Outcomes in people with eating disorders: a transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis.

Journal: World psychiatry : official journal of the World Psychiatric Association (WPA)

Volume: 23

Issue: 1

Year of Publication: 

Affiliated Institutions:  Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada. Department of Mental Health, Local Health Unit, Salerno, Italy. Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark; Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark. Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy. Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK. Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia. Department of Mental Health, Local Health Unit, Lecce, Italy. Department of Neuroscience, University of Padua, Padua, Italy. Department of Mental Health, Local Health Unit, Vicenza, Italy. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Provincial Center for Eating Disorders, Local Health Unit, Treviso, Italy. Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia. Department of Child and Adolescent Psychiatry, Psychiatric University Clinic, Zurich, Switzerland. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.

Abstract summary 

Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

Authors & Co-authors:  Solmi Marco M Monaco Francesco F Højlund Mikkel M Monteleone Alessio M AM Trott Mike M Firth Joseph J Carfagno Marco M Eaton Melissa M De Toffol Marco M Vergine Mariantonietta M Meneguzzo Paolo P Collantoni Enrico E Gallicchio Davide D Stubbs Brendon B Girardi Anna A Busetto Paolo P Favaro Angela A Carvalho Andre F AF Steinhausen Hans-Christoph HC Correll Christoph U CU

Study Outcome 

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Statistics
Citations :  Treasure J, Hübel C, Himmerich H. The evolving epidemiology and differential etiopathogenesis of eating disorders: implications for prevention and treatment. World Psychiatry 2022;21:147‐8.
Authors :  20
Identifiers
Doi : 10.1002/wps.21182
SSN : 1723-8617
Study Population
Male,Female
Mesh Terms
Other Terms
Eating disorders;anorexia nervosa;binge eating disorder;bulimia nervosa;chronicity;cognitive-behavioral therapy;diagnostic migration;family-based therapy;hospitalization;mortality;nutritional interventions;recovery
Study Design
Cohort Study,Cross Sectional Study
Study Approach
Mixed Methods,Systemic Review
Country of Study
Publication Country
Italy