Longitudinal associations between resilience and quality of life in eating disorders
Introduction
Eating disorders (EDs) are a severe psychiatric problem with an extremely negative impact on the quality of life (QoL) of those diagnosed (Harrison et al., 2014, Wade et al., 2012). QoL has been defined as perceived satisfaction and role functioning in the mental, physical and social domains of life, which is influenced both by societal values and norms and individual goals and expectations (WHOQOL Group, 1998). The evaluation of QoL provides an indicator of both the satisfaction with life as perceived by people with EDs and of their recovery level (Mitchison et al., 2016). Several studies have repeatedly reported that individuals with EDs score low on QoL levels and on health related quality of life as a result of their disorder (de la Rie et al., 2007, Jenkins et al., 2011).
Research also shows that there is great heterogeneity in the course of EDs (Zerwas et al., 2013, Keski‐Rahkonen et al., 2014). As some reviews indicate, approximately one-third of people with anorexia nervosa (AN) recover within 4 years of ED onset, whereas around 25% show a chronic course or continuous relapse (Berkman et al., 2007). About half of people with bulimia nervosa (BN) and more than three-quarters of those with binge eating disorder (BED) will report no symptoms of an ED after 5 years (Fairburn et al., 2000). Given that several ED diagnosed patients reach recovery, it is important to identify the factors that predict the improvement of QoL and the reduction of ED symptoms in ED diagnosed individuals. It would aid providers in tailoring treatment to reinforce the patient's unique protective factors for recovery. Resilience emerges as a key concept, which can contribute to explaining the course of QoL and symptoms over time.
The concept of resilience has been described in the field of mental illness as the process of adapting positively to an adversity such as illness (American Psychological Association, 2010). It is understood as a strength that can be fostered and built to promote the recovery process (Las Hayas et al., 2015). Resilience factors are dynamic and can change throughout life (Luthar et al., 2000, Windle, 2011). Thus, it is important to identify the resilience assets of individuals that can help them cope positively with illness and promote better QoL and even recovery (Las Hayas et al., 2015).
Although several studies have displayed the beneficial role of resilience factors in other mental illnesses such as depression, anxiety, schizophrenia, and bipolar disorder (Min et al., 2012, Min et al., 2015, Torgalsbøen, 2012, Echezarraga et al., 2017), the study of resilience factors that can promote the reduction of symptoms and improve QoL in individuals with EDs is scarce. One study (Las Hayas et al., 2014) found that people diagnosed with EDs scored lower than recovered individuals on two resilience factors measured using the Resilience Scale 25 (Wagnild and Young, 1993). These factors were “personal competence”, described as the subjective perception of being capable to withstand life stressors, and “acceptance of self and life”, described as the subjective perception of being capable to thrive and derive meaning from challenges (Wagnild and Young, 1993).
In the current research study we extended the above study by Las Hayas et al. (2014) and examined the longitudinal reciprocal predictive associations between resilience factors, QoL domains, and symptoms of EDs. Whereas the study by Las Hayas et al. provided data about the cross-sectional correlations between resilience factor and QoL, the current longitudinal study allows determining the directionality of the associations between resilience and QoL, which is important for interventions and for theory. For interventions, it is important to determine which factors predict the increase of quality of life and the reduction of EDs as simple correlations only indicate that the variables are associated and several alternative explanations for these correlations are possible. The identification of resilience factors that predict ED recovery and improvement of QoL has several potential benefits because interventions could promote and reinforce the development of these resilience factors and thus contribute to shortening illness and preventing chronicity (Zerwas et al., 2013). From a theoretical point of view, resilience is proposed as a process that will ultimately have a positive impact on the subjective satisfaction with the areas of quality of life. Thus, we hypothesized that the resilience factors of acceptance of self and life and personal competence would predict an increase of QoL and a reduction of ED symptoms over time. In addition, because resilience is considered a process that changes over time and that is influenced by the social, physical and psychological status of the individual (Windle, 2011), we hypothesized that previous levels of QoL would predict also resilience factors. The hypothesized reciprocity between variables included the possibility of several mediational mechanisms in which resilience led to better QoL, and positive QoL in turn led to more resilience. In contrast with the numerous longitudinal studies that examined risk factors for ED, to our knowledge there are no previous longitudinal studies on the role of resilience in ED.
Section snippets
Methods
In this study, we focused on the dimensions of physical health, psychological health, and social functioning of QoL because of their relevance for EDs (Mitchison et al., 2016). We included a specific measure of ED symptoms to control the course of illness over time (2 years). Finally, because chronicity can influence both QoL and symptoms, we also controlled for the number of years since ED onset.
Results
Table 1 displays the correlation coefficients among all variables, as well as descriptive statistics for W1, W2, and W3. Most of the correlations were statistically significant and high. Resilience factors in ED participants were positively associated with QoL domains and negatively associated with ED symptoms in all three waves.
The predictive mediational model was estimated via path analysis. The model included autoregressive paths joining all repeated measures of the variables (resilience,
Discussion
Previous research indicates that there is great variability in the course of ED with some individuals displaying recovery and better QoL than others (Keski‐Rahkonen et al., 2014). Thus, the identification of resilience factors associated with improvement of QoL and reduction of symptoms of ED is important to inform interventions. In the current study, we examined the longitudinal (1 year follow up) reciprocal associations between two resilience attributes (i.e., acceptance of self and life and
Acknowledgment
This research was supported by a grant from the Ministerio de Economía y Competitividad (Spanish Government, Ref. PSI2015-68426-R) and from the Basque Country (Ref. IT982-16)
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