The  Epidemiology  of  Ea0ng  Disorders  

Nadia  Micali,  MD,  PhD,  MRCPSych  Senior  Lecturer  

Child  and  adolescent  Mental  Health,  Pallia0ve  care  and  Paediatrics  sec0on  Popula0on,  Policy  &  Prac0ce  Sec0on  

Ins0tute  of  Child  Health  University  College  London  

RCPsych  Interna0onal  Conference  2014  

 Outline  

•  The  changing  landscape  of  ED  •  Quan0ta0ve  studies:    -­‐  The  incidence  of  ED  in  the  UK  -­‐Prevalence  of  ED  behaviours  and  ED  their  correlates  and  service  use  •  Conclusions  

ED prior to DSM5 •  Anorexia Nervosa (AN) •  Bulimia nervosa (BN) •  Eating Disorders Not Otherwise Specified

(EDNOS) •  [Binge Eating Disorder (BED)]

ED:  and  DSM5  •  Anorexia  Nervosa  amenorrhea  

•  Bulimia  Nervosa  Minimum  frequency:  once  a  week    -­‐Binge  Ea0ng  Disorder    Minimum  frequency:  once  a  week    

 

ED  and  DSM5  •  Ea0ng  Disorders  not  Otherwise  specified  

•  Avoidant  Restric0ve  Food  Intake  disorder  (ARFID)  

•  Purging  Disorder:  purging  in  the  absence  of  bingeing  

OSFED  

ED  are  common  disorders  

•  Prevalence  amongst  females  ~7%,  males  ~1-­‐2%  

•  Few  studies  available  in  the  UK      

 Swanson  et  al,  2011,  Keski-­‐Rakhonen  et  al.,  2009,  Smink  et  al,  2013    

High  mortality  and  morbidity  

•  AN  has  an  SMR  of  5.85  

•  BN  and  EDNOS:  SMR  1.9  

 

•  Schizophrenia:  2.5-­‐2.8  •  Bipolar:  1.9-­‐2.1  •  Unipolar  depression:  1.5-­‐1.6  

High  chronicity:  only  50%  recover  following  treatment  

Arcelus  et  al.,  2011;  Steinhausen  et  al,  2009  

The  Incidence  of  ED  in  the  UK  in  the  21st  century    

Micali,  N.,  Hagberg,  KW.,  Petersen,  I.,  Treasure,  J.  The  Incidence  of  Ea0ng  Disorders  in  the  UK  in  2000-­‐2009:  findings  from  the  General  Prac0ce  Research  Database.  BMJ  Open.  2013;  3:e002646.  doi:10.1136/

bmjopen-­‐2013-­‐002646  

 

Aims  

•  To  determine  gender  and  age  specific  incidence  rates  of  ED  between  2000-­‐2009  in  the  UK  in  primary  care  

•  To  inves0gate  changes  in  the  incidence  of  BN  and  AN    

 

Methods  I  

•  General  Prac0ce  Research  database  (GPRD):    -­‐large  automated  UK  medical  record  database      -­‐contains  informa0on  from  about  400  general  prac0ces  (cumula0ve  follow-­‐up  0me  of  >  20  million  person-­‐years)  represents  ~5-­‐8  %  of  the  UK  popula0on  

Methods  II  

•  All  cases  aged  10-­‐49  receiving  a  new  diagnosis  of  AN,  BN,  EDNOS  (ED  NOS,  ED  unspecified)  were  extracted  

•  Diagnoses  were  validated  in  5-­‐10%  of  overall  sample  

 •  Age  and  gender  specific  yearly  incidence  rates  were  calculated  for  AN,  BN,  EDNOS    

 

The  Incidence  of  ED  amongst  females  aged  10-­‐49  in  the  UK  

The  Incidence  of  ED  amongst  males  aged  10-­‐49  in  the  UK  

Between  2000-­‐2009  ED  diagnoses  in  primary  care  increased  

•  In  females  age-­‐standardised  ED  diagnoses  increased  from51.8  (95%CI:  50.6-­‐52.9)  to  62.6  (95%CI:  61.4-­‐63.8)  per  100,000  

•  20%  increase      •  In  males  ED  diagnoses  increased  from  5.6  (95%CI:  5.3-­‐6.0)  to  7.1  (95%CI:  6.7-­‐7.5)  per  100,000      

•  27%increase  

Incidence  rates  of  ED  in  females  by  age-­‐bands  in  2009  

0"

20"

40"

60"

80"

100"

120"

140"

160"

180"

10(14" 15(19" 20(29" 30(39" 40(49"

AN"BN"EDNOS"ALL"ED"

IR  per  100,000  

Age  bands  

IR=1.7/1,000  

Summary    

•  ED  have  increased  in  incidence  in  the  UK    

•  EDNOS  mainly  responsible  for  increase  

•  About  2  in  1,000  girls  aged  between  15-­‐19  in  the  UK  have  a  new  onset  ED    

•  Detec0on  of  ED  has  increased  

•  EDNOS  now  “on  the  map”  

THE  PREVALENCE  OF  ED  

Ea?ng  disorders  in  a  mul?-­‐ethnic  inner-­‐city  UK  sample:  prevalence,  comorbidity  and  service  use.  Solmi,  F.;  Hotopf,  M.;  Hatch,  S.L.;  Treasure,  J.;  Micali,  N.    

•  Community-­‐based  sample  of  adults  in  South  London  

Two-­‐phase  prevalence  study-­‐Methods  I  

•  The  small  user  postcode  address  file  was  used  as  sampling  frame  to  iden0fy  households.    

•  All  eligible  individuals  aged  16  years  and  over  living  within  selected  and  par0cipa0ng  households  were  invited  to  undertake  the  survey.  

 

Methods  II  •  ED  screening  in  ~  1,600  individuals  using  the  SCOFF  

•  SCID  interviews  in  screen  posi0ve  (Scoring  above  cut-­‐off)  and  gender-­‐matched  screen  nega0ves  

•  A  large  banery  of  measures  on  comorbid  disorders  and  service  use  (CIS-­‐R  for  CMD,  SAPAS  for  personality  disorders,  primary  care  posnrauma0c  stress  disorder  scale,  AUDIT  for  alcohol  use,  ques0ons  on  suicidal  idea0on  and  drug  use)  

•  Objec0ve  BMI  

Epidemiology  of  adult  ED  behaviours  

Socio-­‐demographic-­‐Phase  1    

Conclusions    •  ED  are  common  in  a  mixed  gender  inner-­‐city  sample  

•  No  AN  iden0fied  •  High  levels  of  comorbidity  •  Poor  access  to  care,  especially  specialist  care  

Overall  conclusions  

•  Evidence  that  new  onset  ED  are  increasing  in  primary  care  in  the  UK  

•  Adolescence  is  clearly  a  high  risk  period  

•  ED  are  common,  they  are  associated  with  high  comorbidity  and  low  service  use  

Acknowledgements    

   Francesca  Solmi  Janet  Treasure  Manhew  Hotopf  Stephani  Hatch  Irene  Petersen  Katrina  Hagberg    

•  Bri0sh  Academy  small  grant  

•  NIHR  Clinician  Scien0st  award