MaiStep - Mainzer Schultraining zur Essstörungsprävention
Objectives The aim of this doctoral thesis was to investigate the efficacy of a German skills-based primary prevention program for partial-syndrome and full-syndrome eating disorders (Mainzer Schultraining zur Essstörungsprävention (MaiStep)) in reducing eating disorder symptoms as the primary outcome and associated psychopathology as a secondary outcome. Design Randomized Controlled Trial (RCT), three-intervention-group design, with two intervention groups and one active control group with a 3-month and 12-month follow-up. Setting A project in nine schools within the state of Rhineland-Palatine, Germany; funded by the Ministry of Health and Social Affairs (MSAGD) and the Ministry of Education, Culture and Research (MBWWK). Participants 1,654 adolescents (female/male: 781/873; mean age: 13.1±0.7; BMI: 20.0±3.5) recruited from randomly selected schools. Interventions The implementation and development of the skills based program was based on a systematic review of 63 scientific articles regarding eating disorder prevention in childhood and adolescence. One intervention group was conducted by psychologists and one by trained teachers. The active control group was performed by trained teachers using a stress and addiction prevention program. Main outcome measures The primary outcome measure was the incidence of partial-syndrome and full-syndrome eating disorders after completion of the program; secondary outcomes included self-reported questionnaires about eating disorder pathology. Results MaiStep did not reveal significant group differences at 3-month follow-up but showed a significant difference between the intervention groups and the active control group for partial anorexia nervosa (CHI²(2)) = 8.74, p = .01**) and partial bulimia nervosa (CHI²(2) = 7.25, p = .02*) at 12-month follow-up. Consistent with the primary outcome, the secondary measures were even more effective in the intervention groups at 12-month follow-up. The subscales of the Eating Disorder Inventory (EDI-2) drive of thinness (F (2, 355) = 3.94, p = .02*) and perfectionism (F (2, 355) = 4.19, p = .01**) and the Body Image Avoidance Questionnaire (BIAQ) (F (2, 525) = 18.79, p = .01**) showed significant differences for the intervention groups and demonstrated the effectiveness of MaiStep. Conclusions MaiStep has shown to be a successful program to prevent eating disorders in adolescents at 13 to 15 years of age. In addition, MaiStep was equally effective when conducted by teachers compared to psychologists suggesting feasibility of implementation in real world settings. Trial registration MaiStep is registered at the German Clinical Trials Register (DRKS00005050).
MaiStep, Essstörungen, Prävention, Anorexia nervosa, Bulimia nervosa, prevention, eating disorders
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