Abstract
Purpose
To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas.
Methods
The study cohort consists of patients aged 12–64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases.
Results
The study cohort included 1550 cases, 36.8 % with anorexia nervosa, 21.9 % with bulimia nervosa and 41.3 % with ED not otherwise specified. Adolescents (12–17 years) were 18.6 %, young adults (18–30) 32.7 % and older adults (31–64) 48.7 %. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8 %. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found.
Conclusions
Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care.
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References
American Psychiatric Association (2006) Treatment of patients with eating disorders, third edition. Am J Psychiatry 163((7 Suppl)):4–54
Wilson GT, Shafran R (2005) Eating disorders guidelines from NICE. Lancet 365:79–81. doi:10.1016/S0140-6736(04)17669-1
Ministero della Salute (2013) Appropriatezza clinica, strutturale e operativa nella prevenzione, diagnosi e terapia dei disturbi dell’alimentazione. Quaderni del Ministero della Salute 17/22 Roma, p 1–89
De Virgilio G, Coclite D, Napoletano A, Barbina D, Dalla Ragione L, Spera, Di Fiandra T (2013) Conferenza di consenso sui disturbi del comportamento alimentare (DCA) negli adolescenti e nei giovani adulti. Roma (Rapporti ISTISAN 13/6), p 1–109
Treasure J, Claudino AM, Zucker N (2010) Eating disorders. Lancet 375:583–593. doi:10.1016/S0140-6736(09)61748-7
Zipfel S, Wild B, Groβ G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, von Wietersheim J, Zeeck A, Schade-Brittinger C, Schauenburg H, Herzog W, on behalf of the ANTOP study group (2014) Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatient with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 383:127–137. doi:10.1016/S0140-6736(13)61746-8
Gigantesco A, Masocco M, Picardi A, Lega I, Conti S, Vichi M (2010) Hospitalization for anorexia nervosa in Italy. Riv Psichiatria 45:154–162. doi:10.1708/497.5895
Sukkar SG, Foppiani L, Campostano A (2005) Management and treatment of eating disorders in an Italian Region. Eat Weight Disord 10(3):204–209. doi:10.1007/BF03327548
Dalle Grave R, Calugi S, El Ghoch M, Conti M, Fairburn CG (2014) Inpatient cognitive behavior therapy for adolescent with anorexia nervosa: immediate and longer-term effects. Front Psychiatry 5:14. doi:10.3389/fpsyt.2014.00014
De Virgilio G, Coclite D, Napoletano A, Barbina D, Di Fiandra T (2013) Convegno. Lo stato dell’arte e le prospettive nella gestione dei DCA a un anno dalla Conferenza nazionale di consenso. Istituto Superiore di Sanità. Roma, 30 Ottobre 2013. Atti. Roma (Rapporti ISTISAN 13/49)
Regione Emilia-Romagna (2004) DGR n 1016/2004. Linee guida per il potenziamento dell’assistenza ai disturbi del comportamento alimentare. Bologna
Lora A, Starace F, Di Munzio W, Fioritti A (2014) Italian Community Psychiatry in practice. Description and comparison of three regional systems. J Nerv Ment Dis 202:446–450. doi:10.1097/NMD.0000000000000143
Pedrini L, Colasurdo G, Costa S, Fabiani M, Ferraresi L, Franzoni E, Rocchi MBL, Sisti D, Squarcia A, Trebbi S, Turchetti D, Visconti P, Tullini A, de Girolamo G, The PREMIA Group (2012) The characteristics and activities of child and adolescent mental health services in Italy: a regional survey. BMC Psychiatry 30(12):7. doi:10.1186/1471-244X-12-7
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383. doi:10.1016/0021-9681/87
Fairburn CG, Bohn K (2005) Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM IV. Behav Res Ther 43(6):691–701. doi:10.1016/j.brat.2004.06.011
Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361:407–416. doi:10.1016/S0140-6736(03)12378-1
Micali N, Hagberg KW, Petersen I, Treasure JL (2013) The incidence of eating disorders in the UK in 20002009: findings from the General Practice Research Database. BMJ Open. doi:10.1136/bmjopen-2013-002646
Ricca V, Mannucci E, Mezzani B, Di Bernardo M, Zucchi T, Paionni A, Placidi GPA, Rotella CM, Faravelli C (2001) Psychopathological and clinical features of outpatients with an eating disorder not otherwise specified. Eat Weight Disord 6(3):157–165. doi:10.1007/BF03339765
Tognetti M (2015) Health inequalities: access to services by immigrants in Italy. Open J Soc Sci. doi:10.4236/jss.2015.34002
Preti A, De Girolamo G, Vilagut G, Alonso J, Graaf RD, Bruffaerts R, Demyttenaere K, Pinto-Meza A, Haro JM, Morosini P, ESEMeD-WMH Investigators (2009) The epidemiology of eating disorders in six European countries: results of the ESEMeD Project. J Psychiatr Res 43:1125–1132. doi:10.1016/j.jpsychires.2009.04.003
Hoek HW, van Hoeken D (2003) Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34(4):383–396. doi:10.1002/eat.10222
AVEC. Programma Disturbi del Comportamento Alimentare Area Vasta Emilia Centro (2013). http://salute.regione.emilia-romagna.it/salute-mentale-e-dipendenze/dca. Accessed 19 Sept 2016 (in Italian)
Calugi S, Avaldi VM, Dalle Grave R, Rucci P, Fantini MP (2014) Mental health services use and management of eating disorders in an Italian Department of Mental Health. Eat Weight Disord 19(2):191–197. doi:10.1007/s40519-014-0103-x
Striegel-Moore RH, DeBar L, Wilson GT, Dickerson J, Rosselli F, Perrin N, Lynch F, Kraemer HC (2008) Health service use in eating disorders. Psychol Med 38:1465–1474. doi:10.1017/S0033291707001833
Wonderlich S, Mirchel JE, Crosby RD, Myers TC, Kadlec K, Lahaise K, Swan-Kremeier L, Dokken J, Lange M, Dinkel J, Jorgensen M, Schander L (2012) Minimizing and treating chronicity in the eating disorders: a clinical overview. Int J Eat Disord 45(4):467–475. doi:10.1002/eat.20978
Fassino S, Pierò A, Tomba E, Abbate-Daga G (2009) Factors associated with dropouts from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 9:67. doi:10.1186/1471-244X-9-67
Gowers SG, Weetman J, Shore A, Hossain F, Elvins R (2000) Impact of hospitalisation on the outcome of adolescent anorexia nervosa. Br J Psychiatry 176:138–141. doi:10.1192/bjp.176.2.138
Herpetz-Dahlmann B, Schwarte R, Krei M, Egberts K, Warnke A, Wewetzer C, Pfeiffer E, Fleischhaker C, Scherag A, Holtkamp K, Hagenah U, Bühren K, Konrad K, Schmidt U, Schade-Brittinger C, Timmesfeld N, Dempfle A (2014) Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet 383:1222–1229. doi:10.1016/S0140-6736(13)62411-3
Legenbauer TM, Meule A (2015) Challenges in the treatment of adolescent anorexia nervosa—is enhanced cognitive behavior therapy the answer? Front Psychiatry 6:148. doi:10.3389/fpsyt.2015.00148
Simon J, Schmidt U, Pilling S (2005) The health service use and cost of eating disorders. Psychol Med 35(11):1543–1551. doi:10.1017/S003329170500470
Fursland A, Watson HJ (2014) Eating disorders: a hidden phenomenon in outpatient mental health? Int J Eat Disord 47:422–425. doi:10.1002/eat.22205
Johnston O, Fornai G, Cabrini S, Kendrik T (2007) Feasibility and acceptability of screening for eating disorders in primary care. Fam Pract 24:511–517. doi:10.1093/fampra/cmm029
Acknowledgments
The authors thank Drs. Eleonora Verdini and Giuseppina Lanciotti (Information System Unit, Health Care and Social Authority, Emilia-Romagna Region) for providing data and precious advice on regional administrative databases.
The members of Regional Group on Eating Disorders are Giuliano Limonta, Massimo Rossetti (Department of Mental Health and Pathological Addictions, Piacenza Local Health Authority), Anna Maria Gibin (Department of Mental Health and Pathological Addictions, Parma Local Health Authority), Enrica Manicardi (Reggio Emilia Hospital Trust), Claudio Annovi (Department of Mental Health and Pathological Addictions, Modena Local Health Authority), Carlotta Gentili (Department of Mental Health and Pathological Addictions, Bologna Local Health Authority), Emilio Franzoni (Bologna Hospital-University Trust), Carlo Della Gala (Department of Mental Health and Pathological Addictions, Imola Local Health Authority), Stefano Caracciolo (Ferrara Hospital-University Trust), Ester Giaquinto (Department of Primary Care, Romagna Local Health Authority), Daniela Ghigi (Department of Mental Health and Pathological Addictions, Romagna Local Health Authority).
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The authors declare that they have no conflict of interest.
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Regional databases were linked using a unique patient identifier and data were analyzed in anonymous form. Therefore, approval from the Local Ethics Committee and patients’ informed consent was not sought, in line with Italian privacy regulations.
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The members of Regional Group on Eating Disorders are listed in Acknowledgments.
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Piazza, A., Rucci, P., Clo, M. et al. Health services utilization in patients with eating disorders: evidence from a cohort study in Emilia-Romagna. Eat Weight Disord 21, 625–633 (2016). https://doi.org/10.1007/s40519-016-0323-3
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DOI: https://doi.org/10.1007/s40519-016-0323-3