Recent evidence suggests that additional psychiatric disorders in patients with eating disorders (ED) may contribute to suicide risk. The aim of our study was to investigate the association between eating disorders, its comorbidity and suicidal deaths by the analyzing the data from National Health Insurance Research Databases (NHIRD) and statistical reports on the causes of death. Methods We identified 19,648 patients with ED diagnoses from the Taiwan National Health Insurance Database between 2001 and 2012. The patients who had been diagnosed eating disorders ≥4 times at outpatient visits, or had ≥1 time of hospitalization were recruited as the group of ED (N=9974). The outcome of measurements was defined as the death of the group of eating disorders either by suicide (N=113), accidental death (N=35) or others (N=97). Cox regression was applied to investigate the relationship between psychiatry comorbidities and the suicidal death of the patients with ED. Results Age of onset with Anorexia Nervosa (AN) was significantly younger than Bulimia Nervosa (BN) or Eating disorders, NOS (EDNOS) in patients with ED. The risk of suicide had 2.4-fold higher of preexisting (aHR=2.4; 95% CI=1.6-3.7) but not concurrent (aHR=1.0; 95% CI=0.7-1.5) or subsequent (aHR=0.8; 95% CI=0.4-1.3) any psychiatric comorbidity with ED patients than without psychiatric comorbidity. The risk of suicide was 1.8-fold higher in patients with previous major depressive disorder (aHR=1.8; 95% CI=1.2-2.7), and 2.6-fold higher in patients with prior substance use disorder (aHR=2.6; 95% CI=1.5-4.5). Patients with four or more psychiatric comorbidities had a 6.3fold increased risk of suicide (aHR=6.3; 95% CI=3.1-12.8; p<0.05). Potential confounders In this study we identified psychiatric comorbidities including anxiety disorders (ICD-9-CM code 300 except 300.4), major depressive disorders (ICD-9-CM code 296.2, 296.3, 296.82, 300.4), bipolar disorders (ICD-9-CM This study also approved by the Institutional Review Board of the Tri-Service General Hospital (reference number 1-104-05-048) and was conducted in accordance with the Helsinki Declaration. Informed consent from patients was not required for this study, as they were not asked to follow rules of behavior. Patient data were coded and anonymity of patients was guaranteed.

ObjectivesAlthough depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED.DesignA cross-sectional study.SettingThis population-based study used claims data from Taiwan’s National Health Insurance Research database between 2001 and 2012.ParticipantsThe study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED.Outcome measuresWe tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups.ResultsPatients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED.ConclusionDepression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.