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

神经性厌食症是一种相对罕见但严重的疾病，由于其躯体和心理后果。与任何其他精神疾病患者相比，AN患者的死亡率更高，更有可能有慢性病程。到目前为止，预防干预措施在减少进食障碍风险或未经治疗的疾病持续时间方面并不十分有效，这可能是由于AN在普通人群中的患病率较低，以及患者对其疾病的了解有限。预防干预措施应特别针对处于卫生保健系统特定部分交界处的高危人群。疾病发病和治疗开始之间的间隔，即未经治疗的病程对病程有很大影响。具体地说，如果早期治疗，AN患者的预后会更好。在设计新的有针对性的干预措施之前，必须更好地初步了解影响酒后驾车的重大促进因素和阻碍因素。首先，这项研究的目的是确定酒后驾车的预测因素。基于这些结果，我们旨在指导制定有效的二级预防策略。因此，这项研究有可能最终鼓励AN患者尽早开始治疗，并预防慢性病病程和相关的高昂医疗费用。在首次调查影响酒后驾车的因素时，本研究将遵循多信息者策略：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。计划中的混合方法研究分为三个连续的子研究。在子研究1中，我们希望使用半结构化访谈和多信息者方法(患者、亲属、初级保健医生)来确定影响酒后驾驶的可修改因素。我们将使用扎根理论的方法对访谈进行定性分析，以确定最相关的因素。在第二项研究中，已确定的影响AN患者酒后驾驶的因素将被纳入核对表，我们将对这一新开发的工具进行第一次心理测量评估。在分组研究3中，我们将再次使用多信息者方法，并定量地(每种类型的信息者的计划N；即全科医生、患者、亲属，N=130；10个合作的专科诊所和4个合作的门诊伙伴)确定a)先验确定的不可修改因素和b)检查表中的可修改因素的影响的大小。综上所述，我们旨在提出建议，以指导有效的二级预防措施的概念，以期前瞻性地改善AN患者的预后。

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.