Guided self-help treatment for children and young people with threshold and subthreshold eating disorders: A pilot study protocol

BACKGROUND

Prompt access to evidence-based treatment for children and young people with eating disorders is important for outcomes, yet the gap in service provision remains pervasive. Record levels of young people are waiting for eating disorder treatment and access to care is limited. Guided self-help interventions that are brief and require minimal clinician support have the potential to meet the unprecedented demand for treatment quickly and effectively.

OBJECTIVE

To examine the feasibility, acceptability and proof of concept of a novel, CBT guided self-help intervention for children and young people with threshold and subthreshold eating disorders.

METHODS

A single-arm, proof-of-concept pilot study of the CBT guided self-help intervention will be conducted. Children and young people (aged 11-19) with threshold and subthreshold eating disorders will receive a self-help intervention covering the core components of CBT, supported by 8 weekly guidance sessions delivered remotely. Clinical outcomes (eating-related psychopathology and associated impairment, changes in weight, depression, anxiety, and behavioural difficulties) will be assessed at baseline and post-intervention (12 weeks). Feasibility and acceptability of the intervention will be measured using various outcomes, including adherence to, and engagement with the intervention, rates of recruitment and retention, measure completion and treatment satisfaction. Qualitative data will also be collected for future intervention refinement.

DISCUSSION

If the intervention is shown to produce clinical benefits in this pilot study, a fully powered randomised pilot study will be warranted with the ultimate goal of increasing access to psychological treatment for children and young people threshold and subthreshold eating disorders.

ADMINISTRATIVE INFORMATION

This study protocol (S1 File) adheres to the guidelines outlined in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist for trial protocols [1, 2] which can be found in S1 Checklist. The numbers in parentheses in this protocol correspond to the item numbers in the SPIRIT checklist. The order of items has been modified to group similar items.

Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective

OBJECTIVE

Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch.

METHOD

In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap.

RESULTS

Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal.

CONCLUSIONS

Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.

Low intensity psychological interventions for the treatment of feeding and eating disorders: a systematic review and meta-analysis

BACKGROUND

Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity psychological interventions have the potential to increase such access.

METHODS

A systematic review and meta-analysis were conducted on the use of low intensity psychological interventions for the treatment of feeding and eating disorders. Studies comparing low intensity psychological interventions against high intensity therapies and non-eating disorder specific psychological interventions were included, as well as those with waiting list control arms. There were three primary outcomes: eating disorder psychopathology, diagnostic and statistical manual of mental disorders (DSM) severity specifier-related outcomes and rates of remission/recovery.

RESULTS

Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, low intensity psychological interventions were equivalent on reducing eating disorder psychopathology (g = - 0.13), more effective at improving DSM severity specifier-related outcomes (g = - 0.15), but less likely to achieve remission/recovery (risk ratio (RR) = 0.70). Low intensity psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes.

CONCLUSION

Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. The number of studies for many comparisons was low and the methodological quality of the studies was poor, therefore results should be interpreted with caution. More research is needed to establish the effectiveness of low intensity psychological interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder.

'It opened my eyes': Parents' experiences of their child receiving an anxiety disorder diagnosis

Anxiety disorders are the most common mental health disorders among children, however there is limited guidance on the process of assessing child anxiety disorders and sharing diagnostic outcomes with families. This study aimed to identify aspects of the diagnostic process that are helpful and/or unhelpful for families, and ways to mitigate any potential negative consequences of receiving a child anxiety disorder diagnosis. A qualitative study was conducted with parents of 11 children (aged 7-12 years) with a primary diagnosis of an anxiety disorder, identified through a child mental health service. We used an inductive thematic analysis approach. Elements of the diagnostic process considered helpful or less helpful for families related to four themes: clarity and insight, being heard, the anxiety label and access to support. Findings illustrate the importance of sharing diagnoses compassionately in the context of ensuing treatment, and the benefits of providing families with personalised verbal and written diagnostic information, that is tailored for both parents and children.

Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders

BACKGROUND

Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.

METHODS

The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months.

DISCUSSION

The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective.

TRIAL REGISTRATION

ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.

The brief (seven-item) eating disorder examination-questionnaire: Evaluation of a non-nested version in men and women

OBJECTIVE

Several recent studies have examined the psychometric properties of brief measures of eating disorder attitudes based on the Eating Disorder Examination Questionnaire (EDE-Q). A seven-item version (the EDE-Q7) has been proposed but, as yet, has only been investigated by looking at the items when presented as part of the longer EDE-Q (i.e., as a nested version). The current study presented the EDE-Q7 as a standalone instrument and examined factor structure fit and measurement invariance across male and female genders.

METHODS

University students (244 women; 155 men; 1 did not identify with either gender) completed questionnaires as part of two independent studies. All individuals completed the EDE-Q7 and measures of eating disorder behaviors. In a mixed-gender subsample (n = 286), measures of depression and eating disorder-specific quality of life were also included. Confirmatory factor analysis of the EDE-Q7 was conducted on males and females independently, in addition to estimates of internal consistency reliability and validity. Measurement invariance was assessed through multigroup confirmatory factor analysis.

RESULTS

The EDE-Q7 demonstrated good internal consistency and findings supported measurement invariance by gender. In a mixed-gender subsample, the measure showed positive associations with depression and both eating disorder behaviors and eating disorder-specific quality of life.

