Family-based therapy for anorexia nervosa: results from a 7-year longitudinal Singapore study
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To determine the effectiveness of Family-Based Therapy (FBT) as a treatment for Anorexia Nervosa (AN) in adolescents in a Singaporean cohort. FBT has proven effective in studies in the West, but no such study has been done in Asia.
This is a retrospective analysis of a hospital-based cohort, which included all paediatric patients (≤ 18-years) with AN treated at a tertiary hospital in Singapore between 2011 and 2017 (n = 119). The patients either received manualised FBT (n = 42) or individualized adolescent focussed therapy (non-FBT) (n = 77). Patient characteristics and time to remission were abstracted from patient records. Survival analysis was used to determine median time to remission and remission-free survival rates. Hazard ratios for remission were obtained by cox regression.
Patients in the non-FBT group had a significantly longer time to remission compared with the FBT group after adjustment for age, gender, BMI, psychiatric comorbidity, and ethnicity (p = 0.003, HR = 2.523, 95% CI 1.37–4.64). In the FBT group, the median time to remission was 5.0 months (95% CI 3.4–6.6 months); 11 months shorter than the non-FBT group (p < 0.001, 95% CI 7.9–14.1 months). FBT group remission rates were 69% and 90% at 1 and 2 years, respectively. Non-FBT group remission rates were 30% and 57% at 1 and 2 years, respectively.
This study confirms that FBT is an effective treatment strategy for AN in adolescents in the Asian context. FBT can shorten the illness duration, which reduces disruption to schooling and family life at this critical life stage.
Level of evidence
Level IV, evidence obtained from retrospective review of data before and after the introduction of new intervention.
KeywordsAdolescents Anorexia nervosa Eating disorder Family-based therapy (FBT)
We would like to thank Dr Dimple Rajgor for her assistance in DSRB application preparation, literature search, writing, editing, formatting, reviewing, and submission of the manuscript for publication. We would also like to thank Dr Shen Liang for her assistance with statistical methods.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The study being a retrospective study, formal informed consent is not required as per our institutional guidelines.