Mental Health Impacts of Self-Help Interventions for the Treatment and Prevention of Eating Disorders. A Meta-Analysis.

Objective: Self-help programs are recommended as a first step in the management of eating disorders. Yet, whether self-help interventions have broader mental health benefits beyond symptom and risk reduction remains unclear. As randomized controlled trials (RCTs) also assess general mental health secondary to eating disorder symptoms, we conducted a meta-analysis to investigate whether and to what extent pure self-help interventions for eating disorders produce improvements in these secondary outcomes.

Method: Twenty-seven RCTs of pure self-help interventions for the prevention or treatment of eating disorders were included. Mean age ranged from 16 to 46 years. Most self-help interventions were based on cognitive-behavioral therapy. Most interventions were delivered via digital means (Internet, apps, etc.). Random effects meta-analyses were conducted on six outcomes: depression, anxiety, general distress, quality of life, self-esteem, and psychosocial impairment. Analyses were stratified based on pre-selected (at risk/symptomatic) and clinical samples.

Results: For pre-selected samples (k = 18), significant pooled effects favoring self-help over controls were observed for depression (g = 0.24), anxiety (g = 0.23), distress (g = 0.23) and self-esteem (g = 0.18). Effects remained robust when adjusting for risk of bias. Non-significant effects were observed for quality of life and impairment. Crucially, > 80% of trials on pre-selected samples delivered a waitlist control. For clinical samples (k = 9), significant pooled effects favoring self-help were found for distress (g = 0.39), impairment (g = 0.39), and quality of life (g = 0.29), although these results should be interpreted with caution as the number of studies was low.

Conclusion: Self-help interventions produce small improvements in those mental health symptoms that are typically comorbid with eating disorders.