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

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 54; no. 7; pp. 813 - 821
• Main Authors: Himmerich, Hubertus, Hotopf, Matthew, Shetty, Hitesh, Schmidt, Ulrike, Treasure, Janet, Hayes, Richard D., Stewart, Robert, Chang, Chin-Kuo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2019; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Bulimia; Bulimia Nervosa - mortality; Bulimia Nervosa - psychology; Cause of Death; Cohort Studies; Comorbidity; Confidence intervals; Demographics; Deprivation; England - epidemiology; Epidemiology; Female; Hazards; Health aspects; Humans; Male; Medicine; Medicine & Public Health; Mental disorders; Middle Aged; Mood Disorders - mortality; Mood Disorders - psychology; Mortality; Multivariable control; Original Paper; Patients; Personality Disorders - mortality; Personality Disorders - psychology; Proportional Hazards Models; Psychiatry; Regression analysis; Risk analysis; Risk Factors; Social factors; Socioeconomic data; Socioeconomic Factors; Statistical analysis; Substance abuse; Substance-Related Disorders - mortality; Substance-Related Disorders - psychology; Wales - epidemiology; England; Wales; Substance use disorders; Psychiatric comorbidities; Affective disorders; Eating disorder; Bulimia nervosa; Personality disorder
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-019-01667-0

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 January 2007 to March 2016 for 1501 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.