Long-term eating disorder trajectories and the impact of depression: A naturalistic cohort approach

This study aimed to explore how depressive symptoms were associated with the course of eating disorders (EDs) in a longitudinal naturalistic cohort of individuals with a past or current ED.

Data from 1308 participants enrolled in the Netherlands Eating disorder Register was used. Participants completed one to seven waves of assessment, and the mean duration of follow-up was 98 months (range 0-112). At each follow-up, the presence or absence of an ED was assessed at symptomatic (objective presence of ED symptoms and behaviors) and subjective level (individual perception of illness status). Mixed-effects logistic regression analyses were performed to examine whether depressive symptoms were associated with ED outcomes over time, controlling for BMI, age and ED subtype.

Higher levels of depressive symptoms at baseline were associated with increased odds of ED presence at each wave at symptomatic (OR = 2.22 at wave 0 to OR = 1.26 at wave 6) and subjective level (OR = 2.02 at wave 0 to OR = 1.41 at wave 6) with all p's < 0.001. Over the course of the seven waves, no significant differences were observed between the two levels.

The results show that higher levels of depressive symptoms at baseline were consistently associated with the presence of EDs at follow-up in a naturalistic transdiagnostic sample. This underscores the importance of systematically assessing and addressing depressive symptoms throughout the entire course of EDs.