{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:14:22Z","timestamp":1791314062264,"version":"4.3.1"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychosom Med"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate mortality in anorexia nervosa (AN) with a psychiatric comorbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using Swedish registers, data for 8069 female inpatients with AN were retrospectively collected for 1973\u20132010. Mortality patterns were assessed using standardized mortality ratios (SMRs), Cox regression-derived hazard ratios, and incidence rate ratios. A control cohort of 76,995 women was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with AN and a psychiatric comorbidity had higher mortality rates did than those without a comorbidity. The SMRs for patients with AN and a psychiatric comorbidity were 5.4 (95% confidence interval [CI] = 4.6\u20136.4) and 18.1 (95% CI = 15.2\u201321.3) for natural and unnatural causes of death, respectively. The SMRs for patients with AN without a comorbidity were 2.8 (95% CI = 2.3\u20133.5) and 3.1 (95% CI = 2.2\u20134.1) for natural and unnatural causes of death, respectively. The adjusted hazard ratios for mortality from natural or unnatural causes were 2.0 (95% CI = 1.5\u20132.7) and 5.7 (95% CI = 3.9\u20138.2), respectively. Incidence rate ratios comparing patients with AN and controls, both with psychiatric comorbidities, suggest a negative synergistic effect of comorbid AN and psychiatric disorder on mortality, which was greater for unnatural causes of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Mortality in patients with AN was greater in the presence of a psychiatric comorbidity, and even more pronounced for unnatural causes of death and suicides. Substance abuse, especially alcohol use disorder, increased mortality from natural causes of death. These findings highlight the need for early detection and treatment of psychiatric comorbidity in AN, to potentially improve long-term outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1097\/psy.0000000000000342","type":"journal-article","created":{"date-parts":[[2016,4,30]],"date-time":"2016-04-30T12:10:00Z","timestamp":1462018200000},"page":"910-919","source":"Crossref","is-referenced-by-count":94,"title":["Mortality in Women With Anorexia Nervosa: The Role of Comorbid Psychiatric Disorders"],"prefix":"10.1097","volume":"78","author":[{"given":"Jan","family":"Kask","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Ekselius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasa","family":"Kollia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Ekbom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fotios C.","family":"Papadopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230824","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1176\/appi.ajp.159.8.1284","article-title":"The outcome of anorexia nervosa in the 20th century","volume":"159","year":"2002","journal-title":"Am J Psychiatry"},{"key":"bib2-20230824","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1146\/annurev.nutr.27.061406.093713","article-title":"The genetics of anorexia nervosa","volume":"27","year":"2007","journal-title":"Annu Rev Nutr"},{"key":"bib3-20230824","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1192\/bjp.186.6.516","article-title":"Personality subtypes in eating disorders: validation of a classification in a naturalistic sample","volume":"186","year":"2005","journal-title":"Br J Psychiatry"},{"key":"bib4-20230824","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1002\/eat.20529","article-title":"Thin ideal internalization in Mexican girls: a test of the sociocultural model of eating disorders","volume":"41","year":"2008","journal-title":"Int J Eat Disord"},{"issue":"suppl 1","key":"bib5-20230824","first-page":"I38","article-title":"Risk and protective factors for juvenile eating disorders","volume":"12","year":"2003","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"bib6-20230824","first-page":"30","article-title":"Borderline personality, self-harm behavior, and treatment outcome among eating disorders","volume":"2","year":"2005","journal-title":"Psychiatry (Edgmont)"},{"key":"bib7-20230824","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1176\/appi.ajp.161.12.2215","article-title":"Comorbidity of anxiety disorders with anorexia and bulimia nervosa","volume":"161","year":"2004","journal-title":"Am J Psychiatry"},{"key":"bib8-20230824","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3109\/08039480903265751","article-title":"Suicidal behavior and depression in adolescents with eating disorders","volume":"64","year":"2010","journal-title":"Nord J Psychiatry"},{"key":"bib9-20230824","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/eat.20670","article-title":"Substance use disorders in women with anorexia nervosa","volume":"43","year":"2010","journal-title":"Int J Eat Disord"},{"key":"bib10-20230824","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1176\/ajp.155.7.939","volume":"155","year":"1998","journal-title":"Am J Psychiatry"},{"key":"bib11-20230824","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/1469-7610.00756","article-title":"Prospective 10-year follow-up in adolescent anorexia nervosa\u2014course, outcome, psychiatric comorbidity, and psychosocial adaptation","volume":"42","year":"2001","journal-title":"J Child Psychol Psychiatry"},{"key":"bib12-20230824","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/eat.20827","article-title":"Mortality of eating disorders: a follow-up study of treatment in a specialist unit 1974\u20132000","volume":"44","year":"2011","journal-title":"Int J Eat Disord"},{"key":"bib13-20230824","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/j.1600-0447.2010.01627.x","article-title":"Factors predictive of ten-year mortality in severe anorexia nervosa patients","volume":"123","year":"2011","journal-title":"Acta Psychiatr Scand"},{"key":"bib14-20230824","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1192\/bjp.bp.108.054742","article-title":"Excess