Excess mortality, causes of death and prognostic factors in anorexia nervosa

Fotios C. Papadopoulos · Anders Ekbom · Lena Brandt · Lisa Ekselius

448 citations0/0 files storedThe British Journal of Psychiatry

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Eating Disorders and Behaviors Suicide and Self-Harm Studies Nutrition, Health and Food Behavior

Abstract

BACKGROUND: Anorexia nervosa is a mental disorder with high mortality. AIMS: To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors. METHOD: Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers. RESULTS: The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome. CONCLUSIONS: Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.

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References

1997Suicide as an outcome for mental disorders 1979Anorexia Nervosa 1998Excess mortality of mental disorder 2002The Outcome of Anorexia Nervosa in the 20th Century 1995Mortality in anorexia nervosa 1997The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study

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