Supervisors info:
Ελένη - Κλεάνθη Κατσουγιάννη, Καθηγήτρια, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Φραγκίσκος Γονιδάκης, Επίκουρος Καθηγητής, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Γεωργία Βουρλή, Επιστημονικός Συνεργάτης PhD, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Summary:
Background and Objectives: Eating disorders (ED) occur with increased frequency in puberty and affect the adolescent's smooth psychosomatic development. Newer trends in treatment of ED are focused on intensive care programs, such as the Multi-family therapy model and the Psychoeducation program. The purpose of this study was to examine whether the findings of other countries that show that Multi-family therapy is more effective than Psychoeducation treatment in treating ED, are being verified. A secondary objective was to examine whether the families of sufferers on the one hand would be less psychologically burdened and on the other hand to better deal with the disorder and the affected member, as assessed by the EDSIS and AESED questionnaires after the survey was completed.
Methods: A Parallel group design study of two groups was carried out in collaboration with the actors involved in the "Steps Forward" program. The first group followed Psychoeducational intervention with 107 parents of Anorexia Nervosa (AN) patients and the 2nd followed the model of Multi-family therapy with 40 parents of patients suffering from ED. The tools used were the AESED questionnaire, which measures the accommodation and enabling scale for ED, and the EDSIS questionnaire providing the scale of measurement of an ED symptom impact scale. After the end of the treatment week, the AESED and EDSIS questionnaires were collected and three follow-up sessions were scheduled in the next six months (2nd, 4th and 6th months). In order to statistically evaluate the AESED and EDSIS questionnaires several linear mixed models with random intercept and random slope were fitted and tested, and confounders, such as the medical history of the participants, were tested.
Results: No difference was found between the Psychoeducation program and the Multi-family therapy model, based on the AESED and EDSIS questionnaires (pvalue=0.5596 and pvalue=0.278, respectively). The first two months, after the treatment week, were associated with a statistically significant (pvalue <0.001) reduction in the AESED and EDSIS scores, while the differences between subsequent meetings were statistically insignificant. Parents attending the Psychoeducation program showed a reduction in the initial AESED and EDSIS scores by 8.5 and 9.4 points respectively at the 2nd follow-up meeting, while the parents of Multi-family reported a decrease of 8.6 and 9.4 points. In the next two follow-up meetings there was no statistically significant differentiation of the AESED and EDSIS scores compared to the 2nd meeting. The type of treatment significantly affected the dimensions of AESED, avoidance & modifying routine (pvalue<0.05), control family (pvalue<0.001) and turning a blind eye (pvalue<0.05), while the dimensions of the EDSIS questionnaire were not differentiated between the two therapies. The dimensions of social isolation (EDSIS) and turning a blind eye (AESED) were found to be statistically insignificant (pvalue>0.05), resisting the changes brought by the therapeutic interventions. Control of confounding factors showed that mother and father's medical history variables were statistically significant (t =-2.64 with pvalue=0.0096 and t=-2.64 with pvalue=0.0011 respectively). The loss to follow-up exceeded 38.3%.
Discussion and Conclusions: The type of therapeutic intervention did not play a role in improving the accommodation, the enabling scale and addressing the special difficulties in ED. The treatment was the one that reduced the scores on the two questionnaire scales as the relatives' involvement in group therapy improved their psychological mood and the way they treat the disorder and the sufferer. The upward trend observed in EDSIS and AESED questionnaire scores at the last follow-up meeting suggest relapse of relatives symptoms. Due to the high loss rates (over 38%) in the follow-up, the results are likely to be misinterpreted, and the validity of the research is inadequate. Repeating research with a larger and more varied sample makes it imperative to export more reliable results.
Keywords:
Multi-family Therapy, Psychoeducation, Eating Disorders, EDSIS, AESED.
