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

Autor: Solmi M; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.; Regional Centre for Treatment of Eating Disorders, and On Track: Champlain First Episode Psychosis Program, Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada.; Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany., Monaco F; Department of Mental Health, Local Health Unit, Salerno, Italy.; European Biomedical Research Institute of Salerno, Salerno, Italy., Højlund M; 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., Monteleone AM; Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy., Trott M; Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.; Centre for Public Health, Queen's University, Belfast, UK., Firth J; Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK., Carfagno M; Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy., Eaton M; NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia.; School of Medical, Indigenous and Health Sciences Medicine, University of Wollongong, Wollongong, NSW, Australia., De Toffol M; Department of Mental Health, Local Health Unit, Lecce, Italy., Vergine M; Department of Mental Health, Local Health Unit, Lecce, Italy., Meneguzzo P; Department of Neuroscience, University of Padua, Padua, Italy., Collantoni E; Department of Neuroscience, University of Padua, Padua, Italy., Gallicchio D; Department of Mental Health, Local Health Unit, Vicenza, Italy., Stubbs B; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.; Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK., Girardi A; Department of Neuroscience, University of Padua, Padua, Italy., Busetto P; Provincial Center for Eating Disorders, Local Health Unit, Treviso, Italy., Favaro A; Department of Neuroscience, University of Padua, Padua, Italy., Carvalho AF; Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia., Steinhausen HC; Department of Child and Adolescent Psychiatry, Psychiatric University Clinic, Zurich, Switzerland.; Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.; Department of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark.; Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark., Correll CU; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.; Department of Psychiatry, Northwell Health, Zucker Hillside Hospital, Glen Oaks, NY, USA.; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.; Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
Jazyk: angličtina
Zdroj: World psychiatry : official journal of the World Psychiatric Association (WPA) [World Psychiatry] 2024 Feb; Vol. 23 (1), pp. 124-138.
DOI: 10.1002/wps.21182
Abstrakt: 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.
(© 2024 World Psychiatric Association.)
Databáze: MEDLINE
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