Poorer self-reported mental health and general health among first year upper secondary school students do not predict school dropout: a five-year prospective study.

Introduction: Education is important for socioeconomic, work and health status; thus, dropping out of secondary school is of major concern. In Norway, 1 out of 5 is dropping out from upper secondary education. Academic performance is a known predictor for dropout, but the role of mental and general health status is studied less. Methods: By use of student data collected during the first school year we examined the accumulated risk of school dropout over 5 years. Students entering upper secondary school in a North-Norwegian region (Troms County) completed a comprehensive questionnaire during August 2010 (N = 1,676, 69% response rate). The contribution of mental and general health problems in predicting five-year dropout was of primary interest, adjusted for demographics and academic performance. Results: One-third of the students had dropped out after 5 years. A logistic regression analysis showed no significant effect of mental and general health problems on dropout. Among the covariates, higher grades from lower secondary education reduced the chance of dropping out (OR = 0.31; p < 0.001). Subgroup analyses showed that students in the vocational track reported poorer mental and general health, compared to students in the general track, but this difference was not related to dropout. General track students were also less likely to drop out than vocational track students (OR for dropout 0.66; p < 0.05). Discussion: In conclusion, lower grades from lower secondary education represented a warning flag for school dropout during upper secondary education whereas mental health issues were not.

Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission.

BACKGROUND: Cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design. METHOD: Reports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design. RESULTS: The remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies. CONCLUSIONS: CBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.

To help people with eating disorders (EDs) recover it is important to know what makes therapies effective or not. Therefore, we summarized the effects of two common therapies for eating disorders, cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapy (PIT) and examined how ED diagnosis, comorbid personality disorder and changes in psychopathology could influence ED remission. We found that CBT was most consistently effective, with about 1/3 of patients in remission for anorexia, bulimia, and mixed samples, and 50% for patients with binge eating disorder. The effects of PIT were uncertain due to a lack of studies and could be only marginally effective. In CBT, changing the patients' eating disordered thoughts or their depression or anxiety was not associated with ED remission. We discuss why this may be and suggest that CBT may be more effective because it manages to engage a subgroup of patients who are motivated to change and less depressed or anxious. Thus, patients with more severe symptoms may benefit less. We conclude that CBT may be necessary to help people recover from eating disorders, but that some patients may still require interventions aimed at strengthening self-functions to substitute eating disordered behavior in the long-term.