Department of Psychiatry, University of Oxford, Oxford, UK.
Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.
Lancet. 2015 Feb 26;385 Suppl 1:S24. doi: 10.1016/S0140-6736(15)60339-7.
Clinical impression is that rates of eating disorders vary between schools; we are not aware of any previous research on this topic. We aimed to investigate whether rates of eating disorders in 16-20-year-old girls vary between upper secondary schools, and to test the hypothesis that school characteristics are associated with rates of eating disorders, even after accounting for characteristics of individual students.
This multilevel longitudinal study made use of record-linkage data from Stockholm County, Sweden. Participants were 55 824 Swedish-born girls completing secondary education in 2001-10 at 409 schools. Outcome was any diagnosed eating disorder at 16-20 years, as defined by an ICD (9 or 10) or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic. Multilevel modelling was used to separate individual and school level effects. The Stockholm Regional Ethical Review Board approved the study.
A 4·4% variation in incidence of eating disorders between schools was seen; after taking individual risk factors into account variation between schools was 2·9% (95% CI 1·5-5·0). Schools with a higher proportions of girls than boys had an increased incidence of eating disorders: for each 10% increase in the proportion of girls at a school, the odds ratio for eating disorders was 1·07 (95% CI 1·01-1·13, p=0·017). For each 10% increase in the proportion of parents with post-secondary education, the odds ratio for eating disorders was 1·14 (1·09-1·19, p<0·0001).
Our findings show that the contextual aspects of a school environment are associated with increased incidence of eating disorders. Incidence rates of eating disorders are higher in schools characterised by a high proportion of female students and of students with highly educated parents. To our knowledge, this is the first study to investigate whether rates of eating disorders vary between schools; however, use of registry data means that individuals who did not seek treatment would not have been studied.
HB was supported by a Wellcome Trust Institutional Strategic Support Fund (via the Elizabeth Blackwell Institute).
临床印象是，饮食失调在不同学校的发病率不同；我们不知道之前有关于这个主题的任何研究。我们旨在调查 16-20 岁女孩的饮食失调发病率是否在高中之间存在差异，并检验这样一个假设，即即使考虑到个体学生的特征，学校特征也与饮食失调的发病率有关。
这项多水平纵向研究利用了瑞典斯德哥尔摩县的记录链接数据。参与者为 55824 名在 2001-10 年期间在 409 所学校完成中学教育的瑞典出生女孩。结果为 16-20 岁时任何经 ICD（9 或 10）或 DSM-IV 编码诊断的饮食失调，或从专科饮食失调诊所预约推断出的饮食失调。多水平模型用于分离个体和学校水平的影响。斯德哥尔摩地区伦理审查委员会批准了这项研究。
发现学校之间的饮食失调发病率存在 4.4%的差异；在考虑个体风险因素后，学校之间的差异为 2.9%（95%CI 1.5-5.0）。女生比例高于男生的学校饮食失调发病率更高：每增加 10%的女生比例，饮食失调的比值比为 1.07（95%CI 1.01-1.13，p=0.017）。每增加 10%的父母接受过高等教育的比例，饮食失调的比值比为 1.14（1.09-1.19，p<0.0001）。
我们的研究结果表明，学校环境的背景方面与饮食失调发病率的增加有关。女生比例高和高学历父母的学生比例高的学校，饮食失调发病率较高。据我们所知，这是第一项调查饮食失调发病率在学校之间是否存在差异的研究；然而，使用登记数据意味着没有寻求治疗的个体将不会被研究。
HB 得到了惠康信托机构战略支持基金（通过伊丽莎白·布莱克韦尔研究所）的支持。
