Predictors of Mortality in Eating Disorders | Psychiatry and Behavioral Health | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.226.234.102. Please contact the publisher to request reinstatement.
1.
Harris  ECBarraclough  B Excess mortality of mental disorder.  Br J Psychiatry. 1998;17311- 53Google ScholarCrossref
2.
Moller-Madsen  SNystrup  JNielsen  S Mortality in anorexia nervosa in Denmark during the period 1970-1987.  Acta Psychiatr Scand. 1996;94454- 459Google ScholarCrossref
3.
Crisp  AHCallender  JSHalek  CHsu  LKG Long-term mortality in anorexia nervosa.  Br J Psychiatry. 1992;161104- 107Google ScholarCrossref
4.
Patton  GC Mortality in eating disorders.  Psychol Med. 1988;18947- 951Google ScholarCrossref
5.
Keel  PKMitchell  JE Outcome in bulimia nervosa.  Am J Psychiatry. 1997;154313- 321Google Scholar
6.
Herzog  WDeter  HCFiehn  WPetzold  E Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study.  Psychol Med. 1997;27269- 279Google ScholarCrossref
7.
Engel  KWittern  MHentze  MMeyer  AE Long-term stability of anorexia nervosa treatments: follow-up study of 218 patients.  Psychiatr Dev. 1989;7395- 407Google Scholar
8.
Ramsay  RWard  ATreasure  JRussell  GFM Compulsory treatment in anorexia nervosa.  Br J Psychiatry. 1999;175147- 153Google ScholarCrossref
9.
Sullivan  PF Mortality in anorexia nervosa.  Am J Psychiatry. 1995;1521073- 1074Google Scholar
10.
Theander  S Outcome and prognosis in anorexia nervosa and bulimia: some results of previous investigations, compared with those of a Swedish long-term study.  J Psychiatr Res. 1985;19493- 508Google ScholarCrossref
11.
Streigel-Moore  RHLeslie  DPetrill  SAGarvin  VRosenheck  RA One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims.  Int J Eat Disord. 2000;27381- 389Google ScholarCrossref
12.
Keel  PKDorer  DJEddy  KTDelinsky  SSFranko  DLBlais  MAKeller  MBHerzog  DB Predictors of treatment utilization among women with anorexia and bulimia nervosa.  Am J Psychiatry. 2002;159140- 142Google ScholarCrossref
13.
Svenne  ILarsson  PT Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion.  Acta Paediatr. 1999;88304- 309Google ScholarCrossref
14.
Greenfeld  DMickley  DQuinlan  DMRoloff  P Hypokalemia in outpatients with eating disorders.  Am J Psychiatry. 1995;15260- 63Google Scholar
15.
Herzog  DBKeller  MBSacks  NRYeh  CJLavori  PW Psychiatric comorbidity in treatment-seeking anorexics and bulimics.  J Am Acad Child Adolesc Psychiatry. 1992;31810- 818Google ScholarCrossref
16.
Braun  DLSunday  SRHalmi  KA Psychiatric comorbidity in patients with eating disorders.  Psychol Med. 1994;24859- 867Google ScholarCrossref
17.
Spitzer  RLEndicott  J Schedule for Affective Disorders and Schizophrenia (SADS). 3rd New York New York State Psychiatric Institute1979;
18.
Pfohl  BStangl  DZimmerman  M The Structured Interview for DSM-III Personality Disorders (SID-P). 2nd Iowa City University of Iowa1983;
19.
Keller  MBLavori  PWFriedman  BNielson  EEndicott  JMcDonald-Scott  PAndreasen  NC The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies.  Arch Gen Psychiatry. 1987;44540- 548Google ScholarCrossref
20.
Herzog  DBKeller  MBLavori  PWOtt  IL Short-term prospective study of recovery in bulimia nervosa.  Psychiatry Res. 1988;2345- 55Google ScholarCrossref
21.
Horm  J National Death Index User's Manual.  Appendix A, Assignment of Probabilistic Scores to National Death Index Record Matches Hyattsville, Md National Center for Health Statistics1996;Google Scholar
22.
Calle  ETerrell  DD Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants.  Am J Epidemiol. 1993;137235- 241Google Scholar
23.
US Department of Health and Human Services, US Decennial Life Tables for 1989-91. II Hyattsville, Md US Dept of Health and Human Services1998;16
24.
Vitagliano  FA 1995 Annual Report: Vital Statistics of Massachusetts.  Boston Commonwealth of Massachusetts Department of Public Health1997;
25.
Therneau  TMGrambusch  PM Modeling Survival Data.  New York, NY Springer Publishing Co Inc2000;
26.
Hosmer  DWLemeshow  S Applied Survival Analysis: Regression Modeling of Time to Event Data.  New York, NY John Wiley & Sons Inc1999;
27.
Ihaka  RGentleman  R R: a language for data analysis and graphics.  J Computat Graphics Stat. 1996;5299- 314Google Scholar
28.
Eckert  EDHalmi  KAMarchi  PGrove  WCrosby  R Ten-year follow-up study of anorexia nervosa: clinical course and outcome.  Psychol Med. 1995;25143- 156Google ScholarCrossref
Original Article
February 2003

Predictors of Mortality in Eating Disorders

Author Affiliations

From the Department of Psychology, Harvard University (Dr Keel), Cambridge, Mass, Department of Psychiatry, Massachusetts General Hospital (Drs Dorer and Herzog), Department of Psychology, Boston University (Ms Eddy), the Department of Counseling Psychology, Northeastern University (Dr Franko), Boston; and Ferkauf Graduate School of Psychology, Yeshiva University (Ms Charatan), New York, NY.

Arch Gen Psychiatry. 2003;60(2):179-183. doi:10.1001/archpsyc.60.2.179
Abstract

Background  Anorexia nervosa, but not bulimia nervosa, has one of the highest mortality rates among psychiatric disorders. However, potential predictors of mortality, such as comorbid psychiatric illnesses, remain unclear. We sought to determine mortality ratios and predictors of fatal outcome in women diagnosed as having anorexia or bulimia nervosa.

Methods  Women (N = 246) diagnosed as having either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) between January 1, 1987, and December 31, 1991, participated in a prospective longitudinal study. Vital status was determined by ongoing contact and a National Death Index search as of December 1998 (overall ascertainment, 99.8%) and telephone contact as of October 2000 (ascertainment, 95.0%).

Results  Eleven women died. Standardized mortality ratios were elevated for all causes of mortality (11.6; 95% confidence interval, 5.5-21.3) and suicide(56.9; 95% confidence interval, 15.3-145.7) in anorexia nervosa but not for death (1.3; 95% confidence interval, 0.0-7.2) in bulimia nervosa. Predictors of mortality in anorexia nervosa included severity of alcohol use disorder during follow-up (P<.001). Hospitalization for an affective disorder before baseline assessment seemed to protect women from a fatal outcome (P<.001).

Conclusions  Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care because one third of women who had alcoholism and died had no history of alcohol use disorder at intake.

×