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Mortality in Women With Anorexia Nervosa: The Role of Comorbid Psychiatric Disorders
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Karolinska Inst, Karolinska Hosp, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden..
Harokopio Univ, Dept Nutr & Dietet, Athens, Greece..
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2016 (English)In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 78, no 8, p. 910-919Article in journal (Refereed) Published
Abstract [en]

Objective To investigate mortality in anorexia nervosa (AN) with a psychiatric comorbidity. Methods Using Swedish registers, data for 8069 female inpatients with AN were retrospectively collected for 1973-2010. Mortality patterns were assessed using standardized mortality ratios (SMRs), Cox regression-derived hazard ratios, and incidence rate ratios. A control cohort of 76,995 women was used. Results Patients with AN and a psychiatric comorbidity had higher mortality rates did than those without a comorbidity. The SMRs for patients with AN and a psychiatric comorbidity were 5.4 (95% confidence interval [CI] = 4.6-6.4) and 18.1 (95% CI = 15.2-21.3) for natural and unnatural causes of death, respectively. The SMRs for patients with AN without a comorbidity were 2.8 (95% CI = 2.3-3.5) and 3.1 (95% CI = 2.2-4.1) for natural and unnatural causes of death, respectively. The adjusted hazard ratios for mortality from natural or unnatural causes were 2.0 (95% CI = 1.5-2.7) and 5.7 (95% CI = 3.9-8.2), respectively. Incidence rate ratios comparing patients with AN and controls, both with psychiatric comorbidities, suggest a negative synergistic effect of comorbid AN and psychiatric disorder on mortality, which was greater for unnatural causes of death. Conclusions Mortality in patients with AN was greater in the presence of a psychiatric comorbidity, and even more pronounced for unnatural causes of death and suicides. Substance abuse, especially alcohol use disorder, increased mortality from natural causes of death. These findings highlight the need for early detection and treatment of psychiatric comorbidity in AN, to potentially improve long-term outcomes.

Place, publisher, year, edition, pages
2016. Vol. 78, no 8, p. 910-919
Keywords [en]
eating disorders, anorexia nervosa, psychiatric comorbidity, mortality, aHR = adjusted hazard ratio, AN = anorexia nervosa, BMI = body mass index, CI = confidence interval, ED = eating disorders, HR = hazard ratio, ICD = International Classification of Diseases, IRR = incidence rate ratio, SD = standard deviation, SMR = standardized mortality ratio
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-308779DOI: 10.1097/PSY.0000000000000342ISI: 000386338900004PubMedID: 27136502OAI: oai:DiVA.org:uu-308779DiVA, id: diva2:1054641
Funder
Swedish Society of MedicineAvailable from: 2016-12-08 Created: 2016-11-30 Last updated: 2017-11-29Bibliographically approved

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Kask, JanEkselius, LisaPapadopoulos, Fotis C.

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