the epidemiology of eating disorders
DESCRIPTION
Presentation from the International Congress of the Royal College of Psychiatrists 24-27 June 2014, LondonTRANSCRIPT
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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
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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
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ED prior to DSM5 • Anorexia Nervosa (AN) • Bulimia nervosa (BN) • Eating Disorders Not Otherwise Specified
(EDNOS) • [Binge Eating Disorder (BED)]
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ED: and DSM5 • Anorexia Nervosa amenorrhea
• Bulimia Nervosa Minimum frequency: once a week -‐Binge Ea0ng Disorder Minimum frequency: once a week
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ED and DSM5 • Ea0ng Disorders not Otherwise specified
• Avoidant Restric0ve Food Intake disorder (ARFID)
• Purging Disorder: purging in the absence of bingeing
OSFED
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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
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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
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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
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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
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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
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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
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The Incidence of ED amongst females aged 10-‐49 in the UK
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The Incidence of ED amongst males aged 10-‐49 in the UK
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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
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Incidence rates of ED in females by age-‐bands in 2009
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10(14" 15(19" 20(29" 30(39" 40(49"
AN"BN"EDNOS"ALL"ED"
IR per 100,000
Age bands
IR=1.7/1,000
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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”
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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.
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• Community-‐based sample of adults in South London
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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.
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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
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Epidemiology of adult ED behaviours
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Socio-‐demographic-‐Phase 1
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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
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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
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Acknowledgements
Francesca Solmi Janet Treasure Manhew Hotopf Stephani Hatch Irene Petersen Katrina Hagberg
• Bri0sh Academy small grant
• NIHR Clinician Scien0st award