Skip to main content Accessibility help
×
Home

Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients

  • J. Kask (a1), M. Ramklint (a1), N. Kolia (a2), D. Panagiotakos (a2), A. Ekbom (a3), L. Ekselius (a1) and F. C. Papadopoulos (a1)...

Abstract

Background

Anorexia nervosa (AN) is a psychiatric disorder with high mortality.

Method

A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses.

Results

The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1–5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6–12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9–2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0–22.7), and that for unnatural causes was 35.5 (95% CI 17.7–63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality.

Conclusion

Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.

Copyright

Corresponding author

*Address for correspondence: J. Kask, M.D., Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden. (Email: jan.kask@neuro.uu.se)

References

Hide All
Arcelus, J, Mitchell, AJ, Wales, J, Nielsen, S (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry 68, 724731.
Bou Khalil, R, Hachem, D, Richa, S (2011). Eating disorders and schizophrenia in male patients: a review. Eating and Weight Disorders 16, e150e156.
Braun, DL, Sunday, SR, Huang, A, Halmi, KA (1999). More males seek treatment for eating disorders. International Journal of Eating Disorders 25, 415424.
Bulik, CM, Sullivan, PF, Tozzi, F, Furberg, H, Lichtenstein, P, Pedersen, NL (2006). Prevalence, heritability, and prospective risk factors for anorexia nervosa. Archives of General Psychiatry 63, 305312.
Burns, T, Crisp, AH (1985). Factors affecting prognosis in male anorexics. Journal of Psychiatric Research 19, 323328.
Carlat, DJ, Camargo, CA Jr., Herzog, DB (1997). Eating disorders in males: a report on 135 patients. American Journal of Psychiatry 154, 11271132.
Crisp, AH, Burns, T, Bhat, AV (1986). Primary anorexia nervosa in the male and female: a comparison of clinical features and prognosis. British Journal of Medical Psychology 59, 123132.
Currin, L, Schmidt, U, Treasure, J, Jick, H (2005). Time trends in eating disorder incidence. British Journal of Psychiatry 186, 132135.
Feldman, MB, Meyer, IH (2010). Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals. Psychiatry Research 180, 126131.
Gueguen, J, Godart, N, Chambry, J, Brun-Eberentz, A, Foulon, C, Divac, SM, Guelfi, JD, Rouillon, F, Falissard, B, Huas, C (2012). Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. International Journal of Eating Disorders 45, 537545.
Herpertz-Dahlmann, B, Muller, B, Herpertz, S, Heussen, N, Hebebrand, J, Remschmidt, H (2001). Prospective 10-year follow-up in adolescent anorexia nervosa – course, outcome, psychiatric comorbidity, and psychosocial adaptation. Journal of Child Psychology and Psychiatry 42, 603612.
Hoang, U, Goldacre, M, James, A (2014). Mortality following hospital discharge with a diagnosis of eating disorder: national record linkage study, England, 2001–2009. International Journal of Eating Disorders 47, 507515.
Hudson, JI, Hiripi, E, Pope, HG Jr., Kessler, RC (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 61, 348358.
Kask, J, Ekselius, L, Brandt, L, Kollia, N, Ekbom, A, Papadopoulos, FC (2016). Mortality in women with anorexia nervosa: the role of comorbid psychiatric disorders. Psychosomatic Medicine 78, 910919.
Kjelsas, E, Bjornstrom, C, Gotestam, KG (2004). Prevalence of eating disorders in female and male adolescents (14–15 years). Eating Behaviours 5, 1325.
Korndorfer, SR, Lucas, AR, Suman, VJ, Crowson, CS, Krahn, LE, Melton, LJ 3rd (2003). Long-term survival of patients with anorexia nervosa: a population-based study in Rochester, Minn. Mayo Clinic Proceedings 78, 278284.
