Early changes in depression predict outcomes of inpatient adolescent anorexia nervosa
The aim of this study was to investigate the predictive value of early changes in depression levels during inpatient treatment of adolescent anorexia nervosa (AN).
Fifty-six adolescents (88% girls) aged 10–18 years (M = 15.35, SD = 2.23) diagnosed with AN were assessed at admission and 1 month following admission to an inpatient setting. Depression levels and eating disorder symptoms were reported at both assessments. Re-hospitalization within 12 months of discharge was documented using official national records.
Whereas depression levels at baseline were found equivalent between subsequently re-hospitalized and non-re-hospitalized patients, at 1 month after admission patients who were later re-hospitalized had higher levels of depression compared to those who were not re-hospitalized. These differences remained significant after controlling for weight gain and anti-depressant medication intake. We additionally found that the proportion of boys in the non-re-hospitalized group was substantially larger than their proportion in the re-hospitalized group.
Our results suggest that depression at the point of hospital admission may not be a reliable predictor of treatment outcomes, and highlight the risk of relapse in AN patients whose depression levels do not alleviate after a month of inpatient treatment. Clinicians should consider providing more adjusted and intensive attention to such patients in their efforts to facilitate remission.
Level of evidence III
Well-designed cohort study.
KeywordsAnorexia nervosa Depression Adolescent Inpatient treatment
Compliance with ethical standards
Conflict of interest
On behalf of all the authors, the corresponding author states that there is no conflict of interest.
This study was approved by the Rabin Medical Center Review Board (approval number RMC-0468-12). All the procedures performed in the present study involving human participants were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Written informed consent was obtained from all individual participants and their parents.
- 4.American Psychiatric Association (2006) Practice guideline for the treatment of patients with eating disorders, 3rd ed. ArlingtonGoogle Scholar
- 5.National Collaborating Centre for Mental Health (2004) Eating disorders: core interventions in the treatment and management of Anorexia Nervosa, Bulimia Nervosa and related eating disorders. National Institute for Health and Care Excellence, UKGoogle Scholar
- 12.Franko DL, Tabri N, Keshaviah A, Murray HB, Herzog DB, Thomas JJ, Coniglio K, Keel PK, Eddy KT (2018) Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: data from a 22-year longitudinal study. J Psychiatr Res 96:183–188. https://doi.org/10.1016/j.jpsychires.2017.10.008 Google Scholar
- 14.Hetman I, Klomek AB, Goldzweig G, Hadas A, Horwitz M, Silvana Fennig M (2017) Percentage from target weight (PFTW) predicts re-hospitalization in adolescent anorexia nervosa. Isr J Psychiatry 54(3)Google Scholar
- 15.Herpertz-Dahlmann B, Wewetzer C, Remschmidt H (1995) The predictive value of depression in anorexia nervosa results of a seven-year follow-up study. Acta Psychiatr Scand 91(2):114–119. https://doi.org/10.1111/j.1600-0447.1995.tb09750.x Google Scholar
- 18.Tompkins KA, Swift JK (2014) Psychotherapy process and outcome research. Encyclopedia Clin Psychol. https://doi.org/10.1002/9781118625392.wbecp335
- 19.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5™ (5th edn). American Psychiatric Publishing, Inc., Arlington. https://doi.org/10.1176/appi.books.9780890425596
- 22.Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: Interview or self-report questionnaire? Int J Eat Disord 16(4):363–370. https://doi.org/10.1002/1098-108X(199412)16:4%3c363:AID-EAT2260160405%3e3.0.CO;2-# Google Scholar
- 24.Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. San Antonio 78(2):490–498Google Scholar
- 32.Szegedi A, Jansen WT, van Willigenburg AP, van der Meulen E, Stassen HH, Thase ME (2009) Early improvement in the first 2 weeks as a predictor of treatment outcome in patients with major depressive disorder: a meta-analysis including 6562 patients. J Clin Psychiatry 70:344–353. https://doi.org/10.4088/JCP.07m03780 Google Scholar
- 34.Dell'Osso L, Carpita B, Cremone IM, Muti D, Diadema E, Barberi FM, Massimetti G, Brondino N, Petrosino B, Politi P (2018) The mediating effect of trauma and stressor related symptoms and ruminations on the relationship between autistic traits and mood spectrum. Psychiatry Res. https://doi.org/10.1016/j.psychres.2018.10.040
- 37.Nielsen S, Anckarsäter H, Gillberg C, Gillberg C, Råstam M, Wentz E (2015) Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan–Russell outcome assessment schedule: a controlled community-based study. Mol Autism 6(1):14. https://doi.org/10.1186/s13229-015-0013-4 Google Scholar
- 40.Gregertsen EC, Mandy W, Kanakam N, Armstrong S, Serpell LJPR (2019) Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: a systematic review and meta-analysis. Psychiatry Res 271:484–501. https://doi.org/10.1016/j.psychres.2018.11.068 Google Scholar
- 48.Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA (2000) One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: Evidence from a national database of health insurance claims. Int J Eat Disord 27(4):381–389. https://doi.org/10.1002/(SICI)1098-108X(200005)27:4%3c381:AID-EAT2%3e3.0.CO;2-U Google Scholar
- 49.Strobel C, Quadflieg N, Voderholzer U, Naab S, Fichter MMJE, Weight Disorders-Studies on Anorexia B, Obesity (2018) Short-and long-term outcome of males treated for anorexia nervosa: a review of the literature. Eat Weight Disord 23(5):541–552. https://doi.org/10.1007/s40519-018-0538-6 Google Scholar
- 50.Junne F, Wild B, Resmark G, Giel KE, Teufel M, Martus P, Ziser K, Friederich HC, de Zwaan M, Löwe B (2019) The importance of body image disturbances for the outcome of outpatient psychotherapy in patients with anorexia nervosa: results of the ANTOP-study. Eur Eat Disord Rev 27(1):49–58. https://doi.org/10.1002/erv.2623 Google Scholar
- 51.Prost-Lehmann C, Shankland R, França LR, Laurent A, Flaudias VJPR (2018) Symptomatology long-term evolution after hospitalization for anorexia nervosa: Drive for thinness to explain effects of body dissatisfaction on type of outcome. Psychiatry Res 266:212–217. https://doi.org/10.1016/j.psychres.2018.05.024 Google Scholar
- 52.Marzola E, Abbate-Daga G (2018) Body image disturbances in anorexia nervosa. In: Cuzzolaro M, Fassinao S (eds) Body image, eating, and weight. Springer, Cahm, pp 113–126. https://doi.org/10.1007/978-3-319-90817-5_8