Explanatory Factors for Disease-Specific Health-Related Quality of Life in Women with Anorexia Nervosa

Laura Al-Dakhiel Winkler, Claire Gudex, Mia Beck Lichtenstein, Michael Ejnar Røder, Carol E Adair, Jan Magnus Sjögren, René Klinkby Støving, Laura Al-Dakhiel Winkler, Claire Gudex, Mia Beck Lichtenstein, Michael Ejnar Røder, Carol E Adair, Jan Magnus Sjögren, René Klinkby Støving

Abstract

A better understanding of explanatory factors for disease-specific health-related quality of life (HRQoL) in anorexia nervosa (AN) could help direct treatment providers to aspects of the most relevance for patient wellbeing and recovery. We aimed to investigate whether factors associated with HRQoL are the same for women with AN and normal-weight controls. The participants in this study were women with AN recruited from specialized eating disorder centers in Denmark and healthy, normal-weight controls invited via online social media. Participants completed online questionnaires on medical history, disease-specific HRQoL (Eating Disorders Quality of Life Scale, EDQLS) and generic HRQoL (SF-36), eating disorder symptomatology, depression, psychological wellbeing, and work and social adjustment. Questionnaires were fully completed by 211 women with AN (median age 21.7 years) and 199 controls (median age 23.9 years). Women with AN had poorer scores on all measures, i.e., worse HRQoL, psychological health, and work/social functioning. Eating disorder symptomatology affected EDQLS score in both groups, but poorer HRQoL in women with AN was also significantly associated with worse scores on bulimia, maturity fears, depression, vitality, and with older age. The factors investigated together explained 79% of the variance in EDQLS score. Management of disordered self-assessment and thought processes may be of particular importance to women with AN. Greater emphasis on these aspects alongside weight gain could enhance patient-clinician alliance and contribute to better treatment outcomes.

Keywords: anorexia nervosa; controls; female; quality of life; surveys and questionnaires.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

