Defining and predicting service utilisation in young adulthood following childhood treatment of an eating disorder

Abstract

Background Eating disorder services are often separated into child and adolescent eating disorder services (CAEDSs) and adult eating disorder services (AEDSs). Most patients in CAEDSs present with first-episode illness of short duration, which with appropriate treatment, have a good prognosis. However, some individuals receive further treatment as adults. Little is known about service utilisation in adulthood following childhood/adolescent treatment of an eating disorder. Aims This study aims (a) to estimate the proportion of patients in a CAEDS who use mental health services as young adults, (b) to delineate service utilisation following treatment in CAEDSs and (c) to identify factors in CAEDSs that predict service utilisation in young adulthood. Method A consecutive cohort of 322 patients (aged 13–17 years) seen in a CAEDS in the UK over a 5-year period were included in this audit. Data regarding their use of UK-wide adult mental health services as young adults (i.e. when aged 18–25) were extracted from local and national hospital records. Results A total of 68.3% of CAEDS patients received no mental health treatment as young adults. Although 13% of people seen in a CAEDS had brief eating disorder treatment as young adults, 10% received longer/or more intensive eating disorder treatment. Overall, 10.8% transitioned directly to an AEDS and 7.6% were re-referred following discharge from CAEDS. In our sample, older age and increased use of CAEDSs predicted increased eating disorder treatment in young adulthood. Conclusions Our results indicate that most people seen in CAEDSs do not receive further mental health treatment as young adults. Several features in CAEDSs distinguish mental health service utilisation in young adulthood, which were identified clinically and could be targeted during treatment.

Transitioning services for eating disorder treatment, the relative importance of factors from patient, carer and clinician perspectives: a Q-methodology study

“…Considering the peak age of onset for anorexia nervosa is early adolescence (Pinhas et al , 2011) and the highest risk for bulimia nervosa onset is mid to late adolescence (Stice et al , 2011), many young people treated in child and adolescent mental health (CAMHS) ED services are likely to require continuing treatment in adult ED (AED) services. A recent audit of ED service use (McClelland et al , 2020) showed almost a quarter of patients who received care in CAMHS required further treatment in AED either for enduring illness or due to relapse; this was in line with the results of an earlier study (Arcelus et al , 2008). Approximately one-fifth of patients were noted to have transitioned from young people services for continued treatment at adult services (McClelland et al , 2020).…”

Assessing the impact of First Episode Rapid Early Intervention for Eating Disorders on duration of untreated eating disorder: A multi‐centre quasi‐experimental study

“…The most common reason for patients not receiving FREED as planned were delays related to consecutive involvement of different services, for example transfers between services or transitions from child and adolescent to adult ED services. This speaks to the fact that these transitions can compromise the quality of care provided (McClelland, Simic, Schmidt, Koskina, & Stewart, 2020). Another common reason for delay was the presence of systemic commissioning barriers, such as referral panels or individual commissioners making decisions about access, which prevented patients from receiving timely care.…”

Cost-of-illness for non-underweight binge-eating disorders

“…Although participants were asked to consider costs related to their ED, costs associated with comorbidity were not estimated (e.g., [ 6 , 17 ]) and absence of a control group prevented direct comparisons with other samples (e.g., see [ 10 ]). The questionnaire assessing healthcare use (see [ 25 ]) has not undergone psychometric evaluation and use of centralised sources for cost estimation (e.g., see [ 44 ]) may complement ‘bottom-up’ studies such as the current one.…”