The National Eating Disorders Collaboration collects and provides the latest evidence based research and information available on eating disorders from Australia and around the world. The topics included in our Research and Resources section are wide ranging and recognise the physical, social and emotional aspects and the broad spectrum of eating disorders. All information has been sourced from the NEDC Resources Review, NEDC Evidence Review, books, fact sheets, treatment guidelines, manuals or programs, reports, web-based programs, multimedia, academic peer reviewed journals and individuals working within the eating disorders sector.
Each month in the e-Bulletin we will be highlighting some of the research and information uploaded regularly on our website.
The Sequelae of Dropout
Dropout from treatment for the eating disorders has far-reaching consequences
In spite of improvements in treating eating disorders, research consistently shows that many are leaving the pathways of care without undertaking a full course of treatment, and as such, putting their recovery at risk. Those who drop out of treatment are unlikely to recover on their own and are more likely to have poor long-term outcome. In addition, high dropout rates significantly limit the validity, reliability and generalisability of treatment outcome research in the eating disorders.
In a review of patient dropout, Mari Campbell (2009) identified an increase in people dropping out of treatment from 1991-2006. However, she suggested that the data is plagued by methodological issues, in particular:
- The definitions of the criteria used to identify dropouts in the research literature are vague or missing, and therefore limit comparability and replication across studies
- There is a lack of theoretically driven interventions to target dropout
In order to understand the scope of the problem and give people the best chance of engaging and remaining in care, Campbell indicates the need to learn from those clinicians who have succeeded in reducing dropout and use this learning to plan services and adapt treatments appropriately.
Campbell, M. (2009). Drop-out from treatment for the eating disorders: A problem for clinicians and researchers. European Eating Disorders Review, 17(4), 239-242.
A critical examination of the definitions of dropout used in research studies
A highly variable rate of dropout from treatment for anorexia nervosa has prompted current researchers at the Institute of Psychiatry, King’s College London, to investigate this phenomenon with the aim of increasing the consistency of dropout reporting and facilitating greater understanding of why patients leave treatment prematurely, and ultimately in increasing treatment engagement and completion in anorexia nervosa.
In a systematic review of treatment studies, DeJong, Broadbent and Schmidt (2012) found that the dropout rate in outpatient care for anorexia nervosa ranged from 4.8% to 100%. These rates were affected by factors such as illness severity and treatment approach.
These factors aside, the researchers have also identified that one of the greatest challenges in trying to draw conclusions around dropout from treatment in anorexia nervosa is the lack of consistency in how this concept is defined and reported across studies. DeJong et al., suggest moving away from the label “dropout” and adopting a less pejorative term such as “withdrawal”. In addition, they propose a reporting structure for withdrawal from treatment that they believe will facilitate better understanding of the factors that contribute to dropout.
DeJong, H., Broadbent, H., & Schmidt, U. (2012). A systematic review of dropout from treatment in outpatients with anorexia nervosa. International Journal of Eating Disorders, 45(5), 635-647.
Predictors of dropout from outpatient treatment for eating disorders
A recently published Australian study by Carter et al. (2012) collected data from referrals to a public specialist eating disorder service for youth and adults in Perth, Western Australia, between 2005 and 2010. Of this sample, 45% dropped out of treatment. The primary aim was to identify factors that increase a patient’s risk of dropping out from treatment for an eating disorder.
Based on the 45% of the sample that dropped out of treatment, the results identified both individual and process-based factors that were significant predictors of dropout.
The researchers argue that investigation of the time spent on the wait list for treatment is important because it may be easier to address and modify than individual patient characteristics. The findings suggest that implementing strategies and providing resources for eating disorder services to reduce waiting list times may provide a good opportunity to minimise dropout from treatment for eating disorders in the future.
Carter, O., Pannekoek, L., Fursland, A., Allen, K. L., Lampard, A. M., & Byrne, S. M. (2012). Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behaviour Research and Therapy, 50(7–8), 487-492.
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