References

    1. Amianto F., Spalatro A., Ottone L., Abbate Daga G., Fassino S. Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome. Eur. Psychiatry. 2017;45:198–206. doi: 10.1016/j.eurpsy.2017.07.012.
    1. Agh T., Kovacs G., Supina D., Pawaskar M., Herman B.K., Voko Z., Sheehan D.V. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat. Weight Disord. 2016;21:353–364. doi: 10.1007/s40519-016-0264-x.
    1. Patrick D.L., Erickson P. Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. Oxford University Press; New York, NY, USA: 1993.
    1. Gregertsen E.C., Mandy W., Serpell L. The egosyntonic nature of anorexia: An impediment to recovery in anorexia nervosa treatment. Front. Psychol. 2017;8:2273. doi: 10.3389/fpsyg.2017.02273.
    1. Subramaniam M., Soh P., Ong C., Esmond Seow L.S., Picco L., Vaingankar J.A., Chong S.A. Patient-reported outcomes in obsessive-compulsive disorder. Dialogues Clin. Neurosci. 2014;16:239–254.
    1. Winkler L.A., Christiansen E., Lichtenstein M.B., Hansen N.B., Bilenberg N., Stoving R.K. Quality of life in eating disorders: A meta-analysis. Psychiatry Res. 2014;219:1–9. doi: 10.1016/j.psychres.2014.05.002.
    1. Doll H.A., Petersen S.E., Stewart-Brown S.L. Eating disorders and emotional and physical well-being: Associations between student self-reports of eating disorders and quality of life as measured by the SF-36. Qual. Life Res. 2005;14:705–717. doi: 10.1007/s11136-004-0792-0.
    1. Mitchison D., Hay P., Engel S., Crosby R., Le Grange D., Lacey H., Mond J., Slewa-Younan S., Touyz S. Assessment of quality of life in people with severe and enduring anorexia nervosa: A comparison of generic and specific instruments. BMC Psychiatry. 2013;13:284. doi: 10.1186/1471-244X-13-284.
    1. Adair C.E., Marcoux G.C., Cram B.S., Ewashen C.J., Chafe J., Cassin S.E., Pinzon J., Gusella J.L., Geller J., Scattolon Y., et al. Development and multi-site validation of a new condition-specific quality of life measure for eating disorders. Health Qual. Life Outcomes. 2007;5:23. doi: 10.1186/1477-7525-5-23.
    1. Engel S.G., Wittrock D.A., Crosby R.D., Wonderlich S.A., Mitchell J.E., Kolotkin R.L. Development and psychometric validation of an eating disorder-specific health-related quality of life instrument. Int. J. Eat. Disord. 2006;39:62–71. doi: 10.1002/eat.20200.
    1. Abraham S.F., Brown T., Boyd C., Luscombe G., Russell J. Quality of life: Eating disorders. Aust. N. Z. J. Psychiatry. 2006;40:150–155. doi: 10.1080/j.1440-1614.2006.01762.x.
    1. Akoury L.M., Rozalski V., Barchard K.A., Warren C.S. Eating Disorder Quality of Life Scale (EDQLS) in ethnically diverse college women: An exploratory factor analysis. Health Qual. Life Outcomes. 2018;16:39. doi: 10.1186/s12955-018-0867-1.
    1. Bamford B., Barras C., Sly R., Stiles-Shields C., Touyz S., Le Grange D., Hay P., Crosby R., Lacey H. Eating disorder symptoms and quality of life: Where should clinicians place their focus in severe and enduring anorexia nervosa? Int. J. Eat. Disord. 2015;48:133–138. doi: 10.1002/eat.22327.
    1. Martin J., Padierna A., Lorono A., Munoz P., Quintana J.M. Predictors of quality of life in patients with eating disorders. Eur. Psychiatry. 2017;45:182–189. doi: 10.1016/j.eurpsy.2017.07.001.
    1. Winkler L.A.D., Arnfred S.M., Røder M.E., Gudex C., Lichtenstein M.B., Adair C.E., Clausen L., Sjögren J.M., Støving R.K. Validating the Danish version of the Eating Disorder Quality of Life Scale (EDQLS) in anorexia nervosa. Eat. Weight Disord. under review.
    1. de Onis M., Onyango A.W., Borghi E., Siyam A., Nishida C., Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull. World Health Organ. 2007;85:660–667. doi: 10.2471/BLT.07.043497.
    1. Andersen S.B., Lindgreen P., Rokkedal K., Clausen L. Grasping the weight cut-off for anorexia nervosa in children and adolescents. Int. J. Eat. Disord. 2018;51:1346–1351. doi: 10.1002/eat.22977.
    1. Winkler L.A., Hemmingsen S.D., Gudex C., Blegvad A.C., Stoving R.K., Arnfred S.M.H. A Danish translation of the eating disorder quality of life scale (EDQLS) J. Eat. Disord. 2019;7:11. doi: 10.1186/s40337-019-0241-7.
    1. Ware J.E., Jr., Sherbourne C.D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med. Care. 1992;30:473–483.
    1. Bjorner J.B., Thunedborg K., Kristensen T.S., Modvig J., Bech P. The Danish SF-36 Health Survey: Translation and preliminary validity studies. J. Clin. Epidemiol. 1998;51:991–999. doi: 10.1016/S0895-4356(98)00091-2.
    1. Clausen L., Rosenvinge J.H., Friborg O., Rokkedal K. Validating the eating disorder inventory-3 (EDI-3): A comparison between 561 female eating disorders patients and 878 females from the general population. J. Psychopathol. Behav. Assess. 2011;33:101–110. doi: 10.1007/s10862-010-9207-4.
