Compulsory treatments in eating disorders: a systematic review and meta-analysis
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REVIEW
Compulsory treatments in eating disorders: a systematic review and meta‑analysis Anna Rita Atti1 · Tomas Mastellari1 · Stefano Valente2 · Maurizio Speciani1 · Fabio Panariello2 · Diana De Ronchi1 Received: 6 August 2020 / Accepted: 24 September 2020 © The Author(s) 2020
Abstract Introduction The aims of this systematic review and meta-analysis are to provide a summary of the current literature concerning compulsory treatments in patients with eating disorders (ED) and to understand whether compulsorily and involuntarily treated patients differ in terms of baseline characteristics and treatment outcomes. Methods Relevant articles were identified following the PRISMA guidelines by searching the following terms: “treatment refusal”, “forced feeding”, “compulsory/coercive/involuntary/forced treatment/admission”, “eating disorders”, “feeding and eating disorders”, “anorexia nervosa”, “bulimia nervosa”. Research was restricted to articles concerning humans and published between 1975 and 2020 in English. Results Out of 905 articles retrieved, nine were included for the analyses allowing the comparisons between 242 compulsorily and 738 voluntarily treated patients. Mean body mass index (BMI) was slightly lower in patients compelled to treatments. Mean illness duration, BMI at discharge and BMI variation showed no significant differences between the two groups. Average length of hospitalization was 3 weeks longer among compulsory-treated patients, but this did not result in a higher increase in BMI. No significant risk difference on mortality was estimated (three studies). Conclusions Compulsory treatments are usually intended for patients having worse baseline conditions than voluntary ones. Those patients are unlikely to engage in treatments without being compelled but, after the treatments, albeit with longer hospitalisations, they do achieve similar outcomes. Therefore, we can conclude that forcing patients to treatment is a conceivable option. Level of evidence Level I, systematic review and meta-analysis. Keywords Compulsory admission · Involuntary treatment · Involuntary hospitalization · Eating disorders · Anorexia nervosa · Bulimia nervosa · BMI · Meta-analysis
Introduction Eating disorders (ED) including among others, anorexia nervosa (AN) and bulimia nervosa (BN) are associated with severe morbidity and high mortality burden [1], have a serious impact on patient’s quality of life, and are responsible for increased healthcare utilization and costs [2]. Outpatient care is recommended by clinical guidelines [3, 4] for most of the patients affected by ED [5], including * Anna Rita Atti [email protected] 1
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
Department of Mental Health, Local Health Authority of Bologna, Bologna, Italy
2
adolescents [6]; whereas for all persons with more severe clinical pictures, little or no differences between specialist inpatient care and active outpatient care (or a combination of both) have been demonstrated [7].
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