Length of stay for anorexia nervosa: Systematic review and meta‐analysis

Kan, Carol; Hawkings, Ysabella-Rozetta; Cribben, Hannah; Treasure, Janet

doi:10.1002/erv.2820

Cited by 27 publications

(38 citation statements)

References 87 publications

(22 reference statements)

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“…Previous studies postulated that the BMI at admission as an indicator of illness severity is a predictor of treatment response in terms of a better prognosis in patients with higher BMI at admission and discharge [ 63 , 66 ]. Furthermore, higher levels of eating disorder psychopathology at admission were also associated with longer duration of inpatient stay, which is consistent with the current literature [ 33 , 34 , 36 ]. The severity of eating disorder symptoms associated with a low BMI at admission and possible medical complications often lead to a prolonged inpatient stay as they interfere with a continuous weight gain.…”

Section: Discussionsupporting

confidence: 91%

“…This is why several studies evaluated the short- and long-term effectiveness of inpatient treatment compared with day-clinic and outpatient treatment settings [ 14 , 29 , 30 , 31 , 32 ]. Additionally, research on predictive factors that influence the length of inpatient stay getting into focus in more recent years [ 33 , 34 , 35 ], partly because of the great variation across countries, with a postulated longer duration in Europe (105.6 days) compared to the United States (49.1 days) [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

“…As many patients with AN show an unfavorable treatment outcome, several previous studies focused on identifying underlying positive or negative prognostic factors to increase insight into the mechanisms of AN in order to improve current treatment interventions [ 37 , 40 , 58 , 59 , 60 , 61 , 62 , 63 ]. However, the current evidence does not yet provide a sufficient picture on the factors relevant for favorable treatment outcome on the one hand [ 22 , 24 , 54 , 64 , 65 ], and optimal length of inpatient stay on the other hand [ 33 , 34 , 35 , 36 ], primarily due to the inconsistent results and high heterogeneity of the methods used.…”

Section: Introductionmentioning

confidence: 99%

“…While some studies showed that a binge-purging subtype [ 64 , 65 , 67 , 69 ] as well as the presence of comorbid psychiatric disorders [ 40 , 64 , 70 , 71 ] were associated with worse treatment outcome, other studies failed to verify these findings [ 72 , 73 , 74 , 75 ]. Sociodemographic, clinical, and therapeutic variables could be found that predicted the length of hospital stay including age and BMI at admission [ 33 , 34 , 35 , 36 , 46 ]. Lascar et al [ 33 ] found that a longer duration of inpatient stay was predicted by older age and lower BMI at admission, longer duration of illness, high severity of eating disorder symptoms, binge-purging subtype, readmissions, enteral or a combination on parenteral and oral nutrition during hospitalization, involuntary treatment, and hospitalization away from home.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

Mairhofer

Zeiler

Philipp

et al. 2021

JCM

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This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

Mairhofer

Zeiler

Philipp

et al. 2021

JCM

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“…Exploring the views of clinicians is of relevance as there is currently a lack of empirical evidence and agreement guiding the parameters of intensive treatments for AN and it remains unclear which treatment setting works best for whom [ 10 , 11 ]. This is particularly true as factors such as admission criteria, treatment content and goals, and length of stay vary substantially across intensive treatment settings both within and across countries [ 11 ]. Furthermore, growing literature indicates potential risks and benefits of each intensive treatment approach [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

et al. 2022

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Background Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians’ perspectives and experience of supporting adults with severe AN in intensive settings. Methods We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. Results Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients’ Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients’ home environments, the necessity of patient motivation, and the management of risk. Conclusions Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research.

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Comparing family‐based treatment with inpatient treatment in youth with anorexia nervosa eligible for hospitalization: A 12‐month feasibility study

Haas,

Wechsung,

Kaiser

et al. 2023

Intl J Eating Disorders

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ObjectiveFamily‐based treatment (FBT) for youth with anorexia nervosa (AN), has not been compared to inpatient, multimodal treatment (IMT).MethodProspective, non‐randomized pilot feasibility study of adolescents with AN receiving FBT (n = 31), and as a reference point for exploratory outcome comparisons IMT (n = 31), matched for baseline age and percent median BMI (%mBMI). Feasibility of FBT in youth fulfilling criteria for IMT was assessed via study recruitment and retention rates; acceptability via drop‐out and caregiver strain; safety via adverse events; preliminary treatment effectiveness between groups was assessed via a change in %mBMI, AN psychopathology (Eating Disorder Examination‐Questionnaire, EDE‐Q), and hospital days, over 12 months with intent‐to‐treat, mixed models repeated measures analyses covering post‐intervention usual care until 12 months.ResultsTaking into account that 8 FBT patients (25.8%) crossed over to IMT due to lack of weight gain or psychiatric concerns, FBT and IMT were similarly feasible, acceptable, and safe, apart from more physical antagonism toward others in FBT (p = .010). FBT lasted longer (median [interquartile range, IQR]; 33.6 [17.4, 49.9] vs. 17.3 [14.4, 24] weeks, p < .001), but required fewer hospital days than IMT (median, [IQR], FBT = 1 [0, 16] vs. IMT = 123 [101, 180], p < .001). Baseline comorbidity‐adjusted changes over 12 months did not differ between groups in %mBMI (FBT = 12.6 ± 11.9 vs. IMT = 13.7 ± 9.1; p = .702) and EDE‐Q global score (median, [IQR]; FBT = −1.2 [−2.3, 0.2] vs. IMT = −1.3 [−2.8, −0.4]; p = .733).DiscussionImplementing FBT in this pilot study was feasible, acceptable, and safe for youth eligible for IMT according to German S3 guidelines. Non‐inferiority of FBT versus IMT requires confirmation in a sufficiently large multicenter RCT.Public SignificanceThis pilot study with 62 adolescent patients with anorexia nervosa demonstrated that for 2/3rd of patients eligible for a long hospitalization in the German health care system, outpatient, Family‐based treatment (FBT) was a safe and feasible treatment alternative. Over 12 months, FBT lead to similar weight gain and reduction in eating disorder cognitions as inpatient treatment with fewer hospital days. This pilot study needs to be followed up by a larger, multicenter trial.

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Length of stay for anorexia nervosa: Systematic review and meta‐analysis

Cited by 27 publications

References 87 publications

Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

Comparing family‐based treatment with inpatient treatment in youth with anorexia nervosa eligible for hospitalization: A 12‐month feasibility study

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