    1. Garner D.M. The Eating Disorder Inventory-3 Professional Manual. Psychological Assessment Resources, Inc.; Lutz, FL, USA: 2004.
    1. Beck A.T., Steer R.A., Ball R., Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J. Pers. Assess. 1996;67:588–597. doi: 10.1207/s15327752jpa6703_13.
    1. Thastum M., Ravn K., Sommer S., Trillingsgaard A. Reliability, validity and normative data for the Danish Beck Youth Inventories. Scand. J. Psychol. 2009;50:47–54. doi: 10.1111/j.1467-9450.2008.00690.x.
    1. Bech P. Health-related quality of life measurements in the assessment of pain clinic results. Acta Anaesthesiol. Scand. 1999;43:893–896. doi: 10.1034/j.1399-6576.1999.430906.x.
    1. Bech P., Olsen L.R., Kjoller M., Rasmussen N.K. Measuring well-being rather than the absence of distress symptoms: A comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale. Int. J. Methods Psychiatr. Res. 2003;12:85–91. doi: 10.1002/mpr.145.
    1. Topp C.W., Ostergaard S.D., Sondergaard S., Bech P. The WHO-5 Well-Being Index: A systematic review of the literature. Psychother. Psychosom. 2015;84:167–176. doi: 10.1159/000376585.
    1. Mundt J.C., Marks I.M., Shear M.K., Greist J.H. The Work and Social Adjustment Scale: A simple measure of impairment in functioning. Br. J. Psychiatry. 2002;180:461–464. doi: 10.1192/bjp.180.5.461.
    1. Pedersen G., Kvarstein E.H., Wilberg T. The Work and Social Adjustment Scale: Psychometric properties and validity among males and females, and outpatients with and without personality disorders. Personal. Ment. Health. 2017;11:215–228. doi: 10.1002/pmh.1382.
    1. Lumley T., Diehr P., Emerson S., Chen L. The importance of the normality assumption in large public health data sets. Annu. Rev. Public Health. 2002;23:151–169. doi: 10.1146/annurev.publhealth.23.100901.140546.
    1. Abbate-Daga G., Facchini F., Marzola E., Delsedime N., Giovannone C., Amianto F., Fassino S. Health-related quality of life in adult inpatients affected by anorexia nervosa. Eur. Eat. Disord. Rev. 2014;22:285–291. doi: 10.1002/erv.2302.
    1. Weigel A., Konig H.H., Gumz A., Lowe B., Brettschneider C. Correlates of health related quality of life in anorexia nervosa. Int. J. Eat. Disord. 2016;49:630–634. doi: 10.1002/eat.22512.
    1. Jones A., Evans M., Bamford B., Ford H. Exploring quality of life for eating-disordered patients. Eur. Eat. Disord. Rev. 2008;16:276–286. doi: 10.1002/erv.852.
    1. Iburg K.M., Rasmussen N.K., Avlund K. Severity of self-reported diseases and symptoms in Denmark. Popul. Health Metr. 2006;4:3. doi: 10.1186/1478-7954-4-3.
    1. Jagielska G., Kacperska I. Outcome, comorbidity and prognosis in anorexia nervosa. Psychiatr. Pol. 2017;51:205–218. doi: 10.12740/PP/64580.
    1. Errichiello L., Iodice D., Bruzzese D., Gherghi M., Senatore I. Prognostic factors and outcome in anorexia nervosa: A follow-up study. Eat. Weight Disord. 2016;21:73–82. doi: 10.1007/s40519-015-0211-2.
    1. Netuveli G., Wiggins R.D., Hildon Z., Montgomery S.M., Blane D. Quality of life at older ages: Evidence from the English longitudinal study of aging (wave 1) J. Epidemiol. Community Health. 2006;60:357–363. doi: 10.1136/jech.2005.040071.
    1. Welch G., Hall A., Walkey F. The factor structure of the eating disorders inventory. J. Clin. Psychol. 1988;44:51–56. doi: 10.1002/1097-4679(198801)44:1<51::AID-JCLP2270440111>;2-4.
    1. Bennett K., Stevens R. The internal structure of the Eating Disorder Inventory. Health Care Women Int. 1997;18:495–504. doi: 10.1080/07399339709516303.
    1. Eskild-Jensen M., Stoving R.K., Flindt C.F., Sjogren M. Comorbid depression as a negative predictor of weight gain during treatment of anorexia nervosa: A systematic scoping review. Eur. Eat. Dis. Rev. 2020;28:605–619. doi: 10.1002/erv.2787.
    1. Carrot B., Radon L., Hubert T., Vibert S., Duclos J., Curt F., Godart N. Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa? Eur. Child Adolesc. Psychiatry. 2017;26:969–978. doi: 10.1007/s00787-017-0963-5.
    1. Gibson D., Watters A., Cost J., Mascolo M., Mehler P.S. Extreme anorexia nervosa: Medical findings, outcomes, and inferences from a retrospective cohort. J. Eat. Disord. 2020;8:25. doi: 10.1186/s40337-020-00303-6.
    1. Davies A., Wellard-Cole L., Rangan A., Allman-Farinelli M. Validity of self-reported weight and height for BMI classification: A cross-sectional study among young adults. Nutrition. 2020;71:110622. doi: 10.1016/j.nut.2019.110622.
    1. Wolfe B.E., Kelly-Weeder S., Malcom A.W., McKenery M. Accuracy of self-reported body weight and height in remitted anorexia nervosa. J. Am. Psychiatr. Nurses Assoc. 2013;19:66–70. doi: 10.1177/1078390313481062.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel