Premature termination of treatment for anorexia nervosa: Differences between patient-initiated and staff-initiated discharge

Authors

  • Richard Sly PhD,

    Corresponding author
    1. School of Nursing Sciences, University of East Anglia, Norwich, United Kingdom
    2. Eating Disorders Research Team, St George's, University of London, London, United Kingdom
    • Correspondence to: Dr Richard Sly, School of Nursing Sciences, University of East Anglia, Norwich, UK. E-mail: r.sly@uea.ac.uk

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  • Victoria A. Mountford DClinPsy,

    1. Eating Disorders Research Team, St George's, University of London, London, United Kingdom
    2. Institute of Psychiatry, King's College London, London, United Kingdom
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  • John F. Morgan MD, PhD,

    1. Eating Disorders Research Team, St George's, University of London, London, United Kingdom
    2. Yorkshire Centre for Eating Disorders, Leeds, United Kingdom
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  • J. Hubert Lacey MD, MPhil, FRCPsych

    1. Eating Disorders Research Team, St George's, University of London, London, United Kingdom
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ABSTRACT

Objectives

To investigate treatment drop-out by comparing clinical indicators of patients whose discharge was initiated by staff with those who initiated discharge themselves.

Method

Ninety participants with anorexia completed questionnaires at admission and four weeks into hospitalized treatment. Weight data was collected over this same period. At discharge, participants were categorized into completer (n = 38) or patient-initiated (n = 36) /staff-initiated (n = 16) premature termination groups.

Results

Significant differences between staff-initiated and patient-initiated discharge groups were found at admission. Staff initiated groups were on average older (p = .035), and more likely to have had prior compelled treatment (p = .039). At 4 weeks those in the patient-initiated group had put on weight at a faster rate (p = .032) and reported a decrease in alliance (p = .017). At discharge, staff initiated discharge demonstrated greater time in treatment (p = .001), greater weight gain (p = .027), and a higher discharge BMI (p = .013). At discharge, staff-initiated drop-outs had comparable end-of-treatment outcomes to those who completed treatment as planned.

Discussion

There are key differences between those who prematurely discharge themselves from treatment, compared to those who are prematurely discharged by clinical staff. Future research into drop-out needs to take into account and recognize these differences. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:40–46)

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