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Table 1 Description and results of studies included in the review

From: A systematic review of the frequency, duration, type and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics

Study

Patients/Age/N

Treatment type

Treatment length

Admission data

Discharge data

Follow-up data

1. Ayton et al. [[18]]

Adolescents

16 detained under section 3: 7/16 patients detained under VT, 9/16 before transfer to the clinic.

IT: 14 months

BMI: IT 16.6 ± 2.6, VT 14.2 ± 1.9

BMI: IT 19.6 ± 18.5 VT 18.5 ± 1.6

1 year follow-up

UK

Total N = 50

Nasogastric feeding:

VT: 8 months

Duration of illness: IT 3.8, VT 1.9

Menstrual period: 69% vs. 17%

N =41 (IT: 12/16 and VT: 29/34)

Naturalistic 3 years inclusion

IT: 16 (32%)

IT:69%, VT:12%

 

Age at onset: IT 12.5, VT 14.3

Overall ED outcome on M-R: IT 5.3 ± 3.1, VT 4 ± 2

Good outcome on weight and general functioning: IT 50%, VT 37.9%

VT (parental consent): 34 (68%)

  

Purging type: IT 6%, VT 15%

HONOSCA: IT-28.1 ± 10.4, VT-18.3 ± 7.2

Readmissions:

   

HONOSCA: IT 41.5 ± 4.8, VT 32 ± 5.0

CGAS: IT 47.2 ± 17.0, VT 36.6 ± 15.7

IT 16.7%, VT 34.5%

   

Depression: IT 94%, VT 59% CGAS: IT 13 ± 6.5, VT 27 ± 9.0

 

Deaths: IT =0, VT =2

   

Preadmissions: IT 88%, VT 29%

  
   

Low IQ: IT 19%, VT 3%

  
   

Abuse: IT 44%, VT 12%

  
   

Self-harm: IT 75%, VT 12%

  

2. Carney et al. [[19]-[21]]

Adults and adolescents.

Guardianship or mental health committal. Some tube feeding (46% vs. 16%). Locked ward (42% vs. 1%) Otherwise not defined.

IT: 52 days

BMI: IT 13.2 ± 1.7, VT 14.03 ± 1.8

BMI: IT 14.9 ± 1.4, VT 15.4 ± 2.3

 

Australia

Total N = 70

 

VT: 47 days

Purging type: IT 23%, VT 33%

Weight gain: IT 5.0 ± 6.6, VT 3.7 ± 5.3

 

Naturalistic 5 years inclusion

