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A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa

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Abstract

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient–carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers’ distress change was not a significant predictor of patients’ body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother–offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

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Acknowledgments

This report/article presents independent research commissioned by the National Institute for Health Research (NIHR) under RfPB programme. PB –PG-0609-19025. Research Title: Expert Carers Helping Others (ECHO) (IRAS Code: 55754 CSP: 55754). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. JT and US receive salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London Maudsley NHS Foundation Trust King’s College London and C.R by the Psychiatry Research Trust. We also thank the following principal investigators and site involved in the ECHO project: S. Clark-Stone, 2gether NHS Foundation Trust; W. Clarke, Anuerin Bevan Local Health Board; D. Robertson, Birmingham and Solihull Mental Health NHS Foundation Trust; N. Dawson, Bradford District Care Trust; C. Schrieber-Kounine, Avon and Wiltshire Mental Health Partnership NHS Trust; J. Shapleske, Cambridgeshire and Peterborough NHS Foundation Trust; J. Whittaker, Central Manchester University Hospitals NHS Foundation Trust; A. Jones, Cornwall Partnership NHS Trust; K. Goss, Coventry & Warwickshire Partnership NHS Trust; H. Crowson, Derbyshire Mental Health Services NHS Trust; K. Higgins, Dudley and Walsall Mental Health NHS Trust; N. Green, Humber Mental Health Teaching NHS Trust; A. Lodwick, Hywel dda Health Board; N. Jacobs, Kent and Medway NHS and Social Care Partnership Trust; C. Newell, Kimmeridge Court, Dorset Healthcare University NHS Foundation Trust; J. Morgan, Leeds Partnership NHS Foundation Trust and St George’s University of London; J. Arcelus, Leicestershire Partnership NHS Trust; H. Birchall, Lincolnshire Partnership NHS Foundation Trust; R. Thompson, Norfolk and Waveney Mental Health Foundation Trust; H. Stephens, North Bristol NHS Trust; I. Lea, North Essex Partnership Foundation NHS Trust; L. Addicott, Nottinghamshire Healthcare NHS Trust; S. Sankar, Northamptonshire Healthcare NHS Trust; J. Holliday, Oxford Health NHS Foundation Trust; B. Waites, Powys Local Health Board; H. Strachan, Royal Bolton Hospital; A. Fennell, Black Country Partnership NHS Foundation Trust; A. Wolton, Somerset Partnership NHS Foundation Trust; H. Gahan, South Essex Partnership University NHS Foundation Trust; G. Moss, Sheffield Children’s Hospital; J. Orme, Sheffield Health and Social Care NHS Foundation Trust; K. Moore, South Staffordshire and Shropshire Healthcare NHS Foundation Trust; G. Burgoyne, Suffolk Mental Health Partnership NHS Trust; I. Eisler, South London and Maudsley NHS Foundation Trust; B. Bamford, South-West London and St George’s Mental Health Trust; I. Yi, Surrey and Borders Partnership NHS Foundation Trust; and P. Parker, Worcestershire Mental Health Partnership NHS Trust. Our appreciation extends also to the Mental Health Research Network who have been instrumental in the successful setup of this project.

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    Authors and Affiliations

    1. Department of Psychology and Educational Sciences, University of Palermo, Viale delle Scienze, Edificio 15, 90128, Palermo, Italy

      Laura Salerno & Gianluca Lo Coco

    2. Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

      Charlotte Rhind, Rebecca Hibbs, Ulrike Schmidt, Pamela Macdonald, Elizabeth Goddard, Kate Tchanturia & Janet Treasure

    3. Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK

      Nadia Micali

    4. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

      Nadia Micali

    5. Adolescent Psychiatry, University of Liverpool, Chester, UK

      Simon Gowers

    6. South London and Maudsley NHS Foundation Trust, London, UK

      Gillian Todd

    7. Ilia State University, Tbilisi, Georgia

      Kate Tchanturia

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    1. Laura Salerno
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    Correspondence to Laura Salerno.

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    JT is a co-author of the book used in the carers skills training intervention ECHO and receives royalties.

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    L. Salerno and C. Rhind contributed equally to this work.

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    Salerno, L., Rhind, C., Hibbs, R. et al. A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa. Eur Child Adolesc Psychiatry 25, 1337–1347 (2016). https://doi.org/10.1007/s00787-016-0859-9

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