Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction

Katarina Lindstedt; Emma Forss; Marie Elwin; Lars Kjellin; Sanna Aila Gustafsson

doi:10.1186/s13034-020-00323-9

Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction

Child Adolesc Psychiatry Ment Health. 2020 May 2:14:16. doi: 10.1186/s13034-020-00323-9. eCollection 2020.

Authors

Katarina Lindstedt¹, Emma Forss², Marie Elwin¹, Lars Kjellin¹, Sanna Aila Gustafsson¹

Affiliations

¹ 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
² 2Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Abstract

Background: Despite major research efforts, current recommendations of treatment interventions for adolescents with anorexia nervosa are scarce, and the importance of patient satisfaction for treatment outcome is yet to be established. The overall aim of the present study was to examine treatment interventions and patient satisfaction in a naturalistic sample of adolescents with anorexia nervosa or subthreshold anorexia nervosa and possible associations to outcome defined as being in remission or not at treatment follow-up.

Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat). The samples consisted of 1899 patients who were follow-up registered 1 year after entering treatment and 474 patients who had completed a 1-year patient satisfaction questionnaire. A two-step cluster analysis was used for identifying subgroups of patients who received certain combinations and various amounts of treatment forms.

Results: Patients who received mainly family-based treatment and/or inpatient care were most likely to achieve remission at 1-year follow-up, compared to patients in the other clusters. They were also younger, in general. Individual therapy was the most common treatment form, and was most appreciated among the adolescents. At 1-year follow-up, many patients reported improvements in eating habits, but far fewer reported improvements regarding cognitive symptoms. Overall, the patients rated the therapist relationship in a rather positive way, but they gave quite low ratings to statements associated with their own participation in treatment.

Conclusions: The results indicate that young adolescents who receive mainly family-based treatment and/or inpatient care respond more rapidly to treatment compared to older adolescents who receive mainly individual therapy or mixed treatment interventions. At 1-year follow-up, the adolescents reported improvements in behavioral symptoms and seemed quite satisfied with the therapist relationship.

Keywords: Adolescents; Anorexia nervosa; Cluster analysis; Naturalistic sample; Patients’ perspectives; Treatment.