Excess Mortality Among Patients With Anorexia Nervosa Treated Involuntarily

Anorexia nervosa (AN) is a severe psychiatric disorder with high morbidity and increased relative mortality compared to the general population. Involuntary treatment (IT) is implemented after exhausting voluntary treatment options. This study investigates mortality in patients with AN following IT, using IT as an indicator of patient vulnerability.

A register-based cohort study including individuals diagnosed with AN (ICD-10: F50.0, F50.1) from 2000 to 2016 at any Danish hospital and with an inpatient admission following their AN diagnosis. The exposure was the first instance of any IT event and categories of IT after AN. IT could be associated with AN or any other diagnosis. The outcome was mortality; all-cause and divided into deaths from diseases and medical conditions, external causes, or suicide. Excess mortality was estimated as hazard ratios (HR) using Cox proportional hazards regression. The model was adjusted for sex, age at AN diagnosis, birth year, prior IT, self-harm, and other psychiatric morbidities.

Over the study period 4425 individuals (93.3% female; mean age at diagnosis = 22, SD = 12) were included in the study. Of these, 821 individuals received IT (18.5%) and 206 individuals (4.7%) died. The HRs were elevated for all-cause mortality (HR = 2.21, [95% CI: 1.54-3.17]), external causes (HR = 3.88, [95% CI: 1.94-7.77]), and suicide (HR = 5.30, [95% CI: 2.07-13.54]). The analysis of IT categories only showed an elevated HR for electroconvulsive therapy and somatic concerns (HR = 1.96, [95% CI: 1.04-3.67]).

Despite IT primarily being used to safeguard the life of the most vulnerable patients, mortality for those who received IT was elevated. The results indicate that this patient group requires sustained clinical attention.