A questionnaire survey regarding the support needed by Yogo teachers to take care of students suspected of having eating disorders (second report)

Abstract

BackgroundThe lowering of the age of onset and chronicity have been key problems related to eating disorders (EDs). As the proportion of teens in the estimated onset ages has increased, it has become important to detect students with EDs and to clarify how they can be supported. Though epidemiological surveys of Yogo teachers (school nurse/health science teachers) have been conducted to inquire about the number of such students, none of these were done according to ED type based on DSM-5. Thus, we conducted a wide area survey in Japan with the goal of proposing a better framework of support for Yogo teachers in their efforts to care for students with EDs.MethodsA questionnaire survey organized by ED type (based on DSM-5) was administered to Yogo teachers working at elementary/junior high/senior high/special needs schools in four prefectures of Japan in 2015, and 1,886 responses were obtained. Based on the results, the encounter rates (the proportion of Yogo teachers who had encountered a student with an ED) were calculated, and factors that could affect the rates were examined by logistic regression analysis.ResultsThe order of the encounter rates of the ED types was as follows: Anorexia Nervosa (AN) > Bulimia Nervosa (BN) > Avoidant/Restrictive Food Intake Disorder (ARFID) > Binge Eating Disorder (BED) > Others. The factors significantly affecting the rates were “location, school type, number of students, experience years, and AN knowledge” for AN, “school type, experience years, and BN knowledge” for BN, “school type, experience years, and BED knowledge” for BED, “location, experience years, and ARFID knowledge” for ARFID, and “school type, experience years, and Others knowledge” for Others.ConclusionsBecause the encounter rate of AN was the highest, providing support for AN would be the most effective. Moreover, one factor that affected the encounter rate of all ED types was ED knowledge. In addition to this, senior high schools had the highest encounter rates for AN, BN and BED, and special needs schools had the highest rates for Others. These findings imply that, in order to detect and support ED students at an early stage, it is necessary to offer knowledge of the most prevalent ED types to Yogo teachers at the corresponding school type.

A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings

“…The recent questionnaire survey of children and youth in schools revealed high rates of suspected cases of BN and binge eating disorders (BED) among adolescents, but there were few chances to access special treatment services due to the hesitation of the patients as well as the lack of available delivery services in EDs in the community [ 23 ]. A way of providing support in the community should be required, as the proportion of teens at the estimated onset age of EDs has increased year by year in Japan [ 24 ].…”

The changing profile of eating disorders and related sociocultural factors in Japan between 1700 and 2020: A systematic scoping review

“…Interestingly, despite findings from the national report conducted in 2014–15 indicating low annual incidence rates of BED and no cases of ARFID at hospitals, teachers working with children and adolescents (e.g., elementary school–high school) have reported encountering multiple cases of ARFID and BED amongst their pupils during this time (Seike et al, 2016, 2016). This suggests that patients with these disorders avoid professional help or that clinicians in hospitals are unaware of these disorders in Japan.…”

Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder

“…Potential participants were provided with a link to a web‐based survey in the information letter, with the survey and study database maintained using Research Electronic Data Capture (REDCap; Harris et al, 2009), which was hosted by the BC Children's Hospital Research Institute. Given the high proportion of participants in previous studies who have reported a lack of familiarity with the diagnosis of ARFID (Katzman et al, 2014; Seike et al, 2016), to reduce selection bias study recruitment materials did not include the term ARFID, and instead referred to a survey about familiarity with challenges relating to “picky eating”, and experiences in working with children and youth who may struggle with feeding or nutrition, or have anxiety related to food or eating. This wording was employed to include clinical presentations that the participants outside of specialized feeding or eating disorder programs may have encountered.…”

“…Similarly, a study of Yogo teachers in Japan (health educators who are also responsible for weighing students and reviewing medical records to screen for medical concerns) found that 13.0% of Yogo teachers had encountered youth with symptoms consistent with ARFID. The majority of Yogo teachers indicated they had limited knowledge about ARFID—58.8% reported not knowing the diagnosis well, and 15.4% reported not knowing anything about the diagnosis (Seike et al, 2016). In contrast, less than 1% of the sample reported an absence of knowledge concerning the diagnosis of anorexia nervosa (AN) or bulimia nervosa (BN), suggesting a discrepancy in knowledge across ED diagnoses.…”

“…We also evaluated whether individuals with previous experience in working with a pediatric ARFID population would report more confidence in providing clinical care for this condition relative to those who had not provided care for ARFID. We expected those with clinical experience to report higher confidence than those without ARFID clinical experience, but anticipated low levels of confidence in providing clinical care overall, given previous research demonstrating professionals' lack of familiarity with this diagnosis (e.g., Seike et al, 2016). Finally, we evaluated the application of diagnostic criteria of ARFID in a series of case vignettes, to explore the ability of health professionals with experience working with ARFID to make diagnostic judgments across differing clinical presentations (including psychosocial impairment alone, without weight loss/nutritional deficiency).…”