Identification of barriers and facilitating factors for the treatment initiation of patients with anorexia nervosa: Towards effective secondary prevention strategies and improved prognosis

确定神经性厌食症患者开始治疗的障碍和促进因素：制定有效的二级预防策略并改善预后

• 批准号: 391702426
• 负责人: Professorin Dr. Antje Gumz
• 金额: --
• 依托单位: Lehrstuhl für Psychiatrie und Psychotherapie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2021-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/391702426?language=en
• 关键词: Identification; barriers; facilitating; factors; treatment

Anorexia nervosa is a comparatively rare but serious illness, due to its somatic and psychological consequences. Compared to patients with any other mental illness, patients with AN have a higher mortality rate and are more likely to have a chronic course. Thus far, preventive interventions have not been very effective in reducing eating disorder risk or the duration of untreated illness, probably due to the low prevalence of AN in the general population and patients' limited insight into their illness. Preventive interventions should specifically target those at risk who are at the interface of particular parts of the health care system.The interval between the onset of the disorder and the treatment initiation, i.e. the duration of untreated illness (DUI) has a strong influence on the course of the illness. Specifically, patients with AN have a better prognosis if treated early. A better initial understanding of significant facilitative and hindering factors influencing the DUI is necessary before new targeted interventions can be designed. Primarily, the aim of this study is to identify predictors of the DUI. Based on these results, we aim to guide the development of effective secondary prevention strategies. Thereby, the study has the potential to ultimately encourage earlier treatment initiation of patients with AN and prevent chronic illness courses and associated high health care costs.For the first time in the investigation of factors influencing the DUI, this study will follow a multi-informant strategy: the perspectives of relatives and the primary care physicians will be incorporated in addition to the patients' views. Furthermore, we will specifically focus on factors which are modifiable and precise in their definition. The planned mixed-method study is divided in three consecutive sub-studies. In sub-study 1, we want to identify the modifiable factors influencing the DUI using semi-structured interviews and a multi-informant approach (patients, relatives, primary care physicians). We will determine the most relevant factors by employing a Grounded Theory approach to the qualitative analysis of the interviews. In sub-study 2, the identified factors influencing the DUI in patients with AN will be incorporated into a checklist and we will conduct a first psychometric evaluation of this newly developed instrument. In sub-study 3, we will again use the multi-informant approach and quantitatively (planned N for each type of informant; i.e., GPs, patients, relatives, N=130; 10 co-operating specialized clinics and 4 co-operating outpatient partners) determine the magnitude of the effects of a) a priori determined non-modifiable factors and b) the modifiable factors from the checklist. In conclusion, we aim to give recommendations to guide the conception of effective secondary prevention approaches in order to prospectively improve the prognosis of patients with AN.

神经性厌食症是一种相对罕见但严重的疾病，由于其身体和心理后果。与患有其他精神疾病的患者相比，AN患者的死亡率更高，而且更有可能出现慢性病程。到目前为止，预防性干预措施在减少饮食失调风险或未治疗疾病的持续时间方面并不是很有效，这可能是由于AN在普通人群中的患病率较低以及患者对自己疾病的了解有限。预防性干预措施应专门针对处于卫生保健系统特定部分界面的高危人群。发病和开始治疗之间的时间间隔，即未治疗疾病（DUI）的持续时间，对疾病的病程有很大影响。具体来说，AN患者如果早期治疗，预后会更好。在设计新的有针对性的干预措施之前，有必要更好地初步了解影响酒后驾驶的重要促进和阻碍因素。本研究的主要目的是确定酒后驾车的预测因素。基于这些结果，我们的目标是指导制定有效的二级预防策略。因此，该研究有可能最终鼓励AN患者早期开始治疗，并预防慢性疾病病程和相关的高医疗保健费用。在酒后驾驶影响因素的调查中，本研究将首次采用多信息提供者策略：除了患者的观点外，还将纳入亲属和初级保健医生的观点。此外，我们将特别关注在其定义中可修改和精确的因素。计划的混合方法研究分为三个连续的子研究。在子研究1中，我们希望通过半结构化访谈和多信息提供者方法（患者、亲属、初级保健医生）来确定影响DUI的可修改因素。我们将通过采用扎根理论方法对访谈进行定性分析来确定最相关的因素。在子研究2中，已确定的影响AN患者DUI的因素将被纳入一个检查表，我们将对这个新开发的工具进行第一次心理测量评估。在子研究3中，我们将再次使用多信息提供者方法并定量地（为每种类型的信息提供者计划N个，即全科医生、患者、亲属，N=130； 10个合作专科诊所和4个合作门诊伙伴）确定a)先验确定的不可修改因素和b)清单中的可修改因素的影响程度。总之，我们的目的是提出建议，指导有效的二级预防方法的概念，以前瞻性地改善AN患者的预后。