Abstract
BackgroundBody mass index (BMI) at hospital admission in patients with anorexia nervosa (AN) represents a prognostic marker for mortality, chronicity and future body weight. The current study focused on the associations between BMI standard deviation score (BMI-SDS) at admission and reasons for seeking inpatient treatment. Further interest was given to the relationship between premorbid weight and weight at admission, as well as the effect of both weight at referral and reasons for admission on treatment outcome.MethodsData ascertained in the German Register of Children and Adolescents with AN were analysed to assess the parental and patient overlap for 23 predefined reasons for admission, using factor analyses and regressions models.ResultsComplete parent-patient data sets were available for 360 patients out of 769. The highest consensus rates between parents and patients were obtained for weight and eating behavior related reasons and hyperactivity. Based on factor analysis, four factors emerged. Premorbid BMI-SDS, age and ‘low body weight’ as stated by patients or parents explained almost 40% of the variance of the BMI-SDS at admission.ConclusionsResults underscore the relevance of age and premorbid BMI for BMI at admission. Only single reasons for admission explained further variance, with ‘low body weight’ having the largest effect. Approximately 40% of the variance of BMI-SDS was explained. For the first time, the effect of premorbid BMI for BMI at admission was robustly demonstrated in a multicenter study. Of the variance in BMI-SDS at discharge, our model could explain 37%, with reasons for admission having a small effect. Further investigation of the reasons for admission would be worthwhile to improve treatment and prognosis.
Highlights
Anorexia nervosa (AN) is an eating disorder with a multifactorial etiology, which can be subsumed into the biopsychosocial model for mental disorders
To assess the influence of the dichotomous items, we extended the baseline regression model Ib based on premorbid Body mass index (BMI)-SDS and age at admission to include each of the 23 items for patients and parents, respectively (Additional file 1: Table S3a, b available online)
The explained variance based on premorbid BMI standard deviation score (BMI-SDS), age at admission, and single reasons for admission as delineated by patients or their parents exceeded the 27% explained in our previous study based on premorbid BMI age percentile and age at admission of 161 patients [15]
Summary
Anorexia nervosa (AN) is an eating disorder with a multifactorial etiology, which can be subsumed into the biopsychosocial model for mental disorders. One of the most profound experiences for a patient in the course of AN is the initiation of inpatient treatment. Knowledge about presenting complaints and the reasons for seeking inpatient treatment is scant. Adolescent patients experienced stronger external coercion for treatment when they were younger [7]. A low body weight and more severe eating disorder-specific psychopathology were associated with a greater perceived need for hospitalization as assessed by the patients themselves [7]. Body mass index (BMI) at hospital admission in patients with anorexia nervosa (AN) represents a prognostic marker for mortality, chronicity and future body weight. The current study focused on the associations between BMI standard deviation score (BMI-SDS) at admission and reasons for seeking inpatient treatment. Further interest was given to the relationship between premorbid weight and weight at admission, as well as the effect of both weight at referral and reasons for admission on treatment outcome
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