Health services use in eating disorders.

Department of Psychology, Wesleyan University, Middletown, CT 06459-0408, USA.
Psychological Medicine (Impact Factor: 5.43). 12/2007; 38(10):1465-74. DOI: 10.1017/S0033291707001833
Source: PubMed

ABSTRACT This study examined healthcare services used by adults diagnosed with an eating disorder (ED) in a large health maintenance organization in the Pacific Northwest.
Electronic medical records were used to collect information on all out-patient and in-patient visits and medication dispenses, from 2002 to 2004, for adults aged 18-55 years who received an ED diagnosis during 2003. Healthcare services received the year prior to, and following, the receipt of an ED diagnosis were examined. Cases were matched to five comparison health plan members who had a health plan visit close to the date of the matched case's ED diagnosis.
Incidence of EDs (0.32% of the 104,130 females, and 0.02% of the 93,628 males) was consistent with prior research employing treatment-based databases, though less than community-based samples. Most cases (50%) were first identified during a primary-care visit and psychiatric co-morbidity was high. Health services use was significantly elevated in all service sectors among those with an ED when compared with matched controls both in the year preceding and that following the receipt of the incident ED diagnosis. Contrary to expectations, healthcare utilization was found to be similarly high across the spectrum of EDs (anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified).
The elevation in health service use among women both before and after diagnosis suggests that EDs merit identification and treatment efforts commensurate with other mental health disorders (e.g. depression) which have similar healthcare impact.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the clinical characteristics of patients with eating disorders referred to Community Mental Health Centers (CMHCs) in the Department of Mental Health of Bologna, Italy, and to evaluate the number and type of interventions delivered. Adult patients with eating disorders who had a first contact with CMHCs between January 1, 2007 and December 31, 2012 were extracted from Bologna Local Health Authority database. Moreover, the hospital discharge records of patients were linked to the mental health information system of Bologna. Among the 276 patients with eating disorders identified, 59 (21.4 %) were diagnosed as anorexia nervosa, 77 (27.9 %) as bulimia nervosa and 140 (50.7 %) as eating disorders not otherwise specified. The mean age of the sample was 37.3 (SD = 13.4), with no significant differences among the three diagnostic groups. The number of CMHCs outpatients increased each year from 2007 to 2011 and decreased in 2012. The proportion of new patients by year comprised about 50 % of the total of patients. Psychotherapy accounted for about 10 % of the interventions. Day-hospital and hospital admissions concerned 6.1 and 11.6 % of the sample. CMHCs are part of the system of care outlined by the Regional policies for eating disorders and are responsible for providing the first level of outpatient care to adults. To date, there is the need to extend our monitoring across the whole system of care, to assess the implementation of specific and effective strategies to decrease the age of access of patients and to improve the quality of care delivered with the inclusion of evidence-based treatments in the process of care.
    Eating and weight disorders: EWD 02/2014; 19(2). · 0.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate the strength and role of therapeutic alliance in a trial comparing Cognitive Behavioral Therapy for anorexia nervosa (CBT-AN) and Specialist Supportive Clinical Management for the treatment of severe and enduring AN (SE-AN). Participants were 63 adult females with SE-AN presenting to an outpatient, multisite randomized controlled trial conducted at two clinical sites. Participants completed measures assessing their perception of the quality of the therapeutic relationship, eating disorder (ED) symptomatology, and depressive symptomatology. Beyond the effect of early treatment change and treatment assignment, early therapeutic alliance was a significant predictor of Restraint and Shape Concern at follow-up (ps < .02). Late therapeutic alliance was a significant predictor of weight change, depressive symptomatology, and ED symptomatology at end of treatment and follow-up (ps < .008), with the exception of Shape Concern at follow-up (p = .07). The results suggest that therapeutic alliance can be effectively established in the treatment of SE-AN and may be relevant for treatment response, particularly in late treatment, on some aspects of ED and depressive symptomatology. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
    International Journal of Eating Disorders 09/2013; · 3.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this chapter is to discuss the concept of endophenotypes within the eating disorder (ED) population. As is common in most forms of psychiatric illness, people with ED have additional psychological problems, as do their family members. Affective disorders, addictions, and autistic spectrum disorders commonly occur in association with the individual and/or in the families of those with ED. This chapter will explore the literature related to underlying biological markers that potentially underpin all of these disorders. Some of the biomarkers fulfi l the criteria for an endophenotype, although this is an area that is poorly developed so far in the eating disorder fi eld. It is possible that core inherited vulnerability traits such as anxiety, rigidity, weak coherence, poor social cognition, compulsivity and impulsivity are some of the features held in common with other disorders.

Full-text (2 Sources)

Available from
Jun 4, 2014