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The Bidirectional Relationship between Quality of Life and Eating Disorder Symptoms: A 9-Year Community-Based Study of Australian Women


Mitchison, M and Morin, A and Mond, J and Slewa-Younan, S and Hay, P, The Bidirectional Relationship between Quality of Life and Eating Disorder Symptoms: A 9-Year Community-Based Study of Australian Women, PL o S One, 10, (3) Article e0120591. ISSN 1932-6203 (2015) [Refereed Article]

DOI: doi:10.1371/journal.pone.0120591


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).

Method: 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.

Item Details

Item Type:Refereed Article
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Mental health services
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Women's and maternal health
UTAS Author:Mond, J (Dr Jon Mond)
ID Code:111948
Year Published:2015
Web of Science® Times Cited:33
Deposited By:UTAS Centre for Rural Health
Deposited On:2016-10-17
Last Modified:2017-11-02

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