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Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study
  1. Hristina Petkova1,
  2. Mima Simic2,
  3. Dasha Nicholls3,
  4. Tamsin Ford4,
  5. A Matthew Prina1,
  6. Ruth Stuart1,
  7. Nuala Livingstone5,
  8. Grace Kelly5,
  9. Geraldine Macdonald6,
  10. Ivan Eisler2,
  11. Simon Gowers7,
  12. Barbara M Barrett1,
  13. Sarah Byford1
  1. 1 Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
  2. 2 Michael Rutter Centre for Children and Young People, South London and Maudsley NHS Foundation Trust, London, UK
  3. 3 The Centre for Psychiatry, Imperial College London, London, UK
  4. 4 Institute of Health Research, University of Exeter, Exeter, UK
  5. 5 School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
  6. 6 School for Policy Studies, University of Bristol, Bristol, UK
  7. 7 Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor Sarah Byford; s.byford{at}kcl.ac.uk

Abstract

Objectives This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.

Design Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.

Setting The study was based in the UK and Ireland.

Participants Clinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.

Main outcome measures Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.

Results 305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.

Conclusion These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.

Trial registration number ISRCTN12676087.

  • eating disorders
  • child & adolescent psychiatry
  • epidemiology
  • anorexia nervosa

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  • Contributors HP contributed to data collection, data entry, data cleaning, data analysis, and drafting of the manuscript. MS, TF, SG were co-applicants, contributed to the design of the study, provided clinical expertise, and commented on and approved the manuscript. DN was a co-applicant, contributed to the design of the study, provided expertise on CAPSS methodology, clinical expertise, and commented on and approved the manuscript. AMP contributed to the data analysis and commented on and approved the manuscript. RS contributed to data collection, data entry, data cleaning and data analysis, and commented on and approved the manuscript. NL, GK contributed to data collection, data entry and data management in Northern Ireland, and commented on and approved the manuscript. GM contributed to the design of the study, managed the Northern Ireland research staff, and commented on and approved the final report. IE was a co-applicant, contributed to the design of the study, provided clinical support to the research team, and commented on and approved the manuscript. BMB was a co-applicant, contributed to the design of the study, the data analysis, and commented on and approved the manuscript. SB was principal investigator, led the study, managed the King’s College London research staff, contributed to the design of the study and the data analysis, drafted the paper, and is responsible for the overall content as guarantor.

  • Funding The study was funded by the NIHR Health Service & Delivery Research programme (11/1023/17). The study funders had no role in the study design, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication. The authors were independent from the funders and all authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests Tamsin Ford reports she is Chair of the Child and Adolescent Psychiatry Surveillance Service that was used to run part of the study, which is an unpaid position (other than travel expenses). Kandarp Joshi reports that he was principal investigator for the Aberdeen site for a Sunovion sponsored multisite trial on effectiveness of Lurasidone in paediatric schizophrenia.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the CAPSS Executive Committee, King’s College London Research Ethics Committee (PNM/13/14-105) and the Health Research Authority (CAG 4-03(PR1)/2014) under Section 251 of the NHS Act 2006, which enables disclosure of confidential patient information, where it is not possible to use anonymised information and where seeking consent is not practical.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement As a result of the collection of confidential patient data without consent, and approval from the Health Research Authority for data to be provided for the purposes of the specified activity only, the data cannot be made publicly available for other purposes. However, the CostED research group will consider requests for further analysis on a case by case basis, subject to appropriate ethical/HRA approvals.

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