Lucas, AR, Beard, CM, O'Fallon, WM, Kurland, LT (1991). 50-Year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study. American Journal of Psychiatry 148, 917922.
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450.
Matzkin, V, Slobodianik, N, Pallaro, A, Bello, M, Geissler, C (2007). Risk factors for cardiovascular disease in patients with anorexia nervosa. International Journal of Psychiatric Nursing Research 13, 15311545.
Moller-Madsen, S, Nystrup, J, Nielsen, S (1996). Mortality in anorexia nervosa in Denmark during the period 1970–1987. Acta Psychiatrica Scandinavica 94, 454459.
Nielsen, S, Emborg, C, Molbak, AG (2002). Mortality in concurrent type 1 diabetes and anorexia nervosa. Diabetes Care 25, 309312.
Nielsen, S, Moller-Madsen, S, Isager, T, Jorgensen, J, Pagsberg, K, Theander, S (1998). Standardized mortality in eating disorders – a quantitative summary of previously published and new evidence. Journal of Psychosomatic Research 44, 413434.
Olivardia, R, Pope, HG Jr., Mangweth, B, Hudson, JI (1995). Eating disorders in college men. American Journal of Psychiatry 152, 12791285.
Osby, U, Brandt, L, Correia, N, Ekbom, A, Sparen, P (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry 58, 844850.
Osby, U, Correia, N, Brandt, L, Ekbom, A, Sparen, P (2000). Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophrenia Research 45, 2128.
Papadopoulos, FC, Ekbom, A, Brandt, L, Ekselius, L (2009). Excess mortality, causes of death and prognostic factors in anorexia nervosa. British Journal of Psychiatry 194, 1017.
Raevuori, A, Hoek, HW, Susser, E, Kaprio, J, Rissanen, A, Keski-Rahkonen, A (2009). Epidemiology of anorexia nervosa in men: a nationwide study of Finnish twins. PLoS ONE 4, e4402.
Rivara, FP, Mueller, BA, Somes, G, Mendoza, CT, Rushforth, NB, Kellermann, AL (1997). Alcohol and illicit drug abuse and the risk of violent death in the home. Journal of the American Medical Association 278, 569575.
Royal Colleges of Psychiatrists (2014). CR189. MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa, 2nd edn. (http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr189.aspx).
Sareen, J, Cox, BJ, Afifi, TO, de Graaf, R, Asmundson, GJ, ten Have, M, Stein, MB (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Archives of General Psychiatry 62, 12491257.
Sellgren, C, Landen, M, Lichtenstein, P, Hultman, CM, Langstrom, N (2011). Validity of bipolar disorder hospital discharge diagnoses: file review and multiple register linkage in Sweden. Acta Psychiatrica Scandinavica 124, 447453.
Siegel, JH, Hardoff, D, Golden, NH, Shenker, IR (1995). Medical complications in male adolescents with anorexia nervosa. Journal of Adolescent Health 16, 448453.
Spillane, NS, Boerner, LM, Anderson, KG, Smith, GT (2004). Comparability of the Eating Disorder Inventory-2 between women and men. Assessment 11, 8593.
Suls, J, Bunde, J (2005). Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychological Bulletin 131, 260300.
Weltzin, TE, Cornella-Carlson, T, Fitzpatrick, ME, Kennington, B, Bean, P, Jefferies, C (2012). Treatment issues and outcomes for males with eating disorders. Eating Disorders 20, 444459.
Westman, J, Wahlbeck, K, Laursen, TM, Gissler, M, Nordentoft, M, Hallgren, J, Arffman, M, Osby, U (2015). Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden. Acta Psychiatrica Scandinavica 131, 297306.
Woodside, DB, Garfinkel, PE, Lin, E, Goering, P, Kaplan, AS, Goldbloom, DS, Kennedy, SH (2001). Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. American Journal of Psychiatry 158, 570574.

Keywords

Type Description Title
WORD
Supplementary materials

Kask supplementary material
Table S1

 Word (36 KB)
36 KB
WORD
Supplementary materials

Kask supplementary material
Table S2

 Word (53 KB)
53 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed