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Freier Beitrag

Wirksamkeit eines gestuften, Internetvermittelten Ansatzes zur Prävention von Essstörungen bei Schülern der 7. bis 10. Klasse

Published Online:December 16, 2014https://doi.org/10.1026/0942-5403/a000152

Abstract

Essstörungen sind schwerwiegende Erkrankungen, die vorwiegend Jugendliche und junge Erwachsene betreffen. Eine effektive Prävention ist dringend gewünscht. Das individuelle Risiko kann oft nur unscharf eingeschätzt werden. Daher bieten sich gestufte Strategien wie das Internet-vermittelte Programm YoungEs[s]prit an. In der hier vorgestellten prospektiven, randomisiert-kontrollierten Interventionsstudie wurde die Wirksamkeit von YoungEs[s]prit geprüft. In einem adaptiven Design wurde die Studie in zwei Wellen durchgeführt. Hauptzielkriterium war die kumulierte Inzidenzrate (nach DSM-IV Kriterien) in einem 12-Monatszeitraum. Die statistische Prüfung erfolgte mit Hilfe survival-analytischer Methoden. In der 1.Welle (n=896) zeigte sich die präventive Wirksamkeit von YoungEs[s]prit (Log Rank χ2=4,29, df=1, p=0,038, 2-seitig) mit einem hazard ratio von 1,67. Die kumulierte Inzidenzrate der aktiven Kontrollgruppe lag bei 9,6 % verglichen mit 5,9 % in der YoungEs[s]prit Gruppe. In der 2.Welle (n=771) konnten keine Unterschiede zwischen den Gruppen gefunden werden (4,8 % vs. 5,6 %, Logrank χ2=0,27, df=1, p=0,600, 2-seitig). In der Gesamtbewertung wurde der Nachweis für die Wirksamkeit daher nicht erbracht (p1*p2=0,0228 >cα=0,0087). Während die Rate der 1. Welle mit 9,6 % der in der Literatur berichteten Größenordnung von etwa 10 % entsprach, lag die Rate in der 2. Welle mit 4,8 % ungewöhnlich niedrig. Daher wurde exploriert, inwieweit (1) die unterschiedliche Zusammensetzung der Stichproben, z. B. der größere Anteil von Mädchen in der 2. Welle, (2) die größere Nähe zu Einrichtungen der Versorgung in der 2. Welle oder (3) die gestiegene Aufmerksamkeit für Essstörungen durch die 1. Untersuchungswelle zu dieser niedrigen kumulierten Inzidenzrate beigetragen haben könnten.


Efficacy of an Internet-Delivered Tiered Strategy for Eating Disorder Prevention in High School Students

Eating disorders are serious illnesses predominantly affecting adolescents and young adults. Effective prevention is strongly desired. Estimates of the individual risk are often vague. Therefore, stepwise strategies, such as the German Internet-delivered program YoungEs[s]prit, are appealing. The prospective, randomized controlled intervention study presented here investigated the efficacy of YoungEs[s]prit. The study was conducted in two waves applying an adaptive design. The main outcome was the cumulative incidence rate (according to DSM-IV criteria) over 12 months. Efficacy was statistically tested through survival-analytic methods. Results from the first wave (n = 896) proved the preventive efficacy of YoungEs[s]prit (log rank χ2 = 4.29, df = 1, p = .038, 2-sided) with a hazard ratio of 1.67. The cumulative incidence rate of 9.6 % in the control condition was reduced to 5.9 % in the YoungEs[s]prit condition. Results from the second wave (n = 771) could not show any significant differences between the groups (4.8 % vs. 5.6 %, log rank χ2 = 0.27, df = 1, p = .600, 2-sided). Taking the results of the two waves together, as required by the adaptive design, the study did not prove efficacy. While the rate of 9.6 % in the first wave corresponds to the estimate of about 10 % reported in the literature, the rate of 4.8 % appears unusually small. Therefore, it was explored whether (1) differences between the samples, e. g., the greater proportion of girls in the second wave, (2) a shorter distance to health services in the second wave, or (3) the possibly increased awareness of eating disorders through the activities in the first wave may have contributed to the differences between the estimates for the two waves.

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