- and guided intervention could allow for more efficient care and widespread dissemination, potentially increasing the accessibility and availability of mental health care services for individuals with ED symptoms. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1068-1076).
Collapse
Affiliation(s)
- J J Aardoom
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - A E Dingemans
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - J R van Ginkel
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - P Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - E F Van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
27
|
Gay A, Jaussent I, Sigaud T, Billard S, Attal J, Seneque M, Galusca B, Van Den Eynde F, Massoubre C, Courtet P, Guillaume S. A Lack of Clinical Effect of High-frequency rTMS to Dorsolateral Prefrontal Cortex on Bulimic Symptoms: A Randomised, Double-blind Trial. EUROPEAN EATING DISORDERS REVIEW 2016; 24:474-481. [DOI: 10.1002/erv.2475] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/12/2016] [Accepted: 08/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Aurelia Gay
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | | | - Torrance Sigaud
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | - Stephane Billard
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
| | - Jerome Attal
- Inserm U1061; University of Montpellier; Montpellier France
- University Department of Adult Psychiatry; CHRU Montpellier; Montpellier France
| | - Maude Seneque
- Inserm U1061; University of Montpellier; Montpellier France
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital; CHRU Montpellier; Montpellier France
| | - Bogdan Galusca
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | - Frederique Van Den Eynde
- Eating Disorders Program, Department of Psychiatry, Douglas Hospital; McGill University; Montreal Canada
| | - Catherine Massoubre
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | - Philippe Courtet
- Inserm U1061; University of Montpellier; Montpellier France
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital; CHRU Montpellier; Montpellier France
| | - Sebastien Guillaume
- Inserm U1061; University of Montpellier; Montpellier France
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital; CHRU Montpellier; Montpellier France
| |
Collapse
|
28
|
Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord 2016; 21:353-364. [PMID: 26942768 PMCID: PMC5010619 DOI: 10.1007/s40519-016-0264-x] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHODS A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro. RESULTS Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively. CONCLUSIONS AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.
Collapse
Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.
| | - Gábor Kovács
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary
| | - Dylan Supina
- Formerly of Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | | | | | - Zoltán Vokó
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.,Department of Health Policy and Health Economics, Faculty of Social Sciences, Eötvös Loránd University, 1/a Pázmány Péter Street, 1117, Budapest, Hungary
| | - David V Sheehan
- University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL, 33612, USA
| |
Collapse
|
29
|
Linville D, Cobb E, Lenee-Bluhm T, López-Zerón G, Gau JM, Stice E. Effectiveness of an eating disorder preventative intervention in primary care medical settings. Behav Res Ther 2015; 75:32-9. [PMID: 26523886 DOI: 10.1016/j.brat.2015.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To conduct a pilot effectiveness trial of a brief dissonance-based eating disorder preventative program, the Body Project, when implemented at primary care medical clinics. METHOD Sixty-six female adolescents between the ages of 13 and 17 who reported at least some body image dissatisfaction were recruited at two primary care clinics and randomized to Body Project groups or an educational video control condition; eating disorder risk factors and symptoms were measured at pretest, posttest, and 3-month follow-up. RESULTS Body Project versus educational video control participants showed significantly greater reductions in thin-ideal internalization, pressure to be thin, dieting, and eating disorder symptoms at posttest, which were medium to large effect sizes. Body Project participants also showed greater decreases in body dissatisfaction and negative affect at posttest, though these moderate sized effects were not significant. Effects persisted through 3-month follow-up. CONCLUSION Average pre-post effect sizes (d = 0.58) compare favorably to those observed in past Body Project efficacy (average d = 0.59) and effectiveness trials (average ds of 0.43 and 0.69), suggesting that primary care clinics may represent a novel venue for offering and extending the reach of this eating disorder prevention program.
