Prevention of eating disorders in at-risk college-age women
Prevention of eating disorders in at-risk college-age women
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DOI：
10.1001/archpsyc.63.8.881
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发表时间：
2006-08-01
影响因子：
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通讯作者：
Wilfley, Denise E.
中科院分区：
文献类型：
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作者：
Taylor, C. Barr;Bryson, Susan;Wilfley, Denise E.
背景：饮食失调是大学年龄女性中的一个重要健康问题，鉴于已经确定了饮食失调的可改变风险因素，并且已经评估了减少这些风险因素的干预措施，因此饮食失调可能是可以预防的。目的：确定基于互联网的心理社会干预是否可以预防有 ED 风险的年轻女性出现饮食失调 (ED)。地点：圣地亚哥和加利福尼亚州旧金山湾区。参与者： 通过校园电子邮件、海报和大众媒体招募对体重和体型高度关注的大学年龄女性。确定了 637 名符合条件的参与者，其中 157 人被排除，样本总数为 480 人。招募发生在 2000 年 11 月 13 日至 2003 年 10 月 10 日之间。 干预：一项为期 8 周、基于互联网的认知行为干预（学生团体）的随机对照试验，其中包括一个主持的在线讨论小组。参与者的研究时间长达 3 年。 主要结果指标：主要结果指标是亚临床或临床 ED 发病时间。次要指标包括体重问题量表、全球饮食失调检查问卷、饮食失调清单驱动的瘦弱、贪食症分量表和抑郁情绪的分数变化。对结果的调节因素进行了检查。结果：与对照组相比，学生团体干预组在干预后 (P < .001)、1 年 (P < .001) 和 2 年 (P < .001) 的体重问题量表得分显着降低。与对照组相比，治疗组体重问题量表评分降低的斜率显着更大 (P = .02)。在随访过程中，43 名参与者出现了亚临床或临床 ED。虽然干预组和对照组之间的 ED 发病率总体上没有显着差异，但干预措施显着减少了通过调节分析确定的 2 个亚组中 ED 的发病率：(1) 基线时体重指数 (BMI) 升高（>= 25，按体重公斤数除以米数平方计算）的参与者；(2) 在 1 个地点，参与者具有基线补偿行为（例如， 自我催吐、使用泻药、利尿剂、减肥药、强迫运动）。基线 BMI 升高的干预参与者没有出现 ED，而可比 BMI 对照组（基于生存分析）的 ED 发病率在 1 年时为 4.7%，在 2 年时为 11.9%。在BMI为25或更高的亚组中，与对照组相比，干预组的2年累积生存率显着降低（95%置信区间，干预组为0%；对照组为2.7%至21.1%）。对于具有基线补偿行为的旧金山湾区样本，干预组中有 4% 的参与者在 1 年时出现 ED，14.4% 在 2 年出现 ED。可比对照组的比率分别为 16% 和 30.4%。 结论：在对体重和体形高度关注的大学年龄女性中，为期 8 周的基于互联网的认知行为干预可以显着减轻体重和体形的担忧，持续长达 2 年，并降低 ED 发作的风险，至少在一些高危群体中是这样。据我们所知，这是第一项表明高危人群中 ED 可以预防的研究。
Context: Eating disorders, an important health problem among college-age women, may be preventable, given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors.Objective: To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders (EDs) in young women at risk for developing EDs.Setting: San Diego and the San Francisco Bay Area in California.Participants: College-age women with high weight and shape concerns were recruited via campus e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified, of whom 157 were excluded, for a total sample of 480. Recruitment occurred between November 13, 2000, and October 10, 2003.Intervention: A randomized controlled trial of an 8-week, Internet-based cognitive-behavioral intervention (Student Bodies) that included a moderated online discussion group. Participants were studied for up to 3 years.Main Outcome Measures: The main outcome measure was time to onset of a subclinical or clinical ED. Secondary measures included change in scores on the Weight Concerns Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood. Moderators of outcome were examined.Results: There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention (P < .001), 1 year (P < .001), and 2 years (P < .001). The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group (P = .02). Over the course of follow-up, 43 participants developed subclinical or clinical EDs. While there was no overall significant difference in onset of EDs between the intervention and control groups, the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses: (1) participants with an elevated body mass index (BMI) (>= 25, calculated as weight in kilograms divided by height in meters squared) at baseline and (2) at 1 site, participants with baseline compensatory behaviors (eg, self-induced vomiting, laxative use, diuretic use, diet pill use, driven exercise). No intervention participant with an elevated baseline BMI developed an ED, while the rates of onset of ED in the comparable BMI control group ( based on survival analysis) were 4.7% at 1 year and 11.9% at 2 years. In the subgroup with a BMI of 25 or higher, the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group (95% confidence interval, 0% for intervention group; 2.7% to 21.1% for control group). For the San Francisco Bay Area site sample with baseline compensatory behaviors, 4% of participants in the intervention group developed EDs at 1 year and 14.4%, by 2 years. Rates for the comparable control group were 16% and 30.4%, respectively.Conclusions: Among college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.