Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa

Abstract

Anorexia nervosa (AN) is found associated with increased mortality. Frequent comorbidities of AN include substance use disorders (SUD), affective disorders (AD) and personality disorders (PD). We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders in the observation window between January 2007 and March 2016 for 1970 people with AN, using data from the case register of the South London and Maudsley (SLaM) NHS Foundation Trust, an almost monopoly-secondary mental healthcare service provider in southeast London. We retrieved data from its Clinical Records Interactive Search (CRIS) system as data source. Mortality was ascertained through nationwide tracing by the UK Office for National Statistics (ONS) linked to CRIS database on a monthly basis. A total of 43 people with AN died during the observation period. Standardized Mortality Ratio (SMR) with England and Wales population in 2012 as standard population for our study cohort was 5.21 (95% CI 3.77, 7.02). In univariate analyses, the comorbidity of SUD or PD was found to significantly increase the relative risks of mortality (HRs = 3.10, 95% CI 1.21, 7.92; and 2.58, 95% CI 1.23, 5.40, respectively). After adjustment for demographic and socioeconomic covariates as confounders, moderately but not significantly elevated risks were identified for SUD (adjusted HR = 1.39, 95% CI 0.53, 3.65) and PD (adjusted HR = 1.58, 95% CI 0.70, 3.56). These results suggest an elevated mortality in people with AN, which might be, at least partially, explained by the existence of the comorbidities SUD or PD.

Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden

“…In users of secondary mental healthcare services an SMR of 5.2 (95% confidence interval (CI): 3.8–7.0) was reported for anorexia nervosa and atypical anorexia nervosa according to ICD-10 criteria [ 16 ]. Also using ICD-10 criteria, Suokas et al found a hazard ratio of 6.5 (95% CI: 3.5–12.3) for people with anorexia nervosa and atypical anorexia nervosa treated in tertiary care [ 17 ].…”

Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study

“…Eating disorders (ED) include a variety of diagnoses such as anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder otherwise not specified (EDNOS) (American Psychiatrist Association [APA], ). ED patients have high rates of mortality with psychiatric comorbidity contributing to these elevated rates (Himmerich et al , Himmerich et al ). They are more likely to present to hospital with self‐harm (Perez, Marco, & Canabate, ; Smithuis et al, ) or a suicide attempt (Suokas et al, ).…”

Patients’ and Carers’ Perspectives of Psychopharmacological Interventions Targeting Anorexia Nervosa Symptoms

“…End-of-treatment remission rates of RCTs in adult patients with AN range between 13 and 43% [12]. This is a sobering figure highlighting the pernicious nature of AN and its mortality rate, which is-as already mentioned above-five to six times greater than in the general population [6,13,14].…”

“…A recent longitudinal cohort study showed that only about 30% of patients with AN have recovered after 9 years [5]. AN has also been reported to be associated with a significantly increased mortality with a standardized mortality ratio (SMR) of 5.21 [6]. Thus, novel approaches such as psychopharmacological options should be considered to improve the treatment outcome and the care for people with AN.…”