mortality, causes of death and prognostic factors in anorexia nervosa","volume":"194","year":"2009","journal-title":"Br J Psychiatry"},{"key":"bib15-20230824","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1001\/archpsyc.60.2.179","article-title":"Predictors of mortality in eating disorders","volume":"60","year":"2003","journal-title":"Arch Gen Psychiatry"},{"key":"bib16-20230824","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1002\/eat.20715","article-title":"Mortality and predictors of death in a cohort of patients presenting to an eating disorders service","volume":"43","year":"2010","journal-title":"Int J Eat Disord"},{"key":"bib17-20230824","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1192\/bjp.175.2.147","article-title":"Compulsory treatment in anorexia nervosa. Short-term benefits and long-term mortality","volume":"175","year":"1999","journal-title":"Br J Psychiatry"},{"key":"bib18-20230824","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1002\/(SICI)1098-108X(200007)28:1<20::AID-EAT3>3.0.CO;2-X","article-title":"Mortality in eating disorders: a descriptive study","volume":"28","year":"2000","journal-title":"Int J Eat Disord"},{"key":"bib22-20230824","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1001\/jama.1997.03550070061039","article-title":"Alcohol and illicit drug abuse and the risk of violent death in the home","volume":"278","year":"1997","journal-title":"JAMA"},{"key":"bib23-20230824","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/archpsyc.58.9.844","article-title":"Excess mortality in bipolar and unipolar disorder in Sweden","volume":"58","year":"2001","journal-title":"Arch Gen Psychiatry"},{"key":"bib24-20230824","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0920-9964(99)00191-7","article-title":"Mortality and causes of death in schizophrenia in Stockholm county, Sweden","volume":"45","year":"2000","journal-title":"Schizophr Res"},{"key":"bib26-20230824","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0272-7358(02)00201-5","article-title":"Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships","volume":"23","year":"2003","journal-title":"Clin Psychol Rev"},{"key":"bib27-20230824","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/j.1600-0447.1997.tb09913.x","article-title":"Eating disorders and antecedent anxiety disorders: a controlled study","volume":"96","year":"1997","journal-title":"Acta Psychiatr Scand"},{"key":"bib28-20230824","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.psychres.2012.04.032","article-title":"Depression, anxiety and obsessive-compulsive symptoms in relation to nutritional status and outcome in severe anorexia nervosa","volume":"200","year":"2012","journal-title":"Psychiatry Res"},{"key":"bib29-20230824","first-page":"4","article-title":"Treatment of patients with eating disorders, third edition. American Psychiatric Association","volume":"163","year":"2006","journal-title":"Am J Psychiatry"},{"key":"bib30-20230824","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1176\/ajp.141.11.1441","article-title":"CSF neurochemistry of women with anorexia nervosa and normal women","volume":"141","year":"1984","journal-title":"Am J Psychiatry"},{"key":"bib31-20230824","doi-asserted-by":"crossref","first-page":"679","DOI":"10.7150\/ijms.8.679","article-title":"Anorexia nervosa: a unified neurological perspective","volume":"8","year":"2011","journal-title":"Int J Med Sci"},{"key":"bib32-20230824","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1159\/000371803","article-title":"Leptin in depressive episodes: is there a difference between unipolar and bipolar depression?","volume":"101","year":"2015","journal-title":"Neuroendocrinology"},{"key":"bib33-20230824","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/j.addbeh.2012.10.005","article-title":"Temporal sequence of comorbid alcohol use disorder and anorexia nervosa","volume":"38","year":"2013","journal-title":"Addict Behav"},{"key":"bib34-20230824","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S0191-8869(00)00048-9","article-title":"Personality disorders in the general population: DSM-IV and ICD-10 defined prevalence as related to sociodemographic profile","volume":"30","year":"2001","journal-title":"Pers Indiv Differ"},{"key":"bib35-20230824","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/eat.20463","article-title":"Specific and nonspecific comorbidity in anorexia nervosa","volume":"41","year":"2008","journal-title":"Int J Eat Disord"},{"key":"bib36-20230824","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/eat.22357","article-title":"Seasonal BMI differences between restrictive and purging anorexia nervosa subtypes","volume":"48","year":"2015","journal-title":"Int J Eat Disord"},{"key":"bib37-20230824","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2307\/3002000","article-title":"Limitations of the application of fourfold table analysis to hospital data","volume":"2","year":"1946","journal-title":"Biometrics"},{"key":"bib38-20230824","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","year":"2011","journal-title":"BMC Public Health"},{"key":"bib39-20230824","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/j.1600-0447.2011.01747.x","article-title":"Validity of bipolar disorder hospital discharge diagnoses: file review and multiple register linkage in Sweden","volume":"124","year":"2011","journal-title":"Acta Psychiatr Scand"}],"container-title":["Psychosomatic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00006842-201610000-00005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,16]],"date-time":"2024-06-16T04:00:48Z","timestamp":1718510448000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00006842-201610000-00005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10]]},"references-count":35,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.1097\/psy.0000000000000342","relation":{},"ISSN":["1534-7796","0033-3174"],"issn-type":[{"value":"1534-7796","type":"electronic"},{"value":"0033-3174","type":"print"}],"subject":[],"published":{"date-parts":[[2016,10]]}}}