Collapse
Affiliation(s)
- Deanna Linville
- College of Education, University of Oregon, 5251 University of Oregon, Eugene, OR 97403, USA.
| | - Erin Cobb
- College of Education, University of Oregon, 5251 University of Oregon, Eugene, OR 97403, USA.
| | - Tracy Lenee-Bluhm
- College of Education, University of Oregon, 5251 University of Oregon, Eugene, OR 97403, USA.
| | - Gabriela López-Zerón
- College of Education, University of Oregon, 5251 University of Oregon, Eugene, OR 97403, USA.
| | - Jeff M Gau
- Oregon Research Institute, 1776 Millrace Dr., Eugene, OR 97403, USA.
| | - Eric Stice
- Oregon Research Institute, 1776 Millrace Dr., Eugene, OR 97403, USA.
| |
Collapse
|
30
|
Lindenberg K, Kordy H. Wirksamkeit eines gestuften, Internetvermittelten Ansatzes zur Prävention von Essstörungen bei Schülern der 7. bis 10. Klasse. KINDHEIT UND ENTWICKLUNG 2015. [DOI: 10.1026/0942-5403/a000152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Essstörungen sind schwerwiegende Erkrankungen, die vorwiegend Jugendliche und junge Erwachsene betreffen. Eine effektive Prävention ist dringend gewünscht. Das individuelle Risiko kann oft nur unscharf eingeschätzt werden. Daher bieten sich gestufte Strategien wie das Internet-vermittelte Programm YoungEs[s]prit an. In der hier vorgestellten prospektiven, randomisiert-kontrollierten Interventionsstudie wurde die Wirksamkeit von YoungEs[s]prit geprüft. In einem adaptiven Design wurde die Studie in zwei Wellen durchgeführt. Hauptzielkriterium war die kumulierte Inzidenzrate (nach DSM-IV Kriterien) in einem 12-Monatszeitraum. Die statistische Prüfung erfolgte mit Hilfe survival-analytischer Methoden. In der 1.Welle (n=896) zeigte sich die präventive Wirksamkeit von YoungEs[s]prit (Log Rank χ2=4,29, df=1, p=0,038, 2-seitig) mit einem hazard ratio von 1,67. Die kumulierte Inzidenzrate der aktiven Kontrollgruppe lag bei 9,6 % verglichen mit 5,9 % in der YoungEs[s]prit Gruppe. In der 2.Welle (n=771) konnten keine Unterschiede zwischen den Gruppen gefunden werden (4,8 % vs. 5,6 %, Logrank χ2=0,27, df=1, p=0,600, 2-seitig). In der Gesamtbewertung wurde der Nachweis für die Wirksamkeit daher nicht erbracht (p1*p2=0,0228 >cα=0,0087). Während die Rate der 1. Welle mit 9,6 % der in der Literatur berichteten Größenordnung von etwa 10 % entsprach, lag die Rate in der 2. Welle mit 4,8 % ungewöhnlich niedrig. Daher wurde exploriert, inwieweit (1) die unterschiedliche Zusammensetzung der Stichproben, z. B. der größere Anteil von Mädchen in der 2. Welle, (2) die größere Nähe zu Einrichtungen der Versorgung in der 2. Welle oder (3) die gestiegene Aufmerksamkeit für Essstörungen durch die 1. Untersuchungswelle zu dieser niedrigen kumulierten Inzidenzrate beigetragen haben könnten.
