title: Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout.
abstract: BACKGROUND
  One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology.
  
  
  OBJECTIVE
  The aim of the present study was to identify predictors of dropout from this Web program.
  
  
  METHODS
  A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method.
  
  
  RESULTS
  The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout.
  
  
  CONCLUSIONS
  Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany. ruth.vonbrachel@rub.de.
authors.forename: Ruth
authors.initials: R
authors.lastname: von Brachel
authors.forename: Katrin
authors.initials: K
authors.lastname: Hötzel
authors.forename: Gerrit
authors.initials: G
authors.lastname: Hirschfeld
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rieger
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
authors.forename: Joachim
authors.initials: J
authors.lastname: Kosfelder
authors.forename: Tanja
authors.initials: T
authors.lastname: Hechler
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schulte
authors.forename: Silja
authors.initials: S
authors.lastname: Vocks
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000150:complications*; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D009042:Motivation; D010352:Patient Dropouts / Q000523:psychology*; D055815:Young Adult
keywords: Web-based treatment; anorexia nervosa; attrition; bootstrapping; bulimia nervosa; eHealth, eating disorders; motivation to change; survival analysis