Anna Rita Atti1, Tomas Mastellari2, Stefano Valente3, Maurizio Speciani2, Fabio Panariello3, Diana De Ronchi2. 1. Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy. annarita.atti@unibo.it. 2. Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy. 3. Department of Mental Health, Local Health Authority of Bologna, Bologna, Italy.
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.
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.
Authors: Stephen Wonderlich; James E Mitchell; Ross D Crosby; Tricia Cook Myers; Kelly Kadlec; Kim Lahaise; Lorraine Swan-Kremeier; Julie Dokken; Marnie Lange; Janna Dinkel; Michelle Jorgensen; Linda Schander Journal: Int J Eat Disord Date: 2012-01-23 Impact factor: 4.861
Authors: Tamás Ágh; Gábor Kovács; Dylan Supina; Manjiri Pawaskar; Barry K Herman; Zoltán Vokó; David V Sheehan Journal: Eat Weight Disord Date: 2016-03-04 Impact factor: 4.652