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Cited by 2,864Eating Disorders and BehaviorsNutrition, Health and Food BehaviorSuicide and Self-Harm Studies

Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies

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Arcelus, Jon, Mitchell, Alex J., Wales, Jackie, Nielsen, Søren·2011·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2011.74
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Abstract

CONTEXT: Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified. OBJECTIVE: To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). DATA SOURCES: A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience). STUDY SELECTION: English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders. DATA EXTRACTION: Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis. DATA SYNTHESIS: From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide. CONCLUSIONS: Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.

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  • Eating disorders are associated with high mortality, poor treatment outcomes, and few empirically supported treatment options.

    “due to the high mortality, poor treatment outcomes, and lack of empirically supported treatment options for this population (Arcelus, 2011)”

    From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Arcelus, 2011

    The Introduction describes poor long-term outcomes for anorexia nervosa, and Limitations and Future Studies reports high mortality across anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. Summary of Relevant Studies says the included studies could not establish treatment effects, but the paper does not assess whether empirically supported treatment options are scarce. Its poor-outcome discussion is also specific to anorexia nervosa rather than all eating disorders. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Anorexia nervosa has high mortality.

    “as AN has high mortality [5].”

    From Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined (2022) · cites this paper as [5]

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6 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [8]8. Herzog DB, Greenwood DN, Dorer DJ, Flores AT, Ekeblad ER, Richards A, Blais MA, Keller MB. Mortality in eating disorders: a descriptive study. Int J Eat Disord. 2000;28(1):20-26.
  2. [20]20. Crow S, Praus B, Thuras P. Mortality from eating disorders: a 5-to 10-year rec- ord linkage study. Int J Eat Disord. 1999;26(1):97-101.
  3. [35]35. Crisp AH, Callender JS, Halek C, Hsu LK. Long-term mortality in anorexia ner- vosa: a 20-year follow-up of the St George's and Aberdeen cohorts. Br J Psychiatry. 1992;161:104-107.

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Authors
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S.
Affiliations
Loughborough University (GB)
Corresponding author
Arcelus, Jon
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2011-07-01
Volume
68
Issue
7
Pages
724
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2011.74
OpenAlex
W2093980670
Cited by
2,864
References
66
Citations by year
2026: 185 · 2025: 251 · 2024: 284 · 2023: 230 · 2022: 268 · 2021: 346 · 2020: 241 · 2019: 181 · 2018: 159 · 2017: 173 · 2016: 130 · 2015: 146 · 2014: 116 · 2013: 102 · 2012: 42
FWCI
12.93
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, eating disorders, mortality rates, standardized mortality ratio, suicide, mortality risk factors
MeSH terms
Adolescent, Adult, Age Factors, Anorexia Nervosa, Feeding and Eating Disorders, Female, Humans, Male, Sex Factors, Young Adult

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