Incidence of eating disorders in Danish psychiatric secondary healthcare 1970–2008

Abstract

Objective: Is an increased focus on eating disorders during the past few decades reflected by increasing occurrence in the psychiatric health service system. Method:All first-time diagnoses of eating disorders identified in the Danish Central Psychiatric Research Register 1970-2008 constitute the present research database. Age-standardized rates per 100,000 inhabitants were calculated and autoregressive models were fitted for males and females separately as well as for in-and outpatients.Results: The incidence of eating disorders diagnosed in Danish psychiatric secondary healthcare has increased considerably during a nearly 40-year period of observation both within the general category of eating disorders and also specifically for anorexia nervosa. The steepest increase is seen within females aged 15-19 years, where the highest incidences are also found. Anorexia nervosa constitutes the vast majority of all eating disorders. Throughout the time interval investigated, the number of males, however, is negligible compared to females. Most patients are seen in outpatient services, increasing towards recent years. However, the number of patients being treated as inpatients has increased linearly through the entire four decenniums investigated. Conclusions:Changes in registration principles, public awareness and higher acceptance of mental disorders in the public is the most obvious explanation for the incidence increase of anorexia nervosa and other eating disorders. This study does not answer whether there has been an increase in true incidence in the population.

Time trends in healthcare‐detected incidence of anorexia nervosa and bulimia nervosa in the Norwegian National Patient Register (2010–2016)

“…Several main (Gammelmark et al, 2015;Lucas, Crowson, O'Fallon, & Melton 3rd., 1999;van Son et al, 2006). Several main (Gammelmark et al, 2015;Lucas, Crowson, O'Fallon, & Melton 3rd., 1999;van Son et al, 2006).…”

“…Worldwide, information on recent time-trends in incidence has been largely derived from psychiatric or primary care registers in four countries, namely Denmark, Sweden, the Netherlands, and the UK (Gammelmark et al, 2015;Holland, Hall, Yeates, & Goldacre, 2016;Javaras et al, 2015;Micali, Hagberg, Petersen, & Treasure, 2013;Steinhausen & Jensen, 2015;van Son, van Hoeken, Bartelds, van Furth, & Hoek, 2006). In Denmark, an investigation of the Danish Central Psychiatric Research Register (DCPR) found an overall increase in AN from 1995 to 2010 in females aged 4-65 years (9.9-19.3/100,000), with the most frequent incidence of AN among girls aged 12-15 years (29.2-61.4/100,000) (Steinhausen & Jensen, 2015), whereas lower and stable incidence rates (IRs) of BN were detected.…”

“…Although single timepoint estimates from high-risk or community samples exist (Hoek et al, 2005;Isomaa, Isomaa, Marttunen, Kaltiala-Heino, & Bjorkqvist, 2009;Keski-Rahkonen et al, 2007;Keski-Rahkonen et al, 2009;Nagl et al, 2016;Stice, Marti, & Rohde, 2013;van Hoeken, Veling, Smink, & Hoek, 2010), along with registry-based studies tracking developments from the 1930s to late 1990s (see reviews by Hoek & van Hoeken, 2003;Hsu, 1996), more recent knowledge of whether EDs are increasing or decreasing since the year 2000 has remained limited to few sources. Worldwide, information on recent time-trends in incidence has been largely derived from psychiatric or primary care registers in four countries, namely Denmark, Sweden, the Netherlands, and the UK (Gammelmark et al, 2015;Holland, Hall, Yeates, & Goldacre, 2016;Javaras et al, 2015;Micali, Hagberg, Petersen, & Treasure, 2013;Steinhausen & Jensen, 2015;van Son, van Hoeken, Bartelds, van Furth, & Hoek, 2006). In Denmark, an investigation of the Danish Central Psychiatric Research Register (DCPR) found an overall increase in AN from 1995 to 2010 in females aged 4-65 years (9.9-19.3/100,000), with the most frequent incidence of AN among girls aged 12-15 years (29.2-61.4/100,000) (Steinhausen & Jensen, 2015), whereas lower and stable incidence rates (IRs) of BN were detected.…”

What's in a Self‐report? A Comparison of Pregnant Women with Self‐reported and Hospital Diagnosed Eating Disorder

“…Eating disorders (EDs)-comprising anorexia nervosa, bulimia nervosa, binge ERED and other specified feeding and ED (American Psychiatric Association, 2013)-are severe mental disorders associated with increased mortality (Arcelus, Mitchell, Wales, & Nielsen, 2011). Register-based studies are important for determining agespecific and gender-specific time trends of ED and have provided important insight into the course and outcomes of ED (Crow et al, 2009;Gammelmark et al, 2015;Javaras et al, 2015;Micali, Hagberg, Petersen, & Treasure, 2013;Steinhausen & Jensen, 2015;Zerwas et al, 2015). However, as the registers are most often based on hospital records, only the most severely affected cases referred to secondary care are included, and hence, the occurrence of ED has been found to be higher in community samples than in register-based studies (Micali et al, 2013;Steinhausen & Jensen, 2015;Zerwas et al, 2015).…”

Clinicians' perspective on an app for patient self‐monitoring in eating disorder treatment

“…Moreover, a review of ED self-management apps found RR to be the most evidence-based and comprehensive app available because of its customizable features and CBT framework (Juarascio, Manasse, Goldstein, Forman, & Butryn, 2015). In addition, an increased number of 15-to 20-year-old individuals are diagnosed with EDs (Gammelmark et al, 2015;Smink, Van Hoeken, & Hoek, 2012;Smink, van Hoeken, & Hoek, 2013), which is an age group consisting of diligent smartphone users, who primarily prefer digital options over analog ones (Pew Research Center, 2017). Furthermore, two studies on blended treatment for patients with depression reported positive outcomes with improved symptom levels (Ly et al, 2015;Zwerenz et al, 2017), and reduced use of clinician time (Ly et al, 2015).…”