The British Journal of Psychiatry (2009) 194: 10-17. doi: 10.1192/bjp.bp.108.054742
© 2009 The Royal College of Psychiatrists
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Excess mortality, causes of death and prognostic factors in anorexia nervosa

Fotios C Papadopoulos, MD, PhD

Department of Neuroscience, Psychiatry, University Hospital, Uppsala

Anders Ekbom, MD, PhD and Lena Brandt, BSc

Unit of Clinical Epidemiology, Department of Medicine, Karolinska Hospital, Karolinska Institute, Stockholm

Lisa Ekselius, MD, PhD

Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden

Correspondence: Fotios Papadopoulos, Department of Neuroscience, Psychiatry Uppsala University Hospital, SE-751 85 Uppsala, Sweden. Email: fotis.papadopoulos{at}gmail.com

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Anorexia nervosa is a mental disorder with high mortality.

Aims

To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors.

Method

Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers.

Results

The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5–7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome.

Conclusions

Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.


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Fallacies in Standardised Mortality Ratios in Anorexia nervosa
Gerald F.M. Russell, et al.
BJP Online, 6 Feb 2009 [Full text]
Re: Fallacies in Standardised Mortality Ratios in Anorexia nervosa
Fotios C Papadopoulos, et al.
BJP Online, 19 Mar 2009 [Full text]