title: Excess mortality, causes of death and prognostic factors in anorexia nervosa.
abstract: BACKGROUND
  Anorexia nervosa is a mental disorder with high mortality.
  
  
  OBJECTIVE
  To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors.
  
  
  METHODS
  Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers.
  
  
  RESULTS
  The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome.
  
  
  CONCLUSIONS
  Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.
authors.affiliation: Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden. fotis.papadopoulos@gmail.com
authors.forename: Fotios C
authors.initials: FC
authors.lastname: Papadopoulos
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Lena
authors.initials: L
authors.lastname: Brandt
authors.forename: Lisa
authors.initials: L
authors.lastname: Ekselius
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000856:Anorexia Nervosa / Q000401:mortality* / Q000523:psychology; D002423:Cause of Death; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D001523:Mental Disorders / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult