Abstract

BackgroundEating disorders affect up to 3% of children and adolescents, with recovery often requiring specialist treatment. A substantial literature has accrued suggesting that lower access to health care services, experienced by rural populations, has a staggering effect on health-related morbidity and mortality. The aim of this study was to evaluate whether lower service access foreshadowed a more severe medical and symptom presentation among children and adolescents presenting to a specialist eating disorders program.MethodThe data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N ~1000), a prospective ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals. The sample consisted of 399 children and adolescents aged 8 to 16 years (M =14.49, 92% female) meeting criteria for a DSM-5 eating disorder.ResultsConsistent with the hypotheses, lower service access was associated with a lower body mass index z-score and a higher likelihood of medical complications at intake assessment. Contrary to our hypothesis, eating pathology assessed at intake was associated with higher service access. No relationship was observed between service access and duration of illness or percentage of body weight lost.ConclusionsLower service access is associated with more severe malnutrition and medical complications at referral to a specialist eating disorder program. These findings have implications for service planning and provision for rural communities to equalize health outcomes.

Highlights

  • Eating disorders affect up to 3% of children and adolescents, with recovery often requiring specialist treatment

  • Lower service access is associated with more severe malnutrition and medical complications at referral to a specialist eating disorder program

  • The Helping to Outline Paediatric Eating Disorders (HOPE) Project registry consists of children and adolescents that consecutively presented to this specialist service, Child and Adolescent Health Service Eating Disorder Program (CAHS EDP) between 1996 and 2013

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Summary

Introduction

Eating disorders affect up to 3% of children and adolescents, with recovery often requiring specialist treatment. A substantial literature has accrued suggesting that lower access to health care services, experienced by rural populations, has a staggering effect on health-related morbidity and mortality. The aim of this study was to evaluate whether lower service access foreshadowed a more severe medical and symptom presentation among children and adolescents presenting to a specialist eating disorders program. Distance from services may make health care more difficult to access, in smaller countries this issue is less apparent, suggesting that a critical distance is required before the disadvantage becomes measurable in health behavior or outcomes. For example lower levels of screening may occur, reducing detection rates and delaying diagnosis, and treatment may be delayed or inadequate due to reduced service capacity and limits in expertise

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