A multifaceted approach to early intervention in the eating disorders

Author: Marcela Radunz

Radunz, Marcela, 2023 A multifaceted approach to early intervention in the eating disorders, Flinders University, College of Education, Psychology and Social Work

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Eating disorders (EDs) are serious mental illnesses that have significant physical, social, and economic impacts. The need for early intervention is crucial, but this is a relatively new field of enquiry, and much is not known about the best way to provide services. Therefore, the overarching aim of this thesis was to progress our understanding of early intervention by presenting a multifaceted approach that builds upon the seminal work of previous early intervention models for EDs. This was achieved by addressing the following issues: (1) the lack of validation for duration of untreated illness in predicting poorer treatment outcomes, (2) the importance of focusing early intervention strategies on removing barriers to treatment seeking, and (3) placing early intervention strategies within primary health care settings to remove barriers to treatment seeking and promote earlier help-seeking.

The lack of validation for the use of duration of untreated illness in predicting poorer treatment outcomes was evaluated using a systematic review and meta-analysis investigating the relationship between duration of illness and treatment outcomes (Chapter 3). This study demonstrated a lack of association between duration and treatment outcomes for both anorexia nervosa and bulimia nervosa, suggesting duration does not lead to poorer treatment outcomes and its use to prescribe entry into early intervention programs is problematic.

To examine the importance of focusing early intervention strategies on removing barriers to treatment seeking, a systematic review and meta-analysis investigated the quantitative association on factors (i.e., perceived barriers, characteristics associated with treatment seeking and demographic variables) associated with help-seeking behaviour (Chapter 4). This study revealed denial of illness and the inability of others to provide help to be key barriers to treatment seeking. To address the lack of quantitative studies assessing barriers to treatment seeking using standardised and validated measures, Chapter 6 refined a previously validated assessment tool for barriers to treatment seeking. Confirmatory factor

analyses were conducted, with a 15-item six-factor solution providing the best fit. A range of psychosocial measures had relationships in the expected directions with the questionnaire subscales, with the denial subscale being a unique predictor of treatment seeking.

Chapters 7 and 8 evaluated an early intervention model in EDs focusing on removing barriers to treatment seeking by promoting early and rapid access to treatment. The emerge-ED program is an early intervention strategy in a primary healthcare setting in low socio-economic-status areas in South Australia. A preliminary case series evaluation of emerge-ED (Chapter 7) revealed large within-group effect size decreases from baseline to end of treatment across all clinical outcome measures. Given very high rates of missing data at the follow-up time points and many barriers to treatment delivery, Chapter 8 aimed to replicate findings from the original evaluation in a new cohort of participants. Further, it also aimed to report on participants’ views on barriers to treatment seeking and examine how this early intervention model in primary health care evolved to overcome barriers to treatment delivery in low socio-economic-status populations. Results revealed small to moderate effect size decreases for an ED sessional measure, replicating original findings. The most cited barrier to treatment seeking was denial of illness. To overcome barriers to treatment delivery clinicians had to deviate from treatment protocols and refine inclusion and exclusion criteria to better manage the number of referrals.

Overall, findings suggest duration of illness should not be emphasised when developing early intervention strategies for EDs. Instead, early intervention strategies should emphasize the removal of barriers to treatment seeking and the promotion of early help-seeking. The implementation of early intervention strategies in primary health care, such as the emerge-ED model, tackles several barriers to treatment-seeking and promotes early help-seeking. It does so by reducing the number of providers seen, ensuring the detection of eating disorders in individuals who might present to services for the treatment of comorbid

problems, addressing the gap in the transition between child and adolescent services, and focusing on the provision of eating disorder specialist treatment in areas of low socioeconomic status. There is an urgent need for future research to continue to investigate methods to assess, identify and evaluate interventions to remove barriers to treatment-seeking for people with EDs to promote earlier help-seeking.

Keywords: eating disorders, help seeking, denial, early intervention, barrier to treatment seeking

Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Education, Psychology and Social Work
Supervisor: Professor Tracey Wade