The epidemiology of Eating Disorders
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Transcript of The epidemiology of Eating Disorders
The Epidemiology of Ea0ng Disorders
Nadia Micali, MD, PhD, MRCPSych Senior Lecturer
Child and adolescent Mental Health, Pallia0ve care and Paediatrics sec0on Popula0on, Policy & Prac0ce Sec0on
Ins0tute of Child Health University College London
RCPsych Interna0onal Conference 2014
Outline
• The changing landscape of ED • Quan0ta0ve studies: -‐ The incidence of ED in the UK -‐Prevalence of ED behaviours and ED their correlates and service use • Conclusions
ED prior to DSM5 • Anorexia Nervosa (AN) • Bulimia nervosa (BN) • Eating Disorders Not Otherwise Specified
(EDNOS) • [Binge Eating Disorder (BED)]
ED: and DSM5 • Anorexia Nervosa amenorrhea
• Bulimia Nervosa Minimum frequency: once a week -‐Binge Ea0ng Disorder Minimum frequency: once a week
ED and DSM5 • Ea0ng Disorders not Otherwise specified
• Avoidant Restric0ve Food Intake disorder (ARFID)
• Purging Disorder: purging in the absence of bingeing
OSFED
ED are common disorders
• Prevalence amongst females ~7%, males ~1-‐2%
• Few studies available in the UK
Swanson et al, 2011, Keski-‐Rakhonen et al., 2009, Smink et al, 2013
High mortality and morbidity
• AN has an SMR of 5.85
• BN and EDNOS: SMR 1.9
• Schizophrenia: 2.5-‐2.8 • Bipolar: 1.9-‐2.1 • Unipolar depression: 1.5-‐1.6
High chronicity: only 50% recover following treatment
Arcelus et al., 2011; Steinhausen et al, 2009
The Incidence of ED in the UK in the 21st century
Micali, N., Hagberg, KW., Petersen, I., Treasure, J. The Incidence of Ea0ng Disorders in the UK in 2000-‐2009: findings from the General Prac0ce Research Database. BMJ Open. 2013; 3:e002646. doi:10.1136/
bmjopen-‐2013-‐002646
Aims
• To determine gender and age specific incidence rates of ED between 2000-‐2009 in the UK in primary care
• To inves0gate changes in the incidence of BN and AN
Methods I
• General Prac0ce Research database (GPRD): -‐large automated UK medical record database -‐contains informa0on from about 400 general prac0ces (cumula0ve follow-‐up 0me of > 20 million person-‐years) represents ~5-‐8 % of the UK popula0on
Methods II
• All cases aged 10-‐49 receiving a new diagnosis of AN, BN, EDNOS (ED NOS, ED unspecified) were extracted
• Diagnoses were validated in 5-‐10% of overall sample
• Age and gender specific yearly incidence rates were calculated for AN, BN, EDNOS
The Incidence of ED amongst females aged 10-‐49 in the UK
The Incidence of ED amongst males aged 10-‐49 in the UK
Between 2000-‐2009 ED diagnoses in primary care increased
• In females age-‐standardised ED diagnoses increased from51.8 (95%CI: 50.6-‐52.9) to 62.6 (95%CI: 61.4-‐63.8) per 100,000
• 20% increase • In males ED diagnoses increased from 5.6 (95%CI: 5.3-‐6.0) to 7.1 (95%CI: 6.7-‐7.5) per 100,000
• 27%increase
Incidence rates of ED in females by age-‐bands in 2009
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IR per 100,000
Age bands
IR=1.7/1,000
Summary
• ED have increased in incidence in the UK
• EDNOS mainly responsible for increase
• About 2 in 1,000 girls aged between 15-‐19 in the UK have a new onset ED
• Detec0on of ED has increased
• EDNOS now “on the map”
THE PREVALENCE OF ED
Ea?ng disorders in a mul?-‐ethnic inner-‐city UK sample: prevalence, comorbidity and service use. Solmi, F.; Hotopf, M.; Hatch, S.L.; Treasure, J.; Micali, N.
• Community-‐based sample of adults in South London
Two-‐phase prevalence study-‐Methods I
• The small user postcode address file was used as sampling frame to iden0fy households.
• All eligible individuals aged 16 years and over living within selected and par0cipa0ng households were invited to undertake the survey.
Methods II • ED screening in ~ 1,600 individuals using the SCOFF
• SCID interviews in screen posi0ve (Scoring above cut-‐off) and gender-‐matched screen nega0ves
• A large banery of measures on comorbid disorders and service use (CIS-‐R for CMD, SAPAS for personality disorders, primary care posnrauma0c stress disorder scale, AUDIT for alcohol use, ques0ons on suicidal idea0on and drug use)
• Objec0ve BMI
Epidemiology of adult ED behaviours
Socio-‐demographic-‐Phase 1
Conclusions • ED are common in a mixed gender inner-‐city sample
• No AN iden0fied • High levels of comorbidity • Poor access to care, especially specialist care
Overall conclusions
• Evidence that new onset ED are increasing in primary care in the UK
• Adolescence is clearly a high risk period
• ED are common, they are associated with high comorbidity and low service use
Acknowledgements
Francesca Solmi Janet Treasure Manhew Hotopf Stephani Hatch Irene Petersen Katrina Hagberg
• Bri0sh Academy small grant
• NIHR Clinician Scien0st award