Objective: An extensive number of predictors has been examined across the literature to improve knowledge of relapse in anorexia nervosa (AN). These studies provide various recovery and relapse... Show moreObjective: An extensive number of predictors has been examined across the literature to improve knowledge of relapse in anorexia nervosa (AN). These studies provide various recovery and relapse definitions, follow-up durations and relapse rates. The current study summarizes these values and predictors of relapse in AN in a review and meta-analysis.Method: The study was executed according to PRISMA guidelines. Different databases were searched and studies in which participants did not receive an official clinical diagnosis were excluded. A quality analysis was performed using the National Institute of Health's Study Quality Assessment Tool. Random-effects meta-analyses were conducted to summarize data.Results: Definitions of relapse and recovery were diverse. During an average follow-up period of 31 months an average relapse rate of 37% was found. Predictive variables from 28 studies were grouped in six categories: age and sex, symptoms and behaviors, AN subtype and duration, weight or weight change, comorbidity, and personality. The studies were characterized by non-significant and contradictory results. Meta-analyses were performed for the predictors age, AN duration, pre-treatment BMI, post-treatment BMI and depression. These yielded significant effects for post-treatment BMI and depression: higher pre-treatment depression (SMD = .40 CI [.21-.59] and lower post-treatment BMI (SMD = -.35 CI [-.63 to -.07]) increased relapse chances in AN.Discussion: Our results emphasized a lack of sufficiently powered studies, consistent results, and robust findings. Solely post-treatment BMI and pre-treatment depression predicted relapse. Future research should use uniform definitions, larger samples and better designs, to improve our understanding of relapse in AN.Public significance: Knowledge about predictors is important to understand high relapse rates. Our study performed a review and meta-analysis of relapse predictors in AN. Related to the heterogeneity in studies examining predictors, an overview of relapse and recovery definitions, follow-up durations and relapse rates for AN was provided. Significant effects were found for post-treatment BMI and pre-treatment depression. More studies with uniform definitions are needed to improve clinical implications. Show less
Bree, E.S.J. van; Slof-Op'tLandt, M.C.T.; Furth, E.F. van 2023
ObjectiveOnly half of the patients with eating disorders (EDs) fully recover. To increase these rates, knowledge about predictors is essential. Previous studies found that purging behaviors, BMI,... Show moreObjectiveOnly half of the patients with eating disorders (EDs) fully recover. To increase these rates, knowledge about predictors is essential. Previous studies found that purging behaviors, BMI, ED duration, and depression, predicted symptomatic ED recovery. The current study investigated these four predictors for symptomatic improvement and the subjective experience of recovery. MethodParticipants who completed the baseline and second wave of the Netherlands Eating disorder Registry (NER) (N = 374), were categorized into: (1) Subjective recovery; (2) Clinical improvement; (3) Symptomatic recovery. Using regression analyses, it was investigated if the four baseline factors predicted recovery at wave two. Effects were compared among a binge-purging and restricting group. ResultsIn total, 136 participants were subjectively recovered, 135 showed clinical improvement, and 70 were symptomatically recovered. Overlap occurred between definitions. Lower depression scores predicted subjective recovery (OR 0.77, p < .001) and clinical improvement (OR 0.80, p < .001), and shorter ED duration predicted all definitions (OR 0.99, p < .001; OR 0.99, p < .001; OR 0.99, p = .013). Similar effects were found in the binge-purging group. DiscussionOur study emphasized that the same predictors, like depression, apply to symptomatic improvement and the personal experience of recovery. Depression appears an important factor during ED treatment. Public significanceRecovery rates for EDs are low. To understand this, knowledge about predictors of ED recovery is essential. This study examined the effects of four established predictors across symptomatic improvement and subjective recovery (a more personal experience of recovery). Lower depression scores predicted both, indicating that depression appears important for multiple definitions of recovery and therefore warrants attention during ED treatment. Show less
