Table 4 Impact of interventions on comorbid individual and parent/carer factors (aim 2 and 3)
Author (year) [Country], Design (Setting)a | Mean age (SD), Sample n, % female, race/ethnicity, SES, Diagnosis | Intervention | Young person domain (measure) | Young person outcome | Parent domain (measure) | Parent outcome |
|---|---|---|---|---|---|---|
Randomised controlled trials | ||||||
Field et al. (1998) [USA] RCT (Residential) | nr (nr, range 16–21) N = 24 F: 100% E: Hispanic 68%, Non-Hispanic White 32%, SES: Middle to upper SES [2.2 on Hollingshead Index]) DSM-III-R BN (100%) | Massage therapy + TAU vs TAU 10 massages/5 weeks | Depression (POMS-D, CES-D) Anxiety (state; self-report) (STAI) Anxiety (observational) (BOS) | Pre-post massage on first day Significant decrease on depression (POMS-D; p = .001, ES nr), self-report state anxiety (STAI-state; p = .001, ES nr) and observe anxiety (BOS; p = .005, ES nr). No significant effects for the control group Pre-post massage on last day Significant decrease on depression (POMS-D; p = .001, ES nr), self-report state anxiety (STAI-state; p = .001, ES nr) but not observed anxiety (BOS; p nr, ES nr). No significant effects for the control group Pre-post 5-week (10 massages) intervention plus TAU Significant decrease on depression (CES-D) in both massage (p = .001, ES nr) and control groups (p = .05, ES nr) | Nil measured | Nil measured |
Johnson et al. (1998) [USA] RCT (OP) | 17 (nr) N = 13 F: 100% E: nr SES: nr) DSM-III-R BN (100%) | EFFT vs group CBT 10 weeks CBT Group Therapy vs 10 sessions of EFFT | Depression (BDI) General Psychiatric Symptoms (SCL-90-R) | Both treatment arms Significant decrease in general psychiatric symptomatology after both CBT and EFFT on SCL-90-R and BDI (p’s < .05, EF nr). SCL-90-R subscales not reported. No between group effect EFFT group only: Reduction on BDI (p < .05, EF nr) and SCL-90-R obsessive compulsivity (p < .05, EF nr), interpersonal sensitivity (p < .01, EF nr), depression (p < .05, EF nr), hostility (p < .05) and psychoticism (p < .05, EF nr) subscales | Nil measured | Nil measured |
Le Grange et al. (2007) [USA] RCT (OP) | 16.1 (1.7) N = 80 F: 98% E: White 64%, Hispanic 20%, African American 11%, Other 5% SES: nr DSM-IV BN (46.2%) Subthreshold BN (53.8%) | FBT-BN (n = 41) vs SPT (n = 39) 20 sessions/6 months | Depression (BDI) Self-esteem (RSES) | Mixed effects linear regression models showed no differences between groups at EOT or 6mfu in self-esteem (RSES; p = 0.33, ES nr) and depression (BDI; p = 0.72, ES nr) | Nil measured | Nil measured |
Le Grange et al. (2015) [USA] RCT (OP) | 15.8 (1.5) N = 109 F: 94% E: 46% “ethnic minority” SES: Income > 100 K (CBT-A 40%, FBT-BN 37%), Parent with college degree: [CBT-A 74%, FBT-BN 65%]) DSM -IV BN/Partial BN (100%) | FBT-BN (n = 51) vs CBT (n = 58) vs SPT (n = 20; not included in analysis) 18 sessions/6 months | Depression (BDI) General obsessive–compulsive symptoms (CYBOCS) ED-specific obsessive–compulsive symptoms (YBC-ED) Self-esteem (RSES) | Using mixed effects modelling, depression (BDI) was the only domain that showed a significant group difference (p = .049, d = 0.361) at EOT. The FBT-BN group had lower BDI scores compared to the CBT-A group. No significant between group effects observed for obsessive–compulsive symptoms (CYBOCS) or ED specific obsessive–compulsive symptoms (YBC-ED) at any timepoint (EOT, 6mfu, 12mfu) NB: Self-esteem (Valenzuela, et al. 2018) and obsessive–compulsive (Reilly et al. 2022) data from this trial are presented in secondary analyses | Family Functioning (FES) | Only baseline data reported |
Stefini et al. (2017) [Germany] RCT (OP) | 18.7 (1.9) N = 81 F: 100% E: nr SES: nr DSM-IV BN (77.7%), DSM-IV Partial BN (22.3%) | CBT (n = 39) vs PDT (n = 42) Up to 60 sessions/1 yr | General Psychiatric Symptoms (SCL-90-R) | Significant reduction in general psychiatric symptoms (SCL-90-R) in both groups—CBT group (within subjects p < .001, d = 0.51); PDT group (within subjects p < .001, d = 0.24). No difference between groups (p = .35, d = 0.16) | Nil measured | Nil measured |
RCT secondary analysis | ||||||
Reilly et al. (2022) [USA] Secondary Analysis (Le Grange RCT 2015) (OP) | As per Le Grange, et al. (2015) | As per Le Grange, et al. (2015) | General Obsessive–Compulsive symptoms (CYBOCS) ED Specific Obsessive–Compulsive symptoms (YBC-ED) | Multilevel models showed no change in general obsessive–compulsive symptoms (CYBOCS) over time in either treatment (p = .155, R2 = .01) Significant decrease in ED specific obsessive–compulsive symptoms (YBC-ED) throughout treatment and follow-up, irrespective of treatment type (p < .001, R2 = .03) | Nil measured | Nil measured |
