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Predictors of mortality in eating disorders
Pamela K Keel1, David J Dorer, Kamryn T Eddy
1Department of Psychology, Harvard University, 1320 William James Hall, 33 Kirkland St, Cambridge, MA 02138, USA. pkeel@wjh.harvard.edu
Archives of General Psychiatry
|February 13, 2003
Summary
Anorexia nervosa significantly increases mortality risk, especially from suicide. Alcohol use disorder is a key predictor, while prior hospitalization for affective disorders may be protective. Careful alcohol use assessment is crucial for anorexia nervosa patients.
Area of Science:
- Psychiatry
- Clinical Psychology
- Epidemiology
Background:
- Anorexia nervosa (AN) is associated with high psychiatric mortality rates.
- Predictors of mortality in eating disorders, including comorbid conditions, require further investigation.
- This study examines mortality ratios and predictors in women with AN and bulimia nervosa (BN).
Purpose of the Study:
- To determine standardized mortality ratios (SMRs) for women diagnosed with AN and BN.
- To identify predictors of fatal outcomes in these patient groups.
- To investigate the role of comorbid psychiatric conditions and substance use disorders in mortality.
Main Methods:
- A prospective longitudinal study of 246 women diagnosed with AN (n=136) or BN (n=110) between 1987-1991.
- Vital status was ascertained through ongoing contact and National Death Index searches until October 2000.
- Statistical analyses identified predictors of mortality within the AN and BN cohorts.
Main Results:
- Eleven deaths occurred during the study period.
- Elevated SMRs were observed for all-cause mortality (11.6) and suicide (56.9) in AN, but not in BN.
- Severity of alcohol use disorder during follow-up predicted mortality in AN; prior affective disorder hospitalization appeared protective.
Conclusions:
- Anorexia nervosa is associated with significantly increased mortality, particularly from suicide.
- Alcohol use disorder is a critical predictor of mortality in AN, with a notable proportion of deceased patients developing it during follow-up.
- Physicians must monitor alcohol use patterns in AN patients, as it may emerge during treatment and impact prognosis.