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Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi‐informant study.

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Title: Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi‐informant study.
Authors: Gumz, Antje, Reuter, Laurence, Löwe, Bernd, Voderholzer, Ulrich, Schwennen, Bianca, Fehrs, Helge, Wünsch‐Leiteritz, Wally, Brunner, Romuald, Kästner, Denise, Zapf, Antonia, Weigel, Angelika
Source: International Journal of Eating Disorders. Dec2023, Vol. 56 Issue 12, p2315-2327. 13p.
Subjects: Anorexia nervosa treatment, Research, Attitudes of medical personnel, Interviewing, Treatment delay (Medicine), Patients' attitudes, Family attitudes, Descriptive statistics, Research funding, Anorexia nervosa, Proportional hazards models
Abstract: Introduction: The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis. Objective: To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies. Methods: Within a multicenter, multi‐informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN‐patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA‐checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA‐items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]). Results: We included data from N = 125 female patients with AN (72 adults, 53 adolescents, Mage = 19.2 years, SD = 4.2, MBMI = 15.7 kg/m2, SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, Mage = 46.0 years, SD = 11.0) and N = 40 PCPs (Mage = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p =.046/ HR = 0.395, p =.018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = −0.147, p =.037). PCPs and relatives rated PCPs' competence higher than patients did. Discussion: It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints. Public Significance: Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi‐informant study.
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  Data: <searchLink fieldCode="AR" term="%22Gumz%2C+Antje%22">Gumz, Antje</searchLink><br /><searchLink fieldCode="AR" term="%22Reuter%2C+Laurence%22">Reuter, Laurence</searchLink><br /><searchLink fieldCode="AR" term="%22Löwe%2C+Bernd%22">Löwe, Bernd</searchLink><br /><searchLink fieldCode="AR" term="%22Voderholzer%2C+Ulrich%22">Voderholzer, Ulrich</searchLink><br /><searchLink fieldCode="AR" term="%22Schwennen%2C+Bianca%22">Schwennen, Bianca</searchLink><br /><searchLink fieldCode="AR" term="%22Fehrs%2C+Helge%22">Fehrs, Helge</searchLink><br /><searchLink fieldCode="AR" term="%22Wünsch‐Leiteritz%2C+Wally%22">Wünsch‐Leiteritz, Wally</searchLink><br /><searchLink fieldCode="AR" term="%22Brunner%2C+Romuald%22">Brunner, Romuald</searchLink><br /><searchLink fieldCode="AR" term="%22Kästner%2C+Denise%22">Kästner, Denise</searchLink><br /><searchLink fieldCode="AR" term="%22Zapf%2C+Antonia%22">Zapf, Antonia</searchLink><br /><searchLink fieldCode="AR" term="%22Weigel%2C+Angelika%22">Weigel, Angelika</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Eating+Disorders%22">International Journal of Eating Disorders</searchLink>. Dec2023, Vol. 56 Issue 12, p2315-2327. 13p.
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  Data: <searchLink fieldCode="DE" term="%22Anorexia+nervosa+treatment%22">Anorexia nervosa treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Research%22">Research</searchLink><br /><searchLink fieldCode="DE" term="%22Attitudes+of+medical+personnel%22">Attitudes of medical personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Interviewing%22">Interviewing</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+delay+%28Medicine%29%22">Treatment delay (Medicine)</searchLink><br /><searchLink fieldCode="DE" term="%22Patients'+attitudes%22">Patients' attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Family+attitudes%22">Family attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Anorexia+nervosa%22">Anorexia nervosa</searchLink><br /><searchLink fieldCode="DE" term="%22Proportional+hazards+models%22">Proportional hazards models</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis. Objective: To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies. Methods: Within a multicenter, multi‐informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN‐patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA‐checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA‐items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]). Results: We included data from N = 125 female patients with AN (72 adults, 53 adolescents, Mage = 19.2 years, SD = 4.2, MBMI = 15.7 kg/m2, SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, Mage = 46.0 years, SD = 11.0) and N = 40 PCPs (Mage = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p =.046/ HR = 0.395, p =.018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = −0.147, p =.037). PCPs and relatives rated PCPs' competence higher than patients did. Discussion: It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints. Public Significance: Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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    Identifiers:
      – Type: doi
        Value: 10.1002/eat.24069
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      – Code: eng
        Text: English
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        PageCount: 13
        StartPage: 2315
    Subjects:
      – SubjectFull: Anorexia nervosa treatment
        Type: general
      – SubjectFull: Research
        Type: general
      – SubjectFull: Attitudes of medical personnel
        Type: general
      – SubjectFull: Interviewing
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      – SubjectFull: Treatment delay (Medicine)
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      – SubjectFull: Patients' attitudes
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      – SubjectFull: Family attitudes
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      – SubjectFull: Anorexia nervosa
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      – SubjectFull: Proportional hazards models
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              M: 12
              Text: Dec2023
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