Can you find the right support for children, adolescents and young adults with anorexia nervosa: Access to age‐appropriate care systems in various healthcare systems

Herpertz‐Dahlmann, Beate; Bonin, Eva-Maria; Dahmen, Brigitte

doi:10.1002/erv.2825

Cited by 20 publications

(17 citation statements)

References 80 publications

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“…1 EDs are of particular concern in adolescence and young adulthood, which are critical stages of development that can be negatively affected by the consequences of EDs. 2 EDs pose a significant public health burden, with up to 10% of the total US population struggling with an ED during their lifetime. [3][4][5] The cost of ED care in the US is high, with a 2020 report revealing the annual cost to society of $64.7 billion.…”

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confidence: 99%

Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume

et al. 2022

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ImportanceThe COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking.ObjectiveTo compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic.Design, Setting, and ParticipantsUsing an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospital-based adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were compared separately for inpatient and outpatient settings. Demographic data such as race and ethnicity were not collected because this study used monthly summary data.ExposuresOnset of the COVID-19 pandemic.Main Outcomes and MeasuresMonthly number of patients seeking inpatient/outpatient ED-related care.ResultsAggregate total inpatient ED admissions were 81 in January 2018 and 109 in February 2020. Aggregate total new outpatient assessments were 195 in January 2018 and 254 in February 2020. Before the COVID-19 pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month (95% CI, 0.2%-1.3%). After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month (95% CI, 4.8%-9.7%) through April 2021, then a decrease of 3.6% per month (95% CI, −6.0% to −1.1%) through December 2021. Prepandemic, pooled data showed relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline (95% CI, −50.4% to −26.7%) in April 2020. Subsequently, new assessments increased by 8.1% (95% CI, 5.3%-11.1%) per month through April 2021, then decreased by 1.5% per month (95% CI, −3.6% to 0.7%) through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 (95% CI, 6.2-10.2) additional inquiries for care per month in the first year after onset of the pandemic.Conclusions and RelevanceIn this study, there was a significant COVID-19 pandemic-related increase in both inpatient and outpatient volume of patients with EDs across sites, particularly in the first year of the pandemic. Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.

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confidence: 99%

Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume

et al. 2022

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“…A high proportion of children with eating disorders require a continuity of specialist treatment (Herpertz‐Dahlmann et al., 2021). Children and adolescents with an eating disorder have a 4.5 (95% confidence interval range of 3.5–5.7) times higher risk of being referred for adult mental health treatment than the general population (Castagnini et al., 2016).…”

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confidence: 99%

“…Herpertz‐Dahlmann et al. (2021) identified three main obstacles to continuity of care. The first is that many young people with eating disorders display a lack of insight into their illness and use their newly acquired autonomy to renew weight loss and practice unhealthy eating behaviour.…”

Section: Resultsmentioning

confidence: 99%

A systematic review: Solutions to problems caused by age transition between eating disorder services

Wade

2022

Euro Eating Disorders Rev

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This systematic review examines age transition issues specific to young people with eating disorders, including the extent of, and reasons for, problematic transition. Suggested solutions are examined, with focus on ageintegrated services.Method: PsycINFO, Medline and SCOPUS databases were searched on 4 April, 2022 using two inclusion criteria: (1) a peer-reviewed journal article in English, (2) focus on service transition caused by moving from childhood to adulthood for people with eating disorders. A narrative integration of the content was used.Results: Of the 17 non-overlapping studies located in the review, 6 involved quantitative data. Problematic transition between age-based services was indicated, where a substantial minority of young people who still require help lose contact with speciality services. A variety of reasons for this problematic transition were identified, including differing and sometimes adversarial cultures between age-based services. While a variety of solutions have been suggested, the least explored was the development of age integrated services; only 3 papers focussed primarily on this. Conclusion:The consideration of the advantages of integration and the similarities between age-based services suggested that these potentially outweigh the barriers to integration. An implementation science research agenda is required to test this hypothesis.

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“…Nevertheless, these studies are also limited in that they explore motivation to change only during one treatment setting and not among patients across different treatment settings. However, a change in treatment setting is very common, especially in children and adolescents with AN (17). Investigating motivation to change across treatment settings in adolescent patients could lead to interesting insights into the path to recovery to improve both treatments and outcomes for these patients.…”

Section: Introductionmentioning

confidence: 99%

Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome

et al. 2021

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Introduction: Anorexia nervosa (AN) is a serious mental disorder that typically manifests in adolescence. Motivation to change is an important predictor for treatment outcome in adolescent AN, even though its development over the often long therapeutic process, with transitions between treatment settings, has not yet been studied. In this pilot study, the course of motivation to change and its effect on treatment outcome were investigated over the course of a step-down treatment approach during a 12-month observation period.Methods: Twenty-one adolescents admitted to inpatient treatment because of AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Eating disorder (ED-)specific cognitive [Eating Disorder Inventory 2 (EDI-2) subscales] and physical [% expected body weight (%EBW)] illness severity and motivation to change [Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ)] were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated.Results: Mean motivation to change improved significantly over the course of treatment from the contemplation stage [2nd stage, mean ANSOCQ sum score 47.26 (SD 17.60)] at admission to the action stage [4th stage, mean ANSOCQ sum score 77.64 (SD 18.97)] at the end of HoT (p < 0.001) and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower ED-specific cognitive illness severity (Spearman ρs: −0.53 to −0.77, all p < 0.05). Only pretreatment motivation to change significantly predicted ED-specific cognitive illness severity after the first inpatient treatment phase when taking prior illness severity into account.Conclusions: Motivation to change is an important aspect of treatment success in adolescent AN, especially in the early phase of treatment. In addition, home treatment contributed significantly to a higher motivation. Further longitudinal research into how motivation to change in adolescent patients with AN is related to outcome in this often severe and enduring disease and into targeted therapeutic strategies and interventions that reliably enhance the motivation to change in adolescent patients with AN seems promising.

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Can you find the right support for children, adolescents and young adults with anorexia nervosa: Access to age‐appropriate care systems in various healthcare systems

Cited by 20 publications

References 80 publications

Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume

Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume

A systematic review: Solutions to problems caused by age transition between eating disorder services

Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome

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