Health service use in eating disorders

Department of Psychology, Wesleyan University, Middletown, CT 06459-0408, USA.
Psychological Medicine (Impact Factor: 5.94). 12/2007; 38(10):1465-74. DOI: 10.1017/S0033291707001833
Source: PubMed


This study examined healthcare services used by adults diagnosed with an eating disorder (ED) in a large health maintenance organization in the Pacific Northwest.
Electronic medical records were used to collect information on all out-patient and in-patient visits and medication dispenses, from 2002 to 2004, for adults aged 18-55 years who received an ED diagnosis during 2003. Healthcare services received the year prior to, and following, the receipt of an ED diagnosis were examined. Cases were matched to five comparison health plan members who had a health plan visit close to the date of the matched case's ED diagnosis.
Incidence of EDs (0.32% of the 104,130 females, and 0.02% of the 93,628 males) was consistent with prior research employing treatment-based databases, though less than community-based samples. Most cases (50%) were first identified during a primary-care visit and psychiatric co-morbidity was high. Health services use was significantly elevated in all service sectors among those with an ED when compared with matched controls both in the year preceding and that following the receipt of the incident ED diagnosis. Contrary to expectations, healthcare utilization was found to be similarly high across the spectrum of EDs (anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified).
The elevation in health service use among women both before and after diagnosis suggests that EDs merit identification and treatment efforts commensurate with other mental health disorders (e.g. depression) which have similar healthcare impact.

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Available from: Frances Lynch, Feb 10, 2014
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    • "In the long-term, high relapse rates can be observed (Berkman et al. 2007). Eating disorders cause high costs (Simon et al. 2005; Striegel-Moore et al. 2008) and are considered to be difficult to treat (Berkman et al. 2006; Keel and Haedt 2008; Wilson et al. 2007) All these data emphasize the importance of the early prevention of eating disorders -prevention which takes into account the situation of boys and younger age-classes as well. "
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    ABSTRACT: Aim Disordered eating is a significant social and economic issue in Western societies. Weight and shape concerns are highly prevalent during adolescence and an alarming percentage of adolescents already show disturbed eating patterns. Sociocultural factors like the beauty ideal promoted by the media and social agents are among the main reasons for this trend. Prevention programmes which focus on established protective and risk factors are needed to counteract problematic developments as early as possible. Subject and methods In this paper we describe the development and the contents of a structured school-based eating disorder prevention programme for adolescents. Results The POPS programme (POtsdam Prevention at Schools) is an interactive multisession programme and encompasses nine lessons for pupils and one meeting with the parents. The programme is based on current research on risk and protective factors for eating disorders with an emphasis on sociocultural factors. It is designed to enhance resources based on the life skills approach. We included for instance lessons to enhance healthy eating and exercise habits and to reduce unhealthy dieting, to build up resistance through media literacy and strategies to react to social pressure. To further enhance life skills we integrated the impartation of problem-solving techniques and coping strategies which are potential protective factors not only in relation to eating disorders but also other diseases. In contrast to most existing programmes, psychoeducation on eating disorders is not part of the POPS programme for pupils but part of the information session for the parents. Conclusion POPS is a theory-based, structured prevention programme that can be implemented by teachers as part of regular lessons.
    Preview · Article · Aug 2011 · Journal of Public Health
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    • "Efficacy studies on CBT-GSH have focused on BN and BED primarily in specialty treatment settings (Wilson et al., 2007) even though a majority of patients with eating disorders are identified and treated in primary care settings (Hoek & van Hoeken, 2003; Striegel-Moore et al., 2008). Moreover, evidence suggests that lay individuals believe that eating disorders should be treated in a primary care setting (Mond & Hay, 2008; Mond, Hay, Rodgers, Owen, & Beumont, 2004b). "
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    ABSTRACT: Despite proven efficacy of cognitive behavioral therapy (CBT) for treating eating disorders with binge eating as the core symptom, few patients receive CBT in clinical practice. Our blended efficacy-effectiveness study sought to evaluate whether a manual-based guided self-help form of CBT (CBT-GSH), delivered in 8 sessions in a health maintenance organization setting over a 12-week period by master's-level interventionists, is more effective than treatment as usual (TAU). In all, 123 individuals (mean age = 37.2; 91.9% female, 96.7% non-Hispanic White) were randomized, including 10.6% with bulimia nervosa (BN), 48% with binge eating disorder (BED), and 41.4% with recurrent binge eating in the absence of BN or BED. Baseline, posttreatment, and 6- and 12-month follow-up data were used in intent-to-treat analyses. At 12-month follow-up, CBT-GSH resulted in greater abstinence from binge eating (64.2%) than TAU (44.6%; number needed to treat = 5), as measured by the Eating Disorder Examination (EDE). Secondary outcomes reflected greater improvements in the CBT-GSH group in dietary restraint (d = 0.30); eating, shape, and weight concern (ds = 0.54, 1.01, 0.49, respectively; measured by the EDE Questionnaire); depression (d = 0.56; Beck Depression Inventory); and social adjustment (d = 0.58; Work and Social Adjustment Scale), but not weight change. CBT-GSH is a viable first-line treatment option for the majority of patients with recurrent binge eating who do not meet diagnostic criteria for BN or anorexia nervosa.
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    ABSTRACT: The aim of this chapter is to discuss the concept of endophenotypes within the eating disorder (ED) population. As is common in most forms of psychiatric illness, people with ED have additional psychological problems, as do their family members. Affective disorders, addictions, and autistic spectrum disorders commonly occur in association with the individual and/or in the families of those with ED. This chapter will explore the literature related to underlying biological markers that potentially underpin all of these disorders. Some of the biomarkers fulfi l the criteria for an endophenotype, although this is an area that is poorly developed so far in the eating disorder fi eld. It is possible that core inherited vulnerability traits such as anxiety, rigidity, weak coherence, poor social cognition, compulsivity and impulsivity are some of the features held in common with other disorders.
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