title: The bidirectional relationship between quality of life and eating disorder symptoms: a 9-year community-based study of Australian women.
abstract: OBJECTIVE
  Studies that have investigated quality of life (QoL) in eating disorders (EDs) have been focussed on the impact of the ED on QoL and little is known regarding the possible reciprocal impact of QoL on EDs. The aim of this study was to provide a first-time investigation of possible bidirectional relationships between EDs and both health-related QoL (HRQoL) and psychological distress (PD).
  
  
  METHODS
  Structural equation modeling was applied to longitudinal data collected from a community sample of Australian women (N = 828) surveyed at baseline, five annual follow-ups, and again after nine years. Participants reported height and weight (from which body mass index, BMI, was calculated) and completed measures of ED symptoms (Eating Disorder Examination Questionnaire), HRQoL (12-item Medical Outcomes Study Short Form), and PD (Kessler Psychological Distress Scale).
  
  
  RESULTS
  Overall, evidence was found for a bidirectional relationship, whereby ED symptoms predicted reduced HRQoL and greater PD over time, while lower levels of HRQoL and greater PD in turn predicted increased levels of ED symptoms. These relationships were stable, observable within 12 months, and remained observable over a time period of at least four years. However, also observed were some inconsistent findings where ED symptoms predicted a short term (one year) improvement in mental HRQoL. This short term boost was not sustained at longer follow-ups.
  
  
  CONCLUSIONS
  Not only do ED symptoms impact on HRQoL and PD, but perceived poor HRQoL and PD also contribute to ED symptom development or exacerbation. This supports a movement away from symptom-centric approaches whereby HRQoL is conceptualized as a passive outcome expected to be rectified by addressing ED symptoms. Improvement in QoL and PD might rather be viewed as targets to be pursued in their own right under broader approaches in the treatment of EDs.
authors: School of Medicine, University of Western Sydney, Sydney, Australia.
authors: Deborah
authors: D
authors: Mitchison
authors: Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia.
authors: Alexandre
authors: A
authors: Morin
authors: School of Medicine, University of Western Sydney, Sydney, Australia; Department of Psychology, Faculty of Human Sciences, Macquarie University, Canberra, Australia; Research School of Psychology, Australian National University, Sydney, Australia.
authors: Jonathan
authors: J
authors: Mond
authors: School of Medicine, University of Western Sydney, Sydney, Australia.
authors: Shameran
authors: S
authors: Slewa-Younan
authors: Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, Australia; School of Medicine, James Cook University, Townsville, Australia.
authors: Phillipa
authors: P
authors: Hay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011159:Population Surveillance; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult