Changing the Course of Comorbid Eating Disorders and Depression: What Is the Role of Public Health Interventions in Targeting Shared Risk Factors?

Article excerpt

Authors: Carolyn Black Becker (corresponding author) [1]; Maribel Plasencia [1]; Lisa Smith Kilpela [1]; Morgan Briggs [1]; Tiffany Stewart [2]

Introduction

Despite significant advances within the mental health field in the development and testing of treatments for mental illness, the distance between scientific findings and community-based implementation of evidence-based interventions remains sizeable [1, 2, 3]. Moreover, Kazdin and colleagues have convincingly argued that the dominant delivery mode of intervening with mental illness (i.e., face-to-face psychotherapy provided by a highly trained masters or doctoral level therapist) will never be sufficient to meet the needs of those suffering from mental illness due to a variety of factors (e.g., insufficient number of trained therapists, cost, geographical challenges) [1, 4]. As such, they called on the mental health field broadly to increase the range of models for delivering mental health services. One proposed strategy involves increased collaboration with other disciplines in moving beyond a focus on standard one-on-one psychotherapy [1]. The aim of this paper is to investigate to what degree current research supports the adoption of strategies drawn from public health with the aim of impacting the course of comorbid eating disorders (EDs) and depression through the targeting of shared risk factors and to make suggestions for future directions, both clinically and empirically. We focus on EDs and depression because public health initiatives that can address these dual issues are likely to have greater effect in reducing mental health suffering.

Public health appears to offer a tremendous resource to the ED and depression fields in our efforts to reduce mental illness suffering [5]. More specifically, public health interventions have a longstanding history of contributing to health on a national and international scale. For example, throughout the 20th century, the field of public health improved the United States? population health, adding 25?years to the nation?s average life expectancy [6]. Important public health achievements, which were not limited to the United States, during this time included: immunizations, motor-vehicle safety, control of infectious diseases, food safety, prenatal care, fluoridation of drinking water, and identification of tobacco use as a hazardous health behavior [6]. Of note, these public health initiatives evidenced high scalability (i.e., interventions could be ?scaled up? and delivered to large populations without losing effectiveness); thus the impact of such initiatives was far-reaching and change observable across the population.

Furthermore, as illustrated by the aforementioned examples, the field of public health provides a myriad of strategies and perspectives for widespread impact regarding health behaviors and illness prevention. Although a variety of definitions exist, most public health approaches to behavior change include four main concepts: 1) a focus on population health and public policy; 2) emphasizing promotion and prevention; 3) addressing determinants of health (i.e., risk factors); and 4) engaging in a three-step action plan (i.e., gathering data, creating policies, and ensuring policies are implemented and enforced) [7]. These concepts are evident in an array of existing public health initiatives targeting mental illness.

Written from the perspective of the eating disorder field, the aim of this paper is to address public health efforts that could impact comorbid EDs and depression. We first briefly review the literature on comorbidity. We then discuss shared variable risk factors (i.e., risk factors that have the potential to be changeable [8]) for EDs and depression given that, to our knowledge, no public health program/intervention exists that targets both clinical ED and depression diagnoses. As such, we focus on a variety of public health related interventions that aim to reduce variable risk factors associated with EDs and depression, as well as interventions that seek to reduce continuous measures of ED and depression symptomatology. …