A decade of data from a specialist statewide child and adolescent eating disorder service: does local service access correspond with the severity of medical and eating disorder symptoms at presentation?
BACKGROUND
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.


METHODS
The 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.


RESULTS
Consistent 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.


CONCLUSIONS
Lower 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.
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia.
Jeremy
J
Alman
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia.
Kimberley J
KJ
Hoiles
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia ; School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia Australia ; UNC Center of Excellence for Eating Disorders, Department of Psychiatry, Neurosciences Hospital, 101 Manning Drive, Chapel Hill, North Carolina USA ; Princess Margaret Hospital for Children Eating Disorders Program, GPO Box D184, Perth, 6840 Western Australia Australia.
Hunna J
HJ
Watson
School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia.
Sarah J
SJ
Egan
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia.
Matthew
M
Hamilton
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia.
Julie
J
McCormack
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia.
Julie
J
Potts
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia Australia.
David A
DA
Forbes
Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia.
Chloe
C
Shu
Adolescent; Child; Eating disorders; HOPE Project; Medical complications; Rural