Five‐year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a medical unit
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Objective: Anorexia nervosa (AN) is associated with one of the highest mortality rates of any psychiatric disorder but limited mortality data were reported for those with extremely severe malnutrition. This study aimed to estimate standardized mortality ratio (SMR), investigate predictive factors of mortality and causes of death among a sample of patients with AN admitted to a specialized clinical nutrition unit (CNU) because of extremely severe malnutrition. Methods: Between 11/27/1997 and 01/15/2014, vital status was determined for 384 patients admitted for AN at the first time in the CNU. Sociodemographic, anamnestic, and clinical data were collected. We calculated the SMR. Univariate and multivariate Cox regression analyses were performed to identify mortality predictors. Results: Crude mortality rate was 11.5%. (44 deaths) and SMR 15.9 [CI 95% (11.6–21.4)], 5.2 years post inpatient treatment. Mortality predictors at the time of hospitalization were as follows: older age, occurrence of an in‐hospital suicide attempt, transfer to medical intensive care unit and the following somatic complications: frank anemia, dysnatremia, infectious and cardiac complications. Other predictors of mortality were: past or present history of discharge against medical advice, hematological comorbidities (not related to AN). A longer inpatient length of stay was a protective factor. Conclusion: Very severely malnourished patients with AN hospitalized in a medical unit because of extremely severe somatic issues have a medium‐term mortality rate higher than the general population and even higher than patients in tertiary specialized ED units. This study highlights predictive factors of mortality that will help clinicians in recognizing and managing patients at risk of death.
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In a prospective cohort of 384 patients with severe anorexia nervosa requiring inpatient hospitalization, the standardized mortality ratio was 15.9 for women and 22.4 for men.
“A prospective cohort of 384 patients with severe AN requiring inpatient hospitalization had a standardized mortality ratio (SMR) for women of 15.9 and for men 22.4.”
In that cohort, older age predicted mortality, with mean age at death 41.3 years and the highest standardized mortality ratio of 26 among those admitted at ages 30-34.
“Older age predicted mortality, with mean age at death 41.3 (± 15.3) years; those admitted between ages 30–34 had the highest SMR of 26.”
Patients with severe and enduring anorexia nervosa have higher mortality risks than patients with anorexia nervosa generally.
“Among them, patients with SE-AN have higher mortality risks. [8, 9].”
In that cohort, somatic causes accounted for 43% of deaths and 11.5% of deaths were attributed to suicide.
“Somatic (medical) causes accounted for 43% of deaths, with 11.5% of deaths attributed to suicide [8].”
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Causes of death in patients with a history of severe Anorexia Nervosa
Rienecke, R. D., Duffy, A., Grange, D. L., Joiner, T. E., Manwaring, J. L., Watters, A., & Mehler, P. S. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.06.012
Murphy, K. E., Sidari, M. J., Skerlj, T., McMahon, K. L., Parker, S., Pearson, C., Waldmann, J., & Eggins, E. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01691-x
Ring, J., & McElvaney, R. (2026) · Counselling Psychology Quarterly · doi:10.1080/09515070.2026.2732968
- Authors
- Guinhut, M., Godart, N., Benadjaoud, M., Melchior, J., & Hanachi, M.
- Affiliations
- Université Paris Descartes (FR)
- Inserm (FR)
- Institut de Radioprotection et de Sûreté Nucléaire (FR)
- Université Paris-Saclay (FR)
- Corresponding author
- Guinhut, Marie
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2021-01-15
- Volume
- 143
- Issue
- 2
- Pages
- 130-140
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W3108068051
- Semantic Scholar
- 00fefbb6c3fdab8e6ff058dd84ee2040a850ef19
- Cited by
- 53
- References
- 46
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 12 · 2023: 14 · 2022: 8 · 2021: 3
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion, other-oa)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- anorexia nervosa, severe malnutrition, mortality, standardized mortality ratio, mortality risk factors, causes of death, discharge against medical advice, length of hospital stay, somatic complications, clinical nutrition unit, psychiatric hospitalization
- MeSH terms
- Aged, Anorexia Nervosa, Hospitalization, Humans, Inpatients, Comorbidity, Malnutrition
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