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Long-term burden of morbidity, mortality in eating disorders

Although the incidence of eating disorders was relatively low compared with some other mental disorders in Wales, patients with eating disorders had a higher burden of morbidity, other mental health problems and mortality, according to study findings.

“Given the difficulty of engaging people with eating disorders in treatment and the scarcity of resource provision for such specialist treatment, it is likely that specialist eating disorder treatment teams see a minority of those — whether child, adolescent or adult — with the disorder,” Joanne Demmler, PhD, of Swansea University in the U.K., and colleagues wrote in British Journal of Psychiatry. “In many cases and for a variety of reasons, patients may only be known to, or receive treatment in, primary care.”

Using linked electronic health record data from general practitioner and hospital admissions in Wales, U.K., researchers examined the incidence of new eating disorder diagnoses, the frequency of comorbidities, prescribed medications in cases and controls in the 2 years before and 3 years after diagnosis, and survival.

Overall, 15,558 people received an eating disorder diagnosis between 1990 and 2017 in Wales, and the incidence was highest (24 per 100,000 individuals) in 2003 to 2004.

Demmler and colleagues found that people with eating disorders were more likely to have mental disorders (OR = 4.32; 95% CI, 4.01-4.66) and external causes of morbidity and mortality (eg, self-harm; OR = 2.92; 95% CI, 2.44-3.5) compared with controls. Personality disorder was the most likely mental disorder prior to eating disorder diagnosis (OR = 10.82; 95% CI, 6.58-18.56).

Prior to diagnosis, those with eating disorders had more prescriptions of central nervous system (OR = 3.15; 95% CI, 2.97-3.33), gastrointestinal (OR = 2.61; 95% CI, 2.45-2.79) and dietetic drugs (OR = 2.42; 95% CI, 2.24-2.62). Antipsychotics were the most likely central nervous system drugs to be prescribed before diagnosis (OR = 6.78; 95% CI, 5.48-8.4), according to the study.

The investigators reported that these excess diagnoses and prescriptions remained 3 years after eating disorder diagnosis.

The results showed higher mortality among people with anorexia nervosa (HR = 2.33; 95% CI, 1.95-2.78), bulimia nervosa (HR =1.41; 95% CI, 1.13-1.779) and other eating disorders (HR = 1.82; 95% CI, 1.53-2.18) compared with controls. Females with anorexia were at the highest risk for death (HR = 2.53; 95% CI, 2.09-3.05).

“This illustrates the multi-system, long-term burden of both eating disorders and their physical and mental sequelae, as well as their comorbidities,” Demmler and colleagues wrote. “Our findings suggest that increased diagnoses and prescriptions begin at least 3 years before a diagnosis of an eating disorder is made. Better identification and early interventions would greatly reduce the multiple burdens of eating disorders in future through better identification and early intervention.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.