A network analysis in adolescent anorexia nervosa exploring the connection between both patient and carer reactions and outcome

Objective: This paper used network analysis to test the associations between eating disorder-related psychopathology and carers’ responses to anorexia nervosa symptoms in adolescents. Additionally, the prognostic value of central and bridge network nodes was explored. Method: This is a secondary analysis of a three-armed randomised-controlled-trial of adolescents with anorexia nervosa (n = 149) and their primary carer (n = 149) who were allocated to either treatment as usual (TAU), or one of two versions of a carer skills intervention (ECHO) added to TAU. A network analysis was run in the full sample. The prognostic role of central and bridge nodes was tested through multiple regression analyses. Results: Carers’ depression and emotional over-involvement, as well as patients' depression showed the highest strength centrality. Patients' depression and carers’ accommodation exhibited the highest bridge expected influence. Across the full sample, and in the ECHO group, carers’ accommodation predicted patients' higher body mass index (BMI), while patients' depression predicted worse psychosocial functioning at 1-year follow-up. In the ECHO group, higher carers’ depression also predicted lower BMI. Conclusions: Carers’ accommodation and depression in both carers and patients were involved in the maintenance of psychopathology in adolescents with anorexia nervosa. Depression in both patients and carers is a potential treatment target for family interventions.