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      Internet-Based Motivation Program for Women With Eating Disorders: Eating Disorder Pathology and Depressive Mood Predict Dropout

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          Abstract

          Background

          One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology.

          Objective

          The aim of the present study was to identify predictors of dropout from this Web program.

          Methods

          A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants’ age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method.

          Results

          The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout.

          Conclusions

          Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.

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          Most cited references75

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          R: A language and environment for statistical computing

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            Dropout from Internet-based treatment for psychological disorders.

            The purpose of this review was to present an in-depth analysis of literature identifying the extent of dropout from Internet-based treatment programmes for psychological disorders, and literature exploring the variables associated with dropout from such programmes. A comprehensive literature search was conducted on PSYCHINFO and PUBMED with the keywords: dropouts, drop out, dropout, dropping out, attrition, premature termination, termination, non-compliance, treatment, intervention, and program, each in combination with the key words Internet and web. A total of 19 studies published between 1990 and April 2009 and focusing on dropout from Internet-based treatment programmes involving minimal therapist contact were identified and included in the review. Dropout ranged from 2 to 83% and a weighted average of 31% of the participants dropped out of treatment. A range of variables have been examined for their association with dropout from Internet-based treatment programmes for psychological disorders. Despite the numerous variables explored, evidence on any specific variables that may make an individual more likely to drop out of Internet-based treatment is currently limited. This review highlights the need for more rigorous and theoretically guided research exploring the variables associated with dropping out of Internet-based treatment for psychological disorders.
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              Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases.

              To systematically review the literature on the proportion of community cases with a diagnosable eating disorder who seek eating disorder specific treatment. CSA PsycInfo, Medline/PubMed and Scopus databases were searched for relevant articles that were written in English, published between January 1989 and January 2010, and satisfied three selection criteria: 1) recruited a representative sample of community cases; 2) used a standardized eating disorder screening instrument; 3) reported percentage of cases with eating disorders that sought appropriate (mental health or medical) treatment specifically for their eating disorder. Reference lists were also scanned for relevant articles. Of 200 articles identified, 14 met inclusion criteria, comprising 1581 participants with a diagnosable eating disorder. The pooled proportion seeking treatment was 23.2% (95% CI=16.6, 31.4), however this estimate was associated with significant variability. The proportion seeking treatment for weight loss ranged from 30% to 73%, indicating that individuals with eating disorders are much more likely to receive treatment for a perceived problem with weight. The literature provides a complex picture, as a minority receive appropriate mental health care, yet many receive treatment for weight loss. Significant gaps in the literature currently exist and future research needs to focus on treatment seeking in the young and elderly, males, and in countries outside of Australia and the United States. There is a need for interventions that assist community members, health professionals and treatment services to recognize eating disorders and understand their associated burden and the benefit of providing appropriate and timely treatment. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                March 2014
                31 March 2014
                : 16
                : 3
                : e92
                Affiliations
                [1] 1Department of Clinical Psychology and Psychotherapy Osnabrück University OsnabrückGermany
                [2] 2Department of Clinical Psychology and Psychotherapy Ruhr-University Bochum BochumGermany
                [3] 3Department of Clinical Child and Adolescent Psychology Ruhr-University Bochum BochumGermany
                [4] 4German Paediatric Pain Centre Children’s Hospital Datteln DattelnGermany
                [5] 5Research School of Psychology Australian National University CanberraAustralia
                [6] 6Eating Disorders Unit Institute of Psychiatry at the Maudsley, King’s College University of London LondonUnited Kingdom
                [7] 7Department of Social Sciences and Cultural Studies University of Applied Sciences DüsseldorfGermany
                Author notes
                Corresponding Author: Ruth von Brachel ruth.vonbrachel@ 123456rub.de
                Article
                v16i3e92
                10.2196/jmir.3104
                4004149
                24686856
                b19a261e-de31-4a67-ad21-5734411455b7
                ©Ruth von Brachel, Katrin Hötzel, Gerrit Hirschfeld, Elizabeth Rieger, Ulrike Schmidt, Joachim Kosfelder, Tanja Hechler, Dietmar Schulte, Silja Vocks. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.03.2014.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 14 November 2013
                : 23 December 2013
                : 15 January 2014
                : 19 January 2014
                Categories
                Original Paper
                Original Paper

                Medicine
                attrition,web-based treatment,ehealth, eating disorders,motivation to change,anorexia nervosa,bulimia nervosa,bootstrapping,survival analysis

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