Collapse
Affiliation(s)
| | - Hans Kordy
- Forschungsstelle für Psychotherapie, Universitätsklinikum Heidelberg
| |
Collapse
|
31
|
Stuhldreher N, Wild B, König HH, Konnopka A, Zipfel S, Herzog W. Determinants of direct and indirect costs in anorexia nervosa. Int J Eat Disord 2015; 48:139-46. [PMID: 24634140 DOI: 10.1002/eat.22274] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/28/2014] [Accepted: 03/02/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To estimate direct and indirect costs of anorexia nervosa (AN), and to identify cost determinants. METHODS In a subsample (n = 225) of the ANTOP trial (Anorexia Nervosa Treatment of OutPatients) health care utilization and productivity losses were assessed at baseline for the previous 3 months and monetarily valued. Included were females aged 18 years and older diagnosed with AN or subsyndromal AN, and a body mass index (BMI) between 15 and 18.5 kg/m(2) . To account for missing data multiple imputation was employed. Cost determinants were derived from generalized linear models with gamma distribution and log link function. RESULTS Mean 3-months costs per patient amounted to €5,866 (SE = €576). The largest share of costs (€3,374) resulted from hospitalizations. Determinants of direct costs were analyzed separately for those with hospitalizations for AN, and those without. In the group only treated as outpatients, participants with binge/purge subtype, and those diseased for more than 6 years had higher costs. Moreover, costs were increased in patients with a comorbid mental disorder. In the group with hospitalizations, direct costs increased with BMI. BMI was measured at the end of the observation period, indicating that longer duration of treatment yielded higher weight gain. Indirect costs were not significantly associated with any disease-related characteristic. DISCUSSION Costs resulting from health care utilization and productivity loss are substantial, although the sample studied had not received sufficient treatment. Future research should analyze the development of costs over time.
Collapse
Affiliation(s)
- Nina Stuhldreher
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | | | | |
Collapse
|
32
|
Samnaliev M, Noh HL, Sonneville KR, Austin SB. The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the U.S. Medical Expenditures Panel Survey. Prev Med Rep 2014; 2:32-4. [PMID: 26844048 PMCID: PMC4721298 DOI: 10.1016/j.pmedr.2014.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Very little is known about the economic burden of eating disorders (ED) and related mental health comorbidities. Methods Using 5 years of data from the U.S. Medical Expenditures Panel Survey, we estimated the difference in annual health care costs, employment status, and earned income (2011 US$) between individuals with current ED compared to those without ED. We further estimated the contribution of mental health comorbidities to these disparities in health care costs, employment and earnings. Results Individuals with ED had greater annual health care costs ($1869, p = 0.012), lower but borderline significant employment rates (OR = 0.67, 95% CIs [0.41, 1.09]), and lower but not statistically significant earnings among those who were employed ($2093, p = 0.48), compared to individuals without ED. Among individuals with ED, the presence of mental health comorbidities was associated with higher but not statistically significant health care costs ($1993, p = 0.17), lower borderline significant odds of employment (OR = 0.41, 95% CIs [0.14, 1.20]), and significantly lower earnings ($19,374, p < 0.01). Conclusions Treatment and prevention of ED may have broader economic benefits in terms of heath care savings and gains in work productivity than previously recognized. This exploratory study justifies large scale evaluations of the societal economic impact of eating disorders and comorbidities. Eating disorders were associated with greater health care costs. Eating disorders were associated with lower rates of employment and earnings. Mental health comorbidities contributed substantially to these disparities. Treatment and prevention of ED may have broad economic benefits to society.
Collapse
Affiliation(s)
- Mihail Samnaliev
- Clinical Research Center, Boston Children's Hospital, United States
| | | | - Kendrin R Sonneville
- Boston Children's Hospital, Division of Adolescent Medicine, Boston, MA, United States
| | - S Bryn Austin
- Boston Children's Hospital, Division of Adolescent Medicine, Boston, MA, United States
| |
Collapse
|
33
|
Bush HE, Rossy L, Mintz LB, Schopp L. Eat for life: a work site feasibility study of a novel mindfulness-based intuitive eating intervention. Am J Health Promot 2013; 28:380-8. [PMID: 23941103 DOI: 10.4278/ajhp.120404-quan-186] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the efficacy of a novel intervention for problematic eating behaviors and body dissatisfaction. DESIGN Participants enrolled in the intervention or waitlist comparison group were assessed at pre and post 10 weeks. SETTING Midwestern university. SUBJECTS One hundred twenty-four female employees or partners/spouses. INTERVENTION Eat for Life is a 10-week group intervention integrating mindfulness and intuitive eating skills. MEASURES Self-report questionnaires included the Intuitive Eating Scale, Body Appreciation Scale, Five-Facet Mindfulness Questionnaire, Questionnaire for Eating Disorder Diagnoses, and an author-constructed supplemental and demographic questionnaire. ANALYSIS Analyses of covariance and ordinal regression measured group differences. Structural equation modeling examined mediation effects. Results . Significant differences between groups were observed for body appreciation (F1,121 = 40.17, p = .000, partial eta squared = .25), intuitive eating (F1,121 = 67.44, p = .000, partial eta squared = .36), and mindfulness (F1,121 = 30.50, p = .000, partial eta squared = .20), with mean scores significantly higher in the intervention group than waitlist comparison group after 10 weeks. The intervention group was 3.65 times more likely to be asymptomatic for disordered eating than the comparison group. Mindfulness served as a partial mediator. CONCLUSION The study provides support for an intervention combining intuitive eating and mindfulness for treatment of problematic eating behaviors and body dissatisfaction, with limitations including self-selection and lack of active control group.
