Explanatory Factors for Disease-Specific Health-Related Quality of Life in Women with Anorexia Nervosa.

Laura Al-Dakhiel Winkler,Mia Beck Lichtenstein,Michael Ejnar Røder,Claire Gudex,Carol E Adair,Jan Magnus Sjögren,René Klinkby Støving

doi:10.3390/jcm10081592

Abstract

A better understanding of explanatory factors for disease-specific health-related quality of life (HRQoL) in anorexia nervosa (AN) could help direct treatment providers to aspects of the most relevance for patient wellbeing and recovery. We aimed to investigate whether factors associated with HRQoL are the same for women with AN and normal-weight controls. The participants in this study were women with AN recruited from specialized eating disorder centers in Denmark and healthy, normal-weight controls invited via online social media. Participants completed online questionnaires on medical history, disease-specific HRQoL (Eating Disorders Quality of Life Scale, EDQLS) and generic HRQoL (SF-36), eating disorder symptomatology, depression, psychological wellbeing, and work and social adjustment. Questionnaires were fully completed by 211 women with AN (median age 21.7 years) and 199 controls (median age 23.9 years). Women with AN had poorer scores on all measures, i.e., worse HRQoL, psychological health, and work/social functioning. Eating disorder symptomatology affected EDQLS score in both groups, but poorer HRQoL in women with AN was also significantly associated with worse scores on bulimia, maturity fears, depression, vitality, and with older age. The factors investigated together explained 79% of the variance in EDQLS score. Management of disordered self-assessment and thought processes may be of particular importance to women with AN. Greater emphasis on these aspects alongside weight gain could enhance patient–clinician alliance and contribute to better treatment outcomes.

Highlights

The physical and psychological consequences of anorexia nervosa (AN) are severe and affect many aspects of the patient’s life
Controls were slightly older than the women with AN and, as expected, had significantly higher BMI
The study results show that women with AN reported significantly impaired function compared to healthy, normal-weight controls on all aspects measured, i.e., disease-specific health-related quality of life (HRQoL) (EDQLS total score and all subscale scores), generic health status (SF-36), eating disorder psychopathology (EDI-3), depressive symptomatology (BDI), psychological wellbeing (WHO-5), and work functioning (WSAS)

Summary

Introduction

The physical and psychological consequences of anorexia nervosa (AN) are severe and affect many aspects of the patient’s life. Patient-reported HRQoL is relevant in AN due to the ego-syntonic nature of the disease, and its omission may lead to large discrepancies between what the patient experiences and what the clinician perceives [4] In another ego-syntonic condition, obsessive–compulsive disorder, the use of patient-reported outcome measures was possibly better than clinical measures in predicting prognosis after treatment [5]. HRQoL measures used in eating disorders were initially generic measures (containing items that would be relevant for any patient group and the general population), but more recently, HRQoL measures have been developed for eating disorders Both approaches have found HRQoL to be significantly impaired in AN compared to normal reference groups and patients with somatic or other psychiatric illness [2,6]. While generic HRQoL measures are useful for comparative studies, they may be less sensitive to particular aspects of eating disorders [7], and disease-specific measures may be better indicators of ED severity [8]

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