John Hodsoll1, Charlotte Rhind2, Nadia Micali3,4, Rebecca Hibbs2, Elizabeth Goddard2, Bruno Palazzo Nazar2,5, Ulrike Schmidt2, Simon Gowers6, Pamela Macdonald2, Gillian Todd2, Sabine Landau1, Janet Treasure2. 1. Department of Biostatistics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK. 2. Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK. 3. Behavioural and Brain Sciences Unit, University College London, Institute of Child Health, London, UK. 4. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil. 6. Adolescent Psychiatry, University of Liverpool, Chester, UK.
Abstract
AIM: The aim of the study is to establish the acceptability, feasibility and approximate size of the effect of adding a carer intervention [Experienced Caregivers Helping Others (ECHO)] to treatment as usual (TAU) for adolescents with anorexia nervosa. METHODS: The study is a pilot randomised trial comparing TAU (n = 50) alone or TAU plus ECHO with (n = 50) or without (n = 49) telephone guidance. Effect sizes (ESs) were regression coefficients standardised by baseline standard deviations of measure. RESULTS: Although engagement with ECHO was poor (only 36% of carers in the ECHO group read over 50% of the book), there were markers of intervention fidelity, in that caregivers in the ECHO group showed a moderate increase in carer skills (ES = 0.4) at 12 months and a reduction in accommodating and enabling behaviour at 6 months (ES = 0.17). In terms of efficacy, in the ECHO group, carers spent less time care giving (ES = 0.40, p = 0.04) at 1 year, and patients had a minor advantage in body mass index (ES = 0.17), fewer admissions, decreased peer problems (ES = -0.36) and more pro-social behaviours (ES = 0.53). The addition of telephone guidance to ECHO produced little additional benefit. CONCLUSIONS: The provision of self-management materials for carers to standard treatment for adolescent anorexia nervosa shows benefits for both carers and patients. This could be integrated as a form of early intervention in primary care.
AIM: The aim of the study is to establish the acceptability, feasibility and approximate size of the effect of adding a carer intervention [Experienced Caregivers Helping Others (ECHO)] to treatment as usual (TAU) for adolescents with anorexia nervosa. METHODS: The study is a pilot randomised trial comparing TAU (n = 50) alone or TAU plus ECHO with (n = 50) or without (n = 49) telephone guidance. Effect sizes (ESs) were regression coefficients standardised by baseline standard deviations of measure. RESULTS: Although engagement with ECHO was poor (only 36% of carers in the ECHO group read over 50% of the book), there were markers of intervention fidelity, in that caregivers in the ECHO group showed a moderate increase in carer skills (ES = 0.4) at 12 months and a reduction in accommodating and enabling behaviour at 6 months (ES = 0.17). In terms of efficacy, in the ECHO group, carers spent less time care giving (ES = 0.40, p = 0.04) at 1 year, and patients had a minor advantage in body mass index (ES = 0.17), fewer admissions, decreased peer problems (ES = -0.36) and more pro-social behaviours (ES = 0.53). The addition of telephone guidance to ECHO produced little additional benefit. CONCLUSIONS: The provision of self-management materials for carers to standard treatment for adolescent anorexia nervosa shows benefits for both carers and patients. This could be integrated as a form of early intervention in primary care.
Authors: Julia Philipp; Claudia Franta; Michael Zeiler; Stefanie Truttmann; Tanja Wittek; Hartmut Imgart; Annika Zanko; Ellen Auer-Welsbach; Dunja Mairhofer; Michaela Mitterer; Clarissa Laczkovics; Gabriele Schöfbeck; Elisabeth Jilka; Wolfgang B Egermann; Janet Treasure; Andreas F K Karwautz; Gudrun Wagner Journal: Int J Environ Res Public Health Date: 2021-04-27 Impact factor: 3.390
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