The role of self‐esteem in the treatment of patients with anorexia nervosa – A systematic review and meta‐analysis.
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| Title: | The role of self‐esteem in the treatment of patients with anorexia nervosa – A systematic review and meta‐analysis. |
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| Authors: | Kästner, Denise, Löwe, Bernd, Gumz, Antje |
| Source: | International Journal of Eating Disorders. Feb2019, Vol. 52 Issue 2, p101-116. 16p. 1 Diagram, 8 Charts. |
| Subjects: | Anorexia nervosa, Anorexia nervosa treatment, Bulimia, Psychology information storage & retrieval systems, Medical screening, Medical practice, MEDLINE, Meta-analysis, Self-evaluation, Self-perception, Systematic reviews, Decision making in clinical medicine, Social support, Treatment effectiveness, Predictive tests, Disease remission, Diagnosis |
| Abstract (English): | Objective: We aimed to provide a comprehensive overview of the role of self‐esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self‐esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self‐esteem as an outcome, predictor, moderator, and mediator in AN treatment. Method: The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random‐effects meta‐analyses. Results: A screening of 1,596 abstracts and 203 full‐texts identified 68 relevant publications. Results suggest a significantly lower global self‐esteem in individuals with AN than in healthy controls (d = −1.90, p < .001). In contrast, global self‐esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self‐evaluations may not affect scholastic and professional abilities. Significantly moderate self‐esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short‐term (d = 0.50, p < .001), and long‐term (d = 0.75, p < .001) follow‐up. Self‐esteem did not predict end of treatment remission‐or weight‐related outcome and treatment dropout. However, small to moderate predictive effects were detected on short‐term (r = .15, p = .007) and long‐term remission or weight (r = .33, p = .017). Finally, first indications point to self‐esteem as a mediator in adult AN inpatient treatment. Discussion The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self‐esteem for decisions on after‐care. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | Objetivo Nuestro objetivo fue proporcionar una visión general completa del rol de la autoestima en el tratamiento de pacientes con anorexia nervosa (AN). Específicamente, nuestros objetivos fueron investigar las diferencias en la autoestima entre individuos con AN y controles saludables, o individuos con otros trastornos alimentarios, y examinar la autoestima como un resultado, predictor, moderador y mediador del tratamiento de AN. Método Se buscó en las bases de datos PsycINFO, PSYNDEXplus, Ovid MEDLINE®, y ProQuest estudios publicados de 1990 a 2018. Para estimar los tamaños agregados del efecto, realizamos meta‐análisis de efectos aleatorios. Resultados Un cribado de 1,596 resúmenes y 203 textos completos identificó 68 publicaciones relevantes. Los resultados sugieren una autoestima global significativamente baja en individuos con AN en comparación con los controles sanos (d = −1.90, p < .001). En contraste, la autoestima global de pacientes con AN y BN fue comparable (d = 0.05, p = .529). Puede ser específico de pacientes con AN que las autoevaluaciones negativas puedan no afectar las habilidades académicas y profesionales. Se observaron incrementos de autoestima significativamente moderados en pacientes tratados para AN al final del tratamiento (d = 0.56, p < .001), seguimiento a corto plazo (d = 0.50, p < .001) y largo plazo (d = 0.75, p < .001). La autoestima no predijo remisión al final del tratamiento o pronóstico relacionado al peso ni el abandono de tratamiento. Sin embargo, se detectaron efectos pequeños a moderados en la remisión a corto (r = .15, p = .007) y a largo plazo o peso (r = .33, p = .017). Finalmente, las primeras indicaciones apuntan a la autoestima como mediador en el tratamiento hospitalario de pacientes con AN. Discusión Esta revisión nos proporciona una visión relevante para la teoría, investigación y práctica. Las implicaciones se refieren al apoyo general para abordajes transdiagnósticos y la recomendación de considerar la baja autoestima inicial para decisiones sobre el cuidado posterior. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Objective: We aimed to provide a comprehensive overview of the role of self‐esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self‐esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self‐esteem as an outcome, predictor, moderator, and mediator in AN treatment. Method: The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random‐effects meta‐analyses. Results: A screening of 1,596 abstracts and 203 full‐texts identified 68 relevant publications. Results suggest a significantly lower global self‐esteem in individuals with AN than in healthy controls (d = −1.90, p < .001). In contrast, global self‐esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self‐evaluations may not affect scholastic and professional abilities. Significantly moderate self‐esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short‐term (d = 0.50, p < .001), and long‐term (d = 0.75, p < .001) follow‐up. Self‐esteem did not predict end of treatment remission‐or weight‐related outcome and treatment dropout. However, small to moderate predictive effects were detected on short‐term (r = .15, p = .007) and long‐term remission or weight (r = .33, p = .017). Finally, first indications point to self‐esteem as a mediator in adult AN inpatient treatment. Discussion The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self‐esteem for decisions on after‐care. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 02763478 |
| DOI: | 10.1002/eat.22975 |
