Barts Health NHS Foundation Trust, London, UK.
Department of Psychiatry, University of Oxford, Oxford, UK.
Int J Eat Disord. 2024 Jan;57(1):162-172. doi: 10.1002/eat.24091. Epub 2023 Nov 10.
Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population.
A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis.
We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH.
Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required.
This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.
神经性厌食症（AN）和神经性贪食症（BN）是与高自杀率（SH）相关的饮食失调症。这是英国首次在医院人群中对这种关联进行量化的全国性研究。
这是一项使用 1999 年至 2021 年全国住院患者统计数据的回顾性队列研究。暴露队列包括年龄<35 岁、因 AN 或 BN 住院的患者。参考队列包括医院对照组。我们计算了每个队列中 SH 的发病率比值（RR）。在两个队列中，根据多个社会人口统计学指标进行匹配。主要结局是随后有 SH 诊断的住院或死亡记录。
我们确定了 15004 名女性和 1411 名男性患有 AN，6055 名女性和 741 名男性患有 BN。女性 AN 患者入院后因故意自伤而再次入院的 RR（95%CI）为 4.9（95%CI 4.7-5.1），男性为 4.8（95%CI 3.9-5.8）。对于 BN，女性为 9.0（95%CI 8.4-9.6），男性为 9.8（95%CI 7.7-12.2）。AN 和 BN 与其他 SH 之间存在很强的关联。
在英国医院因 AN 或 BN 入院的女性和男性患者再次入院 SH 的风险非常高。对于某些 SH 行为，如酒精中毒，RR 升高了 10 多倍。BN 的风险比 AN 更高。临床医生应该意识到风险增加的幅度。需要为那些有风险的人提供适当的支持。
这项研究是英国首次在医院人群中对 AN 和 BN 与 SH 之间的关联进行确认和量化的研究。我们发现，因神经性厌食症或神经性贪食症入院的女性和男性患者再次入院 SH 的风险增加。临床医生意识到这种风险增加，以支持那些有 SH 风险最高的患者，这一点非常重要。
