Hospitalization following eating disorder diagnosis: The buffering effect of marriage and childbearing events.
Hospitalization following eating disorder diagnosis: The buffering effect of marriage and childbearing events.
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DOI：
10.1016/j.ssmph.2020.100672
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Utz RL
中科院分区：
文献类型：
--
作者：
Tabler J;Utz RL
饮食失调 (ED) 被定义为因对食物、体重或体型的痴迷而导致的异常饮食行为。在美国，ED 影响着 1000 万男性和 2000 万女性，估计女性终生患病率为 15%。急诊科的诊断通常伴随着一系列不利的身心健康结果，包括自杀风险增加。鉴于与 ED 相关的复杂合并症，治疗在住院和门诊环境中进行。本研究使用犹他州人口数据库中关联的行政和健康记录创建了一组女性 n = 4183 名和男性 n = 423 名，她们在 1995 年至 2015 年间被诊断为 ED。Cox 比例风险回归用于建模与 ED 相关的住院轨迹，包括随后自杀/自残行为相关住院的风险。为了更好地估计与不同医疗保健利用模式相关的风险状况，模型探讨了与家庭相关的生命历程事件（分娩、婚姻转变）和社会人口特征（种族、性别和人口普查区收入中位数）如何改变初步诊断后的住院轨迹。结果表明，增加门诊治疗与初次 ED 相关住院风险降低相关，但随后 ED 相关再入院的风险较高。此外，向婚姻过渡（即结婚）与 ED 相关和自杀/自残行为相关住院（初次住院和随后再次入院）的风险降低相关。儿童数量的增加仅与初次急诊住院的风险降低相关，但与再次入院无关。在评估个人因 ED 相关住院的风险时，社会和卫生服务研究人员应将治疗轨迹与个人的生活经历（特别是婚姻转变）结合起来，同时考虑社会人口特征和门诊护理的利用。未来的研究应进一步研究婚姻是否代表 ED 患者健康轨迹的重要转折点。生育可降低首次饮食失调住院的风险。婚姻可以降低饮食失调住院和再入院的风险。婚姻可以降低患有饮食失调症的人自杀住院的风险。较高的门诊治疗可降低首次饮食失调住院的风险。较高的门诊治疗会增加饮食失调再入院的风险。
Eating Disorders (ED) are defined as abnormal eating behaviors, stemming from an obsession with food, body weight, or body shape. EDs affect 10 million men and 20 million women in the US, with an estimated 15% lifetime prevalence among women. An ED diagnosis is often accompanied with a host of adverse physical and mental health outcomes, including a heightened risk for suicidality. Given the complex comorbidities associated with EDs, treatment occurs in inpatient and outpatient settings. This study used linked administrative and health records from the Utah Population Database to create a cohort of women n = 4183 and men n = 423 who had a known diagnosis of ED between 1995 and 2015. Cox proportional hazard regression was used to model ED-related hospitalization trajectories, including subsequent risk for suicidality/self-injurious behavior-related hospitalization. To better estimate the risk profiles associated with different health care utilization patterns, models explored how family-related life course events (childbirth, marriage transitions) and sociodemographic characteristics (race, sex, and median income at census-block) modify hospitalization trajectories following initial diagnosis. Results suggested that increased outpatient treatment was associated with reduced risk of initial ED-related hospitalization, but higher risk for subsequent ED-related hospital readmission. In addition, transition to marriage (i.e., getting married) was associated with reduced risk of ED-related and suicidality/self-injurious behavior-related hospitalizations (initial hospitalization and subsequent readmission). Increased number of children was only associated with reduced risk of initial ED-hospitalization, but not readmission. When assessing individuals' risk for ED-related hospitalizations, social and health services researchers should contextualize treatment trajectories within the individual's life experiences, particularly marital transitions, while simultaneously considering sociodemographic characteristics and utilization of outpatient care. Future research should further examine whether marriage represents an important turning point in the health trajectories of individuals with EDs. Childbearing reduces risk of initial eating disorder hospitalization. Marriage reduces risk of eating disorder hospitalization and readmission. Marriage reduces risk of suicidality hospitalization for persons with prior eating disorder. Higher outpatient treatment reduces risk of initial eating disorder hospitalization. Higher outpatient treatment increases risk of eating disorder hospital readmission.
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