Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa

Abstract

Background Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. Methods We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. Results A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. Conclusions These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.

Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

“…Rates were higher for males [SMR 7.2 (95% CI 6.6–8.0)] compared to females [SMR 4.6 (95% CI 4.3–4.9)]. This is in line with other recent studies that also found higher mortality rates among males: in people treated for bulimia nervosa in secondary mental healthcare services an overall SMR of 2.5 (95% CI 1.5–4.0) was reported, with significantly higher rates among males compared to females [crude hazard ratio 5.4 (95% CI 1.8–16.5)] [ 54 ]. In another study on hospitalization for anorexia nervosa, in-hospital mortality in males was more than twice that for females [odds ratio 2.4 (95% CI 1.5–3.8)] [ 55 ].…”

Suicide attempts requiring hospitalization in patients with eating disorders: A retrospective cohort study

“…The comorbidity exposures of interest were diagnoses of substance misuse (F10–F19), bipolar disorder (F31), depression (F32 and F33), and personality disorder (F60) determined by structured information in EHRs on diagnoses from drop‐down fields in the source record. The selection of comorbid diagnoses was based on previous studies using similar data sources, which were known to be most associated with this study's primary outcome of interest (Himmerich et al, ).…”

“…Eating disorders (ED) include a variety of diagnoses such as anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder otherwise not specified (EDNOS) (American Psychiatrist Association [APA], ). ED patients have high rates of mortality with psychiatric comorbidity contributing to these elevated rates (Himmerich et al , Himmerich et al ). They are more likely to present to hospital with self‐harm (Perez, Marco, & Canabate, ; Smithuis et al, ) or a suicide attempt (Suokas et al, ).…”

Medical complications of bulimia nervosa

“…10 More than 70% of people with eating disorders report concomitant psychiatric comorbidity-affective disorders, anxiety, substance use, and personality disorders are most common in BN. 11 Psychiatric comorbidities as well as hopelessness, shame, and impulsivity associated with the illness may contribute to challenges with nonsuicidal self-harm, suicidal ideation, and death by suicide. Individuals with BN experience lifetime rates of nonsuicidal self-harm of 33% and are nearly 8 times more likely to die by suicide than the general population.…”