Collapse
|
34
|
Dooley-Hash S, Lipson SK, Walton MA, Cunningham RM. Increased emergency department use by adolescents and young adults with eating disorders. Int J Eat Disord 2013; 46:308-15. [PMID: 23044650 DOI: 10.1002/eat.22070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study describes patterns of emergency department (ED) utilization by patients who screen positive for eating disorders. METHOD ED patients aged 14-20 years (n = 1,920) completed a computerized questionnaire. The analyses compared the rates of ED use between patients who screened positive for an eating disorder and those who did not and examined the reasons for ED use amongst patients with eating disorders. RESULTS ED patients who screened positive for eating disorders were significantly more likely to have previously visited the ED and, on average, utilized the ED at a rate 1.6 times higher than patients who screen negative for eating disorders. The most common chief complaints among patients who screen positive for eating disorders were abdominal pain and other gastrointestinal-related problems. DISCUSSION Patients with eating disorders utilize the ED more frequently than those without and commonly present for complaints seemingly unrelated to their eating disorder.
Collapse
Affiliation(s)
- Suzanne Dooley-Hash
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | | | | | | |
Collapse
|
35
|
Federici A, Wisniewski L. An intensive DBT program for patients with multidiagnostic eating disorder presentations: a case series analysis. Int J Eat Disord 2013; 46:322-31. [PMID: 23381784 DOI: 10.1002/eat.22112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/30/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study presents case-series data on a novel outpatient program that blends dialectical behavior therapy (DBT) with standard eating disorder (ED) interventions (i.e., food exposure, weight monitoring, cognitive modification, ED psychoeducation) for patients with complex and multidiagnostic ED presentations. METHOD Quantitative and qualitative data was collected on a sample of seven consecutively admitted women who presented with a severe ED, a history of several failed treatment attempts, pervasive emotion dysregulation, and significant Axis I or II psychiatric comorbidity (e.g., PTSD, borderline personality disorder). RESULTS Treatment was associated with reductions in ED symptoms, suicidal and self-injurious behaviors, treatment interfering behaviors, psychiatric and medical hospitalizations, and clinician burnout. DISCUSSION Overall, the results suggest that this blended DBT/cognitive behavior therapy for ED treatment model is a promising intervention for this complex and "hard to treat" population.
Collapse
Affiliation(s)
- Anita Federici
- Cleveland Center for Eating Disorders, Cleveland, Ohio 44122, USA
| | | |
Collapse
|
36
|
Linville D, Aoyama T, Knoble NB, Gau J. The effectiveness of a brief eating disorder training programme in medical settings. J Res Nurs 2012. [DOI: 10.1177/1744987112452182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the longitudinal effectiveness of a brief eating disorder training on primary care providers’ self-perceived knowledge, skills and attitudes regarding eating disorder screening and intervention. Method: We trained 45 primary care providers (including nurses, nurse practitioners and physicians) practicing in 10 medical sites and measured their self-perceived knowledge, skills and attitudes on eating disorder screening and intervention using a 23-item questionnaire prior to, 1 week and 6 months after the training. Results: The eating disorder knowledge score and eating disorder skill level score showed pretest to posttest gains that were associated with large effect sizes ( d = 1.25 and 1.31, respectively). The significance and magnitude of effects carried over through the 6-month follow-up evaluation. Unlike the eating disorder knowledge and skill scores, there was no significant improvement in eating disorder attitudes from pretest to posttest or from pretest to the 6-month follow-up. Discussion: Findings show support for the effectiveness of a brief eating disorder training on primary care providers’ reported knowledge and skills for addressing eating disorders in their practice. These results underscore the importance of providing information to primary care providers on how they can more adequately screen and intervene with eating disorders, as part of primary care to their patients.
