A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK

Abstract

BackgroundIndividual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored.MethodAdmission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177).ResultsOne hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control.ConclusionsOverall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.

Patients’ perspective on inpatient treatment for eating disorders: A mixed-methods study of satisfaction, experience of care and perceived helpfulness of components of treatment

“…Research demonstrates that outcomes of, and satisfaction with inpatient treatment for AN are variable [25] with minority of patients finding treatment 'extremely helpful' [7]. While weight may be restored, psychological symptoms remain and repeated readmission is common [7,[26][27][28].…”

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

“…A recent multicentre cohort study of short-term outcomes of hospital treatment of AN in the UK found a mean admission BMI of 14 kg/m 2 , a mean discharge BMI of 17.3 kg/m 2 and a mean illness duration of 8 years for adults. 219 This suggests that our case mix was very similar to that of a typical adult inpatient with AN.…”

“…Furthermore, the average length of stay reported in HES is much lower than that reported by a recent 384 which reported a length of stay of over 18 weeks, and a recent study on the duration of stay in UK specialist ED units reported an average length of stay of 26 weeks for adults and of 29 weeks for adolescents. 219 One possible explanation is that HES conflates stays in psychiatric or ED units (typically for weight restoration or other mental health concerns such as self-harm) and stays in medical or paediatric units often linked to acute medical issues, which tend to be much shorter. In addition, HES data may not be entirely reliable.…”

“…219 The median duration of the admission was 153.5 (range 28-991) days and one patient was not discharged throughout the 2 years of the study. …”

Predictors of Outcome in Inpatients with Anorexia Nervosa: A Prospective Multi-Center Study

“…Nevertheless, the proportion of patients with poor responses in recent naturalistic studies appears to be critically high: more than half of the patients remain underweight (BMI <17.5) at discharge [1,2], and there is a strong need for more effective treatments for inpatients with AN [3]. …”