Examining Race as a Predictor and Moderator of Treatment Outcomes for Binge-Eating Disorder: Analysis of Aggregated Randomized Controlled Trials
Examining Race as a Predictor and Moderator of Treatment Outcomes for Binge-Eating Disorder: Analysis of Aggregated Randomized Controlled Trials
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DOI：
10.1037/ccp0000404
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发表时间：
2019-06-01
影响因子：
5.9
通讯作者：
Grilo, Carlos M.
中科院分区：
文献类型：
--
作者：
Lydecker, Janet A.;Gueorguieva, Ralitza;Grilo, Carlos M.
目的：检查种族是否预测或调节对暴食症（BED）治疗的反应。方法：参与者为 592 名患有 DSM-IV 定义的 BED 的成年人（n = 113 名黑人；n = 479 名白人），他们参加了在 1 个医疗中心进行的随机对照试验 (RCT)。数据来自 BED 测试认知行为疗法、行为减肥、多模式治疗和/或控制条件的随机对照试验。参与者测量了体重和身高，并在基线、治疗期间和治疗后使用既定访谈和自我报告措施进行评估。结果：种族并没有显着调节治疗结果。混合模型揭示了种族的主要影响：在不同时间点上，黑人参与者比白人参与者有更少的暴食事件和更低的抑郁症。种族在广义估计方程中也有主要影响，与白人参与者相比，黑人参与者获得暴食缓解的比例明显更高。种族并没有预测体重减轻的百分比，但黑人参与者体重减轻 5% 的比例明显低于白人参与者。种族并不能显着预测全球饮食失调的严重程度。结论：尽管流行病学和 RCT 研究报告的寻求治疗方面存在差异，但黑人在 BED 治疗研究中似乎具有与白人相当或更好的治疗结果，只是他们在治疗后实现 5% 体重减轻的可能性较小。这表明，在不同人群中传播基于证据的暴食症治疗方法是有希望的，并且治疗方法在传播之前可能不需要进一步调整。需要进行实施研究来测试不同提供者、环境和患者群体的治疗效果，以增进对潜在预测因素和调节因素的理解。
Objective: To examine whether race predicted or moderated response to treatments for binge-eating disorder (BED). Method: Participants were 592 adults (n = 113 Black; n = 479 White) with DSM-IV-defined BED who participated in randomized controlled trials (RCTs) at 1 medical center. Data were aggregated from RCTs for BED testing cognitive-behavioral therapy, behavioral weight loss, multimodal treatment, and/or control conditions. Participants had weight and height measured and were assessed using established interviews and self-report measures at baseline, throughout treatment, and post treatment. Results: Race did not significantly moderate treatment outcomes. Mixed models revealed a main effect of race: Black participants had fewer binge-eating episodes and lower depression than White participants across time points. Race also had a main effect in generalized estimating equations with a significantly greater proportion of Black participants achieving binge-eating remission than White participants. Race did not predict percent weight loss, but a significantly lower proportion of Black participants attained 5% weight loss than White participants. Race did not significantly predict global eating-disorder severity. Conclusion: Despite disparities in treatment-seeking reported in epidemiological and RCT studies, Black individuals appear to have comparable or better treatment outcomes in BED treatment research compared with White individuals, except they were less likely to attain 5% weight loss at post treatment. This suggests that disseminating evidence-based treatments for BED among diverse populations holds promise and treatments may not require further adaptation prior to dissemination. Implementation research is needed to test treatment effectiveness across diverse providers, settings, and patient groups to improve understanding of potential predictors and moderators.