Valenzuela et al. (2018) [USA] Secondary Analysis (Le Grange RCT 2015) (OP) | As per Le Grange, et al. (2015) | As per Le Grange, et al. (2015) | Depression (BDI) Self-esteem (RSES) | Significant reduction in depression (BDI) in both groups (p < .001, estimate = − 3.18 [95%CI − 3.78, − 2.57]). No difference between groups (p nr, estimate = − 0.11 [95%CI − 0.72, 0.49]) Significant improvement in self-esteem (RSES) in both groups (p < .001, estimate = − 3.30 [95%CI 2.35, 4.25]). No difference between groups (p nr, estimate = 0.25 [95%CI − 0.70, 1.20]) | Nil measured | Nil measured |
Single-arm studies | ||||||
Kotler et al. (2003) [USA] Case Series (OP) | 16.2 (1.0) N = 10 F: 100% E: Caucasian 50%, Hispanic 30%, Asian American 10%, Indian 10%, SES: nr DSM-IV BN (80%) EDNOS (20%) | Fluoxetine 60 mg/day with supportive psychotherapy 8 weeks | Depression (BDI) Anxiety (SCARED) | Significant decrease on anxiety (SCARED; p < .05, ES nr), but not depression (BDI; p nr, ES nr) | Nil measured | Nil measured |
Lazaro et al. (2010) [Spain] Case Series (Day Hospital) | 16.3 (1.1) N (BN group): 44 F: 90.9% E: nr SES: nr Mixed ED sample (AN/BN/EDNOS) DSM-IV BN (63.6%) EDNOS-BN (36.3%) | Structured behavioural self-esteem and social skills group therapy in day treatment programme 8 sessions/2 months | Self-esteem/concept (PHC-SCS) Self-esteem in eating disorders (SEED) Social Skills (BAS-3) | Significant improvement on 3 self-esteem/concept (PHC-SCS) subscales; intellectual/school status (p = .010, ES nr), physical appearance (p = .008, ES nr), freedom from anxiety (p = .040, ES nr). No change in behavioural adjustment (p = .582, ES nr), popularity (p = .141, ES nr) or happiness/satisfaction (p = .438, ES nr) subscales No change in self-concept (SEED) related others (p = .079, ES nr) or weight/shape (p = .054, ES nr) Significant improvements on 2 social skills (BAS-3) subscales; consideration for others (p = .015, ES nr), and social withdrawal (p = .042, ES nr). No change in self- control in social relations (p = .138, ES nr), social anxiety/shyness (p = .230, ES nr), or leadership (p < .001, ES nr). No change on consideration for others (p = .066, ES nr) subscales | Nil measured | Nil measured |
Martinez-Mallen et al. (2007) [Spain] Case Series (OP/Day Hospital) | 16.7 (SD 1.5) N = 25 F: 100% E: nr SES: nr DSM-IV BN (100%) (not responded to standard care) | Cue Exposure Program 12 session/6-weeks | Depression (BDI) Anxiety (state and trait) (STAI) | Significant reduction in state (STAI-state; p < .05, ES nr) and trait (STAI-trait; p < .05, ES nr) anxiety Significant reduction in depression (BDI; p < .05, ES nr) NB: p values are from one-way ANOVA using 3 timepoints (baseline, EOT, 6 m FU) | Nil measured | Nil measured |
Murray et al. (2015) [USA] Case Series (PHP) | 15.7 (1.11) N = 35 F: 100%, E: Caucasian 63.8%, Hispanic 14.5%, Asian 2.9%, Black 2.9%, Other 15.9% SES: nr BN (100%) | Integrated FBT and DBT 3-10 h/day, up to 6 days/week. Mean treatment length 77.18 days (SD 38.91) | Emotion regulation (DERS) | Significant improvement on 1 DERS subscale; access to emotion regulation strategies (p = .045, ES nr) at end-of-treatment. No significant change in global score or non-acceptance, goal difficulties, impulse difficulties, emotional awareness, lack of emotional clarity and global subscales of DERS (all p’s > .05, ES nr) | Parent eating-disorder-related self-efficacy (PVA) | Significant increase in eating-disorder-related parental self-efficacy (PVA) across treatment (p = .001, ES nr) |
Stewart et al. (2021) [UK] Retrospective audit (OP) | 15.6 (1.4) N = 50 F: 98% E: nr SES: nr BN (100%) | MFT-BN Weekly/4 months | Depression (RCADS-D) Anxiety (RCADS-A) Emotion regulation (DERS) | Significant reduction in depression (RCADS-depression; p = .011, d = − 0.78), anxiety (RCADS-anxiety; p = .025, d = − 0.64) and global emotion regulation (DERS-total; p = .001, d = − 2.17) | Parent depression (HADS) Parent anxiety (HADS) Parent negative experiences of caregiving (ECI) | Significant reduction in parental depression (HADS-depression; p = .045, d − 0.33) and negative experiences of caregiving (ECI; p = .026, d − 0.46). No change in parental anxiety (HADS-anxiety; p = .120, d = − 0.31) |