DISCUSSION

The present study adds to the literature supporting the psychometric properties of the EDE-Q7, extending this to use of the questionnaire as a standalone instrument. Measurement invariance suggests that the measure may be appropriate for college-age men and women, although future studies should establish psychometric properties more fully.

Predictors of uptake of general and tailored services to improve employee health and wellbeing

ISSUE ADDRESSED

Healthy workplace programs can improve employee health and wellbeing. However, there is little research on how they are adopted by organisations. The study aimed to investigate uptake and predictors of service use amongst organisations utilising a comprehensive government-funded healthy workplace program.

METHODS

Employees taking part in the Healthier Workplaces WA program can access general services (ie, basic information on workplace health and wellbeing) and tailored services (ie, personalised support on implementing changes). A sample of 358 eligible program participants from 204 organisations completed a service experience survey 6 months after engaging with any service. Predictors of service use were analysed using a Kruskal-Wallis H test.

RESULTS

On average, respondents accessed 3.4 (out of 7) services. General services were accessed more frequently than tailored services. The Kruskal-Wallis H test showed that respondents working in Human Resources or Health and Safety and those from large organisations were more likely to access a greater range of services compared to employees in other roles and those working in small to medium organisations. Additionally, greater perceived support from management or co-workers was associated with greater service use.

CONCLUSIONS

Respondents reported accessing general services more than tailored services. Service use was greater amongst those who perceived greater support from their managers and/or co-workers, those who worked in large organisations and those who worked in HR/OHS. SO WHAT?: These findings are informative for practitioners assisting organisations to improve health and wellbeing initiatives and service providers interested in increasing service uptake. A mix of general and tailored services is likely to be useful in building employees' capacity to increase health and wellbeing in their workplace. Support from management and co-workers is an important facilitator, and small organisations may require more focussed targeting due to the lower tendency to engage with these programs and increased benefits.

IgM ANCA in healthy individuals and in patients with ANCA-associated vasculitis

Low levels of IgM auto-antibodies have been reported in health and disease. IgM anti-neutrophil cytoplasmic antibodies (ANCA) have been reported in patients with ANCA-associated vasculitis (AAV). We sought to investigate if healthy individuals may have IgM ANCA in their sera. The first aim of the study was to determine whether IgM ANCA was present in healthy individuals and in patients with ANCA-associated vasculitis. The second aim was to determine what happens to IgM ANCA levels over time. The third aim was to determine whether bacterial infections affected IgM ANCA levels in non-AAV patients. Sera from healthy individuals and patients with AAV were tested for IgM ANCA by immunofluorescence on fixed neutrophils, immunoprecipitation, Western blot and ELISA. Peripheral blood mononuclear cells were isolated and tested by ELISpot for circulating IgM ANCA B cells. To determine whether infection affected IgM ANCA levels, we studied non-AAV patients with bacterial endocarditis or Staphylococcus aureus bacteraemia and measured IgM ANCA levels over time. IgM ANCA is detectable in both healthy individuals and patients with AAV and the titres decreased with increasing age. Circulating IgM ANCA B cells were identified by ELISpot. In the presence of infection, we could not find a significant change in IgM ANCA levels. We report the presence of low-level specific IgM ANCA in the sera of healthy individuals and in patients with ANCA-associated vasculitis. Bacterial infection did not affect the level of IgM ANCA in this small study.

Implementation Outcomes Following Participation in a Large-Scale Healthy Workplace Program Conducted Across Multiple Worksites

PURPOSE

To measure implementation outcomes of a freely available workplace health promotion program (Healthier Workplace Western Australia [HWWA]) that provides employees with services and supports to make changes in their workplaces.

SETTING

Western Australian workplaces.

SUBJECTS

Employees accessing HWWA services.

INTERVENTION

A range of services (training sessions, tailored advice, grant schemes, online resources) were offered relating to nutrition, physical activity, smoking, alcohol consumption, and mental health.

DESIGN/MEASURES

Of the 1627 individuals e-mailed 6 months after participation in HWWA, 345 (21%) individuals who recalled accessing one or more services completed a survey assessing the number and type of changes they had implemented and the perceived barriers to doing so.

ANALYSIS

Negative binomial regressions and one-way analysis of variances assessed whether respondent characteristics or number of services used was associated with the number and types of changes made. A qualitative analysis of the perceived barriers was also conducted.

RESULTS

The majority of respondents (86%) reported implementing one or more changes. Greater perceived responsibility/authority to make change (β = .56, P < .01), perceived support from coworkers (β = .23, P < .05), and number of HWWA services used (β = .04, P < .05) were positive predictors of the number of changes made. Frequently reported barriers included cost/budget restrictions, lack of management support, and resistance from staff.

CONCLUSION

The HWWA program facilitated implementation of various healthy workplace initiatives across the organizations represented in the evaluation.

Evaluation of a Workplace Health and Wellbeing Training Course Delivered Online and Face-To-Face

Organisations may benefit from training champions to promote healthy workplace environments and initiatives. This study compared the perceived usefulness and relative effectiveness of an employee training course offered via online and face-to-face formats. Individuals who took part in the training course were assessed on their perceived competence and confidence to implement changes pre- and post-training. Repeated measures Analysis of Variance (ANOVA) and a t-test were conducted to test for significant differences between pre- and post-training scores and/or mode of training, respectively. Although the face-to-face training course was rated as slightly more useful, there were no significant differences between the two modes of training for the other dependent variables, and both modes led to significantly greater perceived competence and confidence post-training. These findings demonstrate the potential benefits of training employees to implement changes in their workplaces.

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