Collapse
Affiliation(s)
- Deanna Linville
- Assistant Professor and Program Director, Couples and Family Therapy, University of Oregon, USA
| | - Tessa Aoyama
- Marriage and Family Therapist Intern, Adolescent Counseling Services, USA
| | - Naomi B. Knoble
- Counseling Psychology Doctoral Student, Department of Counseling Psychology and Human Services, University of Oregon, USA
| | - Jeff Gau
- Senior Data Analyst, Oregon Research Institute, USA
| |
Collapse
|
37
|
Van Son GE, Hoek HW, Van Hoeken D, Schellevis FG, Van Furth EF. Eating Disorders in the General Practice: A Case-Control Study on the Utilization of Primary Care. EUROPEAN EATING DISORDERS REVIEW 2012; 20:410-3. [DOI: 10.1002/erv.2185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
38
|
Stuhldreher N, Konnopka A, Wild B, Herzog W, Zipfel S, Löwe B, König HH. Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. Int J Eat Disord 2012; 45:476-91. [PMID: 22294558 DOI: 10.1002/eat.20977] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To review cost-of-illness studies (COIs) and cost-effectiveness analyses (CEAs) of eating disorders (EDs) and to describe their methodological quality. METHOD A systematic literature search was done. Search results passed through a selection process, included studies were classified as COIs, CEAs, or "other cost studies" (OCS). Costs were inflated and converted to 2008 US$ purchasing power parities (PPP). Quality criteria were developed and applied to each study. RESULTS Five COI, two CEA, and eleven "OCS" were reviewed. Most studies focused on anorexia nervosa and bulimia nervosa. Annual costs per patient ranged from 1,288 to 8,042 US$-PPP. All interventions, investigated in CEA, were more effective and less costly than the alternative treatments. DISCUSSION The number of publications investigating costs in EDs has increased recently. However, no COI provided a comprehensive estimate of costs, and the comparability of CEA was limited. Nonetheless, the results indicate that the costs arising from EDs are substantial.
Collapse
Affiliation(s)
- Nina Stuhldreher
- Department of Medical Sociology and Health Economics, University Medical Centre Hamburg-Eppendorf, Germany.
| | | | | | | | | | | | | |
Collapse
|
39
|
Cook B, Hausenblas H, Tuccitto D, Giacobbi PR. Eating disorders and exercise: a structural equation modelling analysis of a conceptual model. EUROPEAN EATING DISORDERS REVIEW 2011; 19:216-25. [PMID: 21584914 DOI: 10.1002/erv.1111] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite the well-established health benefits of physical activity, the role of exercise for eating disorders (ED) is controversial; thus dictating a need for a better understanding of the mechanisms of exercise and ED. The purpose of our study was to examine a conceptual model that hypothesizes regular exercise without psychological compulsion might impart beneficial effects for preventing and treating ED. METHOD University students (N = 539) completed self-report assessments of quality of life, exercise level, ED risk and exercise dependence symptoms. Structural equation modelling analysis was undertaken to examine the conceptual model's proposed relationships. RESULTS Mediation analysis and model comparison tests showed that the partially mediated model without the physical well-being latent construct fit the data best. DISCUSSION Our results provided initial support for the conceptual model by showing that the psychological benefits, but not the physical benefits, conveyed by exercise were associated with reduced ED risk.
Collapse
|