Predictors of dropout from inpatient treatment for anorexia nervosa: Data from a large French sample

Huas, Caroline; Godart, Nathalie; Foulon, C.; Pham‐Scottez, Alexandra; Divac, Snežana M.; Fedorowicz, V.; Peyracque, Emilie; Dardennes, Roland; Falissard, Bruno; Rouillon, Frédéric

doi:10.1016/j.psychres.2009.12.004

Cited by 56 publications

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“…The findings of our research do not suggest a direct relationship between initial BMI and outpatient treatment outcome. Therefore, according to our study, low body weight at the start of the treatment, which is one factor that has been suggested to strongly influence treatment outcome, 30,31 does not seem to affect clearly our outpatient results. These findings oppose other studies that had considered that Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com…”

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Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

et al. 2017

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RESUMOIntrodução: A anorexia nervosa é uma doença severa, geralmente crónica e potencialmente fatal, de etiologia complexa e caraterizada por restrição alimentar, sobrevalorização da importância do peso corporal e da imagem, medo intenso de ganho ponderal e distorção da imagem corporal. A anorexia nervosa está associada a altas taxas de mortalidade, suicídio e diminuição da qualidade de vida. O nosso objetivo é apresentar um programa de tratamento da anorexia nervosa de um hospital universitário português e determinar o impacto da duração da doença, antes da admissão, no outcome. A nossa hipótese é que pacientes com maior longevidade da doença apresentam piores prognóstico e outcome. Material e Métodos:A amostra incluiu dados de 169 pacientes vistos consecutivamente e pela primeira vez no Centro Hospitalar de São João, entre 2010 e 2015. Realizámos um estudo observacional retrospetivo, que incluiu os dados colhidos na admissão e durante o seguimento.Resultados: Dos doentes inicialmente selecionados, 14,8% alcançaram remissão total, 16% remissão parcial e 14,2% terminaram com exacerbação/estagnação da doença. A taxa de dropout foi 55% durante o nosso período de estudo. Encontrámos diferenças estatisticamente significativas relativamente ao outcome para diferentes tempos de duração da doença (p = 0,007).Discussão: Existem vários fatores frequentemente associados com mau outcome na anorexia nervosa. A interpretação dos resultados foi limitada pela alta taxa de dropouts e falta de critérios de definição consistentes. Conclusão:Os nossos resultados apoiam a ideia de que a duração da doença tem um papel preponderante no outcome e prognóstico da doença.Palavras-chave: Anorexia Nervosa/tratamento; Prognóstico; Progressão da Doença; Resultado do Tratamento ABSTRACT Introduction: Anorexia nervosa is a severe, usually chronic, life-threatening disease of complex etiology characterized by food restriction, overestimation of the importance of body weight and image, intense fear of weight gain and distortion of body image. Anorexia nervosa is associated with high rates of mortality, suicide and decreased quality of life. Our aim is to present an anorexia nervosa treatment program offered in a major university hospital in Portugal, and to determine the impact of illness duration before admission on the outcome. Our hypothesis is that patients with greater disease longevity may have worse prognosis and poorer outcome. Material and Methods:The sample included data from case records of 169 patients seen consecutively and for the first time at Centro Hospitalar São João, between 2010 and 2015. We performed a retrospective observational study which included data collected at admission and from later follow-up years.Results: From the initially selected patients, 14.8% reached total remission, 16% accomplished partial remission and 14.2% ended up with exacerbation/stagnation of the disease. The dropout rate was of 55% throughout our study period. We found significant differences on outcome rates between distinct illness duration grou...

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“…31,32 The present study has several limitations that should be considered. It was a retrospective medical chart review whereby the information collected was dependent exclusively on case records.…”

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Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

et al. 2017

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“…Em ambos os grupos, mais de 70% das pacientes residiam na Grande São Paulo, e o abandono do tratamento não sofreu influência de tal variável. Assim como no nosso estudo, a procedência não foi um fator relacionado ao abandono do tratamento hospitalar para anorexia nervosa na pesquisa de Surgenor et al (2004 Assim como no presente estudo, o estado civil foi investigado como fator de risco para o abandono do tratamento em outras pesquisas (Surgenor et al, 2004;Woodside et al, 2004;Huas et al, 2011) que igualmente não encontraram relação significativa com essa variável. Entretanto, quando investigamos a existência de relacionamento amoroso e sua associação com o tipo de alta recebida, encontramos esta variável como fator de risco para o abandono do tratamento.…”

Section: Análise Multivariadaunclassified

“…Outras pesquisas são concordantes com o fato de que a duração da doença não se apresenta como fator de risco para o abandono do tratamento hospitalar para anorexia nervosa (Zeeck et al, 2005;Huas et al, 2011), em hospital dia para transtornos alimentares (Franzen et al, 2004), ambulatorial para bulimia nervosa (Fassino et al, 2003) e para a anorexia nervosa (Fassino et al, 2002) e internação hospitalar e domiciliar para transtornos alimentares (Dalle Grave et al, 2008). Uma maior duração da doença foi reportada como fator de risco para o abandono do tratamento ambulatorial para adolescentes com bulimia nervosa (Hoste et al, 2007) e em uma pesquisa sobre tratamento hospitalar para anorexia nervosa (Treat et al, 2005).…”

Section: Análise Multivariadaunclassified

“…Apesar de para muitas pacientes ter seu início motivado pela tentativa de atingir um ideal cultural de magreza, ao longo do tempo, o emagrecimento característico da anorexia nervosa, começa a servir a várias funções adaptativas como sensação de vitória e controle sobre sua vida e enfrentamento de situações consideradas ameaçadoras pelo indivíduo (Touyz et al, 2003;NordbØ et al, 2012 Quando subdividimos os pacientes da nossa amostra quanto ao diagnóstico recebido -anorexia nervosa e bulimia nervosa -também não encontramos relação entre o abandono do tratamento hospitalar e presença de comorbidades nos dois grupos. Esta interação já foi relatada em estudos sobre o abandono do tratamento ambulatorial para bulimia nervosa (Cooker et al, 1993;Waller, 1997;Steel et al, 2000) e para a anorexia nervosa (Lock et al, 2006;Lockwood, 2012), além de tratamento hospitalar para anorexia nervosa (Zeeck et al, 2005;Huas et al, 2011 Em anorexia nervosa, a ocorrência de psicoterapia familiar para adultos foi associada a um maior ganho de peso durante o tratamento, além de redução do nível de stress para os familiares (Dare et al, 2001;Whitney et al, 2012). O envolvimento familiar foi apontado como estratégia eficaz na redução do abandono do tratamento ambulatorial para adolescentes com bulimia nervosa (Hoste et al, 2007).…”

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Fatores de risco para o abandono do tratamento hospitalar para transtorno alimentares

Carvalho¹

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SUMMARY/ABSTRACTCarvalho, LSL. Risk factors for dropping out of inpatient treatment for eating disorers [Dissertação]. São Paulo, "Faculdade de Medicina, Universidade de São Paulo"; 2013.INTRODUCTION: Although is a frequent event, there is no consensus on what factors would be involved in the dropout of treatment for eating disorders. This study aimed to identify risk factors for the dropout of an inpatient treatment for anorexia nervosa and bulimia nervosa. Aspects previous to the hospitalization, clinical features present at the admission and factors related to the period of the inpatient treatment of patients who dropped out and completed treatment were compared. METHODS: We performed a retrospective study, case-control, with the dropout of the treatment being considered the interest condition. Medical records of female patients admitted to a specialized ward in treating anorexia nervosa and bulimia nervosa between the years 2005 and 2010 were reviewed. RESULTS: A total of 259 admissions and 178 patients, research subjects were 103 women, of which 83 completed treatment and 20 dropped out, resulting in a dropout rate of treatment of 19.42%. For the statistical treatment of the data was performed univariate analysis with subsequent multivariate logistic regression with backward stepwise selection analysis of the variables considered significant. In univariate analysis, professional removal due to illness severity, existence of affective relationship, lower BMI at admission, admissions motivated by low weight, diagnosis of anorexia nervosa and existence of purging behaviors (present in all patients who dropped out the treatment) were considered as factors related to dropout treatment. After conducting the logistic regression, we found that patients at admission who were removed from the job due to the illness severity, maintained a romantic relationship and were hospitalized due to low weight were more likely to dropout the treatment. CONCLUSIONS: In this sample, the dropout of treatment was influenced by sociodemographic factors (professional removal due to illness severity and existence of a romantic relationship), for diagnostic variables (diagnosis of anorexia nervosa and purging symptoms) and aspects of symptom severity (lower BMI and hospitalization motivated by low weight). These results lead us to the egosyntonic character of eating disorders, especially anorexia nervosa, and bring a paradox: patients that on admission showed more severe symptoms of the Eating Disorder (with lower weight and disabled to work) were more likely to dropout of the treatment. Although it has several limitations, mainly due to the retrospective design, the present research is the first study of dropout of inpatient treatment for eating disorders held in Brazil. It is suggested to run with prospective investigations to confirm or refute our findings.

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Length of Stay of Inpatients with Eating Disorders

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Simpson

Voy

2013

Clin Psychology and Psychoth

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Future efforts should be invested in prospective studies, including several years' post-discharge follow-up, to explore correlations with LOS and guide treatment decisions. PRACTITIONER MESSAGE: Inpatient treatment in specialist eating disorder units is associated with nutritional and psychological benefits in adults and adolescents. Treatment requiring legal detention or nasogastric feeding involves longer admission. Further research is needed to see whether benefits are lasting.

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Predictors of dropout from inpatient treatment for anorexia nervosa: Data from a large French sample

Cited by 56 publications

References 35 publications

Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

Fatores de risco para o abandono do tratamento hospitalar para transtorno alimentares

Length of Stay of Inpatients with Eating Disorders

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