PhD Early Intervention in Eating Disorders

Closing Date

15 Oct 2018

Salary

Up to £16,777 per annum

Address

Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Duration

3 years

Project Description

Start date: 1st February 2019 

Eating Disorders (EDs) are severe mental disorders with a peak onset in adolescence / early adulthood, at a developmentally sensitive time when the brain is still developing. Thus, they have the potential for seriously impacting on cognitive, socio-emotional and educational trajectories. EDs are associated with high levels of disability and mortality and pose a major burden for individuals and families. Importantly, starvation, extreme weight loss practices and raised stress hormones (cortisol) have neurotoxic effects, leading to lasting brain changes which negatively affect chances of recovery. Thus, early effective intervention within about 3 years of onset is essential to prevent the disorder becoming chronic and treatment-refractory. 

A key barrier to early effective treatment is poor access to services. Research studies have shown that ED patients who have to wait for treatment tend to drop out more and deteriorate or stay symptomatic whilst waiting. Younger patients seem to be particularly at risk of deterioration whilst waiting. Importantly, once patients who waited do start treatment they have worse outcomes than those treated immediately. In summary, available evidence provides a compelling case for reducing the duration of untreated ED or DUED (and wait-time as an important component of DUED) in young people with ED. 

This mixed-methods project will evaluate implementation of FREED (first episode rapid early intervention for EDs), an evidence-based service model for adolescents and emerging adults (Schmidt et al., 2016), across a network of ten specialist ED services in England (FREED-4-All). We have previously shown that introduction of FREED into a specialist ED service shortens DUED and improves outcomes in anorexia nervosa patients with recent onset eating disorders, compared to similar patients being seen with a standard outpatient model where lengthy waits for assessment and treatment are common place (Brown et al., 2018; McClelland et al., 2018). 
To provide context, the PhD project will start with a systematic review of novel and established service models for EDs and the evidence supporting them. The candidate will then carry out studies focusing on the implementation of FREED in the network. This will include a qualitative interview study of different health professionals (psychologists, nurses, doctors) working in participating services to establish their attitudes, expectations and views on early intervention in general and the FREED model in particular and perceived facilitators and barriers to implementation. In addition, the candidate will collect data on the duration of untreated illness in participating services and how this is impacted by the implementation of FREED. Further, they will assess the fidelity of implementation through comparing clinician-self-rated with objective implementation fidelity via audio recordings from assessment and early treatment sessions. They will also assess impact of implementation of FREED on routine clinical outcomes (body mass index, eating disorder symptoms, quality of life) in participating ED services. Finally they will conduct a Delphi study with young people in the community to obtain their views on clinical prioritisation in EDs services. 

The successful candidate for this project will be registered in, and be part of the vibrant postgraduate research community in the King’s College London Eating Disorders Research Group in the Department of Psychological Medicine in the Institute of Psychiatry, Psychology and Neuroscience. 

Supervisors: Prof Ulrike Schmidt and Dr Karina Allen 

For information on the application process, please visit https://www.kcl.ac.uk/ioppn/study/prospective-students/programmes-of-study/pgr/fundedresearchopportunities/us-edphd-2018.aspx 

Candidate profile: Applications are invited from candidates with an interest in multi-disciplinary research and who have a 1st class or upper second degree in psychology or any other relevant health related discipline. A master’s degree in a relevant area will be an advantage, as will be experience of working with people with eating disorders or other mental health conditions.

Funding Notes

This studentship is funded by the Health Foundation for 3 years for UK and EU candidates. It includes a tax-free stipend up to £16,777 per annum (MRC rate), full fees and an allowance for research consumables and conference travel. 
 

References

Brown A, McClelland J, Boysen E, Mountford V, Glennon D, Schmidt U. The FREED Project (first episode and rapid early intervention in eating disorders): service model, feasibility and acceptability. Early Interv Psychiatry. 2018 Apr;12(2):250-257. 

McClelland J, Hodsoll J, Brown A, Lang K, Boysen E, Flynn M, Mountford VA, Glennon D, Schmidt U. A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED). Eur Eat Disord Rev. 2018 Mar;26(2):129-140. 

Schmidt U, Brown A, McClelland J, Glennon D, Mountford VA. Will a comprehensive, person-centered, team-based early intervention approach to first episode illness improve outcomes in eating disorders? Int J Eat Disord. 2016 Apr;49(4):374-7. 

For more information and to apply, click here