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.4 per 100 000 of the total population (95% CI ¼ 12.7 26.8) wasfound on 1 January 1985 [30].Lucas et al.[31] used a very extensive case-finding method, which included all medical records of healthcareproviders, general practitioners and specialists in the community ofRochester, Minnesota.They also screened records mentioning relateddiagnostic terms for possible non-detected cases.They found an overallgender- and age-adjusted point prevalence of 149.5 per 100 000 (95%CI ¼ 119.3 179.7) on 1 January 1985.A main explanation for this difference can be found in the inclusion ofprobable and possible cases by Lucas et al.Definite cases constituted only39% (82 out of 208) of all incident cases identified in the period 1935 1989[32].Applying this rate to the point prevalence of 149.5 gives an estimatedpoint prevalence of 58.9 per 100 000 for definite cases in Rochester,Minnesota, on 1 January 1985.The remaining difference with the pointprevalence reported by Hoek [30] could be explained by the greater varietyof medical sources searched by Lucas et al.[31]. TABLE 2.1 Two-stage surveys of prevalence of anorexia nervosa in young femalesSubjects MethodsPrevalenceStudy Source Age (years) n Screening* Criteria (%)Button and Whitehouse [18] College students 16 22 446 EAT Feighner 0.2Szmukler [19] Private schools 14 19 1331 EAT Russell 0.8State schools 14 19 1676 EAT Russell 0.2King [20] General practice 16 35 539 EAT Russell 0Meadows et al.[21] General practice 18 22 584 EAT DSM-III 0.2**Johnson-Sabine et al.[22] Schoolgirls 14 16 1010 EAT Russell 0Råstam et al.[23] Schoolgirls 15 2136 Growth chart + DSM-III 0.47questionnaire DSM-III-R 0.23Whitaker et al.[24] Highschool girls 13 18 2544 EAT DSM-III 0.3Whitehouse et al.[25] General practice 16 35 540 Questionnaire DSM-III-R 0.2Rathner and Messner [26] Schoolgirls + case 11 20 517 EAT DSM-III-R 0.58registerWlodarczyk-Bisaga and Dolan [27] Schoolgirls 14 16 747 EAT DSM-III-R 0Steinhausen et al.[28] Schoolgirls 14 17 276 EDE-S DSM-III-R 0.7Nobakht and Dezhkam [29] Schoolgirls 15 18 3100 EAT DSM-IV 0.9*EAT Eating Attitudes Test; EDE-S Eating Disorder Examination, Screening Version.**Not found by screening (EAT score below threshold).78_____________________________________________________________________________EATING DISORDERS EPIDEMIOLOGY AND CULTURAL ASPECTS: A REVIEW ______________________________ 79IncidenceStudies of clinical samples will always show an underestimation of theincidence of eating disorders in the community, because only a minority ofpeople with these disorders come to medical attention.The incidencestudies of anorexia nervosa have used psychiatric case registers, medicalrecords of hospitals in a circumscribed area, registrations by generalpractitioners, or medical records of healthcare providers in a community.All record-based studies will grossly underestimate the true incidence,because not all cases will be referred to mental healthcare or becomehospitalized.Therefore, it is unclear whether the increase in cases reportedin healthcare facilities reflects an actual increase in the incidence in thecommunity, because it might be due to improved methods of case detectionor to the wider availability of services.Table 2.2 summarizes the results ofthe studies on the incidence of anorexia nervosa that report overall rates forthe total population.The overall rates vary considerably, ranging from 0.10 in a hospitalrecords-based study in Sweden in the 1930s to 12.0 in a medical records-based study in the USA in the 1980s, both per 100 000 population peryear.Incidence rates derived from general practices on average represent morerecent onset eating disorders than those based on other medical records.There were two studies of this type [42,44].In the study in The Netherlands[42], general practitioners using DSM-III-R criteria have recorded the rate ofeating disorders in a large (n ¼ 151 781) representative sample (1.1%) of theDutch population.The incidence rate of anorexia nervosa was 8.1 per100 000 person-years (95% CI ¼ 6.1 10.2) during the period 1985 1989.During the study period, 63% of the incident cases were referred to mentalhealthcare, accounting for an incidence rate of anorexia nervosa in mentalhealthcare of 5.1 per year per 100 000 population [ Pobierz caÅ‚ość w formacie PDF ]

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