Predictive factors of dropout from inpatient treatment for anorexia nervosa.
BMC Psychiatry. 2016-09-30; 16(1):
DOI: 10.1186/s12888-016-1010-7
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1. BMC Psychiatry. 2016 Sep 30;16(1):339.
Predictive factors of dropout from inpatient treatment for anorexia nervosa.
Roux H(1)(2)(3)(4)(5)(6)(7), Ali A(1)(2)(3)(4)(5)(6)(7), Lambert S(8), Radon
L(1)(2)(3)(4)(5)(6)(7), Huas C(2)(3)(4)(5)(6)(7), Curt F(1), Berthoz
S(1)(2)(3)(4)(5)(6)(7), Godart N(9)(10)(11)(12)(13)(14)(15); EVHAN Group.
Collaborators: Godart N, Berthoz S, Lalanne C, Duclos J, Mattar L, Roux H,
Thiébaud MR, Vibert S, Hubert T, Courty A, Ringuenet D, Benoit JP, Blanchet C,
Moro MR, Bignami L, Nordon C, Rouillon F, Cook S, Doyen C, Siméoni MM, Gerardin
P, Lebecq S, Podlipski MA, Gayet C, Lasfar M, Delorme M, Pommereau X, Bioulac S,
Bouvard M, Carrere J, Doncieux K, Faucher S, Fayollet C, Prexl A, Billard S, Lang
F, Mourier-Soleillant V, Greiner R, Gay A, Carrot G, Lambert S, Rousselet M,
Placé L, Venisse JL, Bronnec M, Falissard B, Genolini C, Hassler C, Tréluyer JM,
Chacornac O, Delattre M, Moulopo N, Turuban C, Auger C.
Author information:
(1)Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard
Jourdan, 75014, Paris, France.
(2)Faculté de Médecine, Université Paris Descartes, Paris, France.
(3)Center of Research in Epidemiology and Population Health, INSERM U1018, Paris
Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.
(4)Université Paris Descartes, Paris, France.
(5)Université Paris Sud, Villejuif, France.
(6)UVSQ, Villejuif, France.
(7)Université Paris-Saclay, Villejuif, France.
(8)Service d’Addictologie, CHU Nantes, Paris, France.
(9)Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard
Jourdan, 75014, Paris, France. .
(10)Faculté de Médecine, Université Paris Descartes, Paris, France.
.
(11)Center of Research in Epidemiology and Population Health, INSERM U1018, Paris
Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.
.
(12)Université Paris Descartes, Paris, France. .
(13)Université Paris Sud, Villejuif, France. .
(14)UVSQ, Villejuif, France. .
(15)Université Paris-Saclay, Villejuif, France. .
BACKGROUND: Patients with severe Anorexia Nervosa (AN) whose condition is
life-threatening or who are not receiving adequate ambulatory care are
hospitalized. However, 40 % of these patients leave the hospital prematurely,
without reaching the target weight set in the treatment plan, and this can
compromise outcome. This study set out to explore factors predictive of dropout
from hospital treatment among patients with AN, in the hope of identifying
relevant therapeutic targets.
METHODS: From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in
10 centres across France were divided into two groups: those under 18 years (when
the decision to discharge belongs to the parents) and those aged 18 years and
over (when the patient can legally decide to leave the hospital). Both groups
underwent clinical assessment using the Morgan & Russell Global Outcome State
questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for
assessment of eating disorder symptoms and outcome. Psychological aspects were
assessed via the evaluation of anxiety and depression using the Hospital Anxiety
and Depression Scale (HADS). Socio-demographic data were also collected. A number
of factors identified in previous research as predictive of dropout from hospital
treatment were tested using stepwise descending Cox regressions.
RESULTS: We found that factors predictive of dropout varied according to age
groups (being under 18 as opposed to 18 and over). For participants under 18,
predictive factors were living in a single-parent family, severe intake
restriction as measured on the « dietary restriction » subscale of the Morgan &
Russell scale, and a low patient-reported score on the EDE-Q « restraint concerns »
subscale. For those over 18, dropout was predicted from a low depression score on
the HADS, low level of concern about weight on the EDE-Q subscale, and lower
educational status.
CONCLUSION: To prevent dropout from hospitalization for AN, the appropriate
therapeutic measures vary according to whether patients are under or over
18 years of age. Besides the therapeutic adjustments required in view of the
factors identified, the high dropout rate raises the issue of resorting more
frequently to compulsory care measures among adults.
DOI: 10.1186/s12888-016-1010-7
PMCID: PMC5045614
PMID: 27716113 [Indexed for MEDLINE]