title: Predictive factors of dropout from inpatient treatment for anorexia nervosa.
abstract: BACKGROUND
  Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets.
  
  
  METHODS
  From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions.
  
  
  RESULTS
  We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status.
  
  
  CONCLUSIONS
  To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.|Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.|Université Paris Descartes, Paris, France.|Université Paris Sud, Villejuif, France.|UVSQ, Villejuif, France.|Université Paris-Saclay, Villejuif, France.
authors.forename: H
authors.initials: H
authors.lastname: Roux
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.|Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.|Université Paris Descartes, Paris, France.|Université Paris Sud, Villejuif, France.|UVSQ, Villejuif, France.|Université Paris-Saclay, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Ali
authors.affiliation: Service d'Addictologie, CHU Nantes, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Lambert
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.|Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.|Université Paris Descartes, Paris, France.|Université Paris Sud, Villejuif, France.|UVSQ, Villejuif, France.|Université Paris-Saclay, Villejuif, France.
authors.forename: L
authors.initials: L
authors.lastname: Radon
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Paris, France.|Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.|Université Paris Descartes, Paris, France.|Université Paris Sud, Villejuif, France.|UVSQ, Villejuif, France.|Université Paris-Saclay, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Huas
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Curt
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.|Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France.|Université Paris Descartes, Paris, France.|Université Paris Sud, Villejuif, France.|UVSQ, Villejuif, France.|Université Paris-Saclay, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Berthoz
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France. nathalie.godart@imm.fr.|Faculté de Médecine, Université Paris Descartes, Paris, France. nathalie.godart@imm.fr.|Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France. nathalie.godart@imm.fr.|Université Paris Descartes, Paris, France. nathalie.godart@imm.fr.|Université Paris Sud, Villejuif, France. nathalie.godart@imm.fr.|UVSQ, Villejuif, France. nathalie.godart@imm.fr.|Université Paris-Saclay, Villejuif, France. nathalie.godart@imm.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Godart
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anorexia nervosa; Dropout; Inpatient; Predictive factor; Treatment