Excess Mortality Among Patients With Anorexia Nervosa Treated Involuntarily

Area of Science:

• Psychiatry
• Public Health
• Epidemiology

Background:

• Anorexia nervosa (AN) is a severe psychiatric disorder associated with high morbidity and mortality.
• Involuntary treatment (IT) is a measure for patients with AN who have exhausted voluntary options, indicating significant vulnerability.

Purpose of the Study:

• To investigate mortality rates in patients diagnosed with anorexia nervosa (AN) after receiving involuntary treatment (IT).
• To use IT as an indicator of patient vulnerability and its association with mortality in AN.

Main Methods:

• A Danish register-based cohort study (2000-2016) included individuals diagnosed with AN.
• Exposure was defined as the first instance of IT, regardless of diagnosis.
• Mortality (all-cause, external causes, suicide) was assessed using Cox proportional hazards regression, adjusted for covariates.

Main Results:

• The study included 4425 individuals with AN; 18.5% received IT, and 4.7% died.
• Elevated hazard ratios (HR) were observed for all-cause mortality (HR=2.21), external causes (HR=3.88), and suicide (HR=5.30) in patients receiving IT.
• Electroconvulsive therapy and somatic concerns were associated with an elevated HR (1.96).

Conclusions:

• Despite IT being a safeguard for vulnerable patients, those receiving it exhibited increased mortality.
• This patient group with anorexia nervosa requires sustained clinical attention and specialized care.
• Further research into the specific needs and interventions for high-risk AN patients undergoing IT is warranted.