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Depression, Worry, and Psychosocial Functioning
Predict Eating Disorder Treatment Outcomes in a
Residential and Partial Hospitalization Setting
Laura Fewell, BA, McCallum Place Eating Disorder Centers, Cheri A. Levinson, PhD, University of Louisville, and Lynn Stark, DNP, McCallum Place Eating Disorder Centers
Background
• Many people with EDs have other comorbidities
• Nearly two-thirds have an anxiety
disorder (Kaye et al, 2004)
• Approximately half have a depressive
disorder (Pearlstein, 2002)
• Intensive treatment is often needed for serious
EDs
• Inpatient
• Residential
• Partial Hospitalization
• Yet findings on the effectiveness of such
centers vary (Fichter et al, 2006)
Measures
Participants:
Eating Disorder Examination Questionnaire (EDE-Q;
• 439 female (94%) and male (6%) patients
• Ages 11-60 (M = 23.92; SD = 9.67)
• Primarily European American (N = 412; 94%)
• Receiving intensive ED treatment
• 62.9% diagnosed with AN
Fairburn, 2008)
Procedure:
• Ex: “To what extent have your…eating habits…
40
• Do depression, worry, and psychosocial
functioning predict ED symptomatology,
impairment, or body mass index (BMI) [in AN] at
one year follow up?
Hypotheses:
1. ED symptomatology and impairment will be
significantly lower at discharge and one year
follow up than at treatment admission
2. BMI in AN will be significantly higher at discharge
and one year follow up than at treatment
admission
3. Higher levels of depression will predict higher ED
symptomatology and impairment at one year
follow up
4. Higher levels of worry will predict higher ED
symptomatology and impairment at one year
follow up
5. Lower levels of psychosocial functioning will
predict higher ED symptomatology and
impairment at one year follow up
• Ex: “My worries overwhelm me.”
World Health Disability Assessment Schedule 2.0
4.5
(WHODAS; Ustün et al, 2010)
4
30
3.5
CIA*
25
20
3
15
2.5
10
2
5
• Do patients improve after intensive ED treatment?
• Do patients maintain improvement one year
after discharge?
Beck Depression Inventory II (BDI-II; Beck et al, 1996)
• 21-item measure of depression
Penn State Worry Questionnaire (PSWQ; Meyer et al, 1990)
• Measures trait assessment of pathological worry
EDE-Q and CIA Over Time
• Identifying factors that influence ED outcomes is
necessary for improving treatment approaches
Research Questions:
made it difficult to eat out with others?”
• Patients completed measures at admission,
discharge, and one year follow up
• BMI was collected at admission, discharge and
(self-reported) at one year follow up
35
Objectives
• Self-report questionnaire designed to assess ED
behaviors and thoughts
Clinical Impairment Assessment (CIA; Bohn & Fairburn, 2008)
• 16-item measure of psychological and social
impairment related to an ED
0
EDE-Q**
• Eating disorders (EDs) affect up to 13.1% of the
U.S. population by age 20 (Stice et al, 2013)
Methods
• 36-item, self-report measure of psychosocial
functioning
• Global score comprised of six domains of abilities
“Ex: “How much difficulty did you have in
maintaining a friendship?
Body Mass Index (BMI)
1.5
Admission
Discharge
Results
1 Year Follow Up
*Score of 16 predicts “eating disorder case status”
**Clinical cutoff score is 4.0
Change over time:
• ED symptomatology and impairment were lower
and BMI in AN was higher at discharge and one
year follow up than admission
β
Part r
Worry
.25**
.26**
Depression
.25**
.20**
Psychosocial Functioning
-.61**
-.52**
Admission EDE-Q
.57**
.48**
β
Part r
• Depression and worry predicted both ED
symptomatology and impairment at one year
follow up
• Psychosocial functioning predicted ED
symptomatology (b =-.61, p <.001) and impairment
(b =-.41, p <.001), but the direction was negative
• Depression (p =.09) and worry (p =.83) did not
predict BMI in AN at one year follow up
Worry
.34**
.27**
Discussion
Depression
.19*
.13*
Psychosocial Functioning
.-41**
-.31**
Admission CIA
.32**
.21**
Regression 1: One Year Follow
Up ED Symptoms
Regression 2: One Year Follow
Up Impairment
** p < .001; * p < .05
Predictors of Outcomes:
• Patients showed significant improvement after
undergoing intensive ED treatment
• Depression, worry, and psychosocial functioning
predicted ED impairment and symptoms at one year
follow up
• Clinicians should consider treating depression,
worry, and psychosocial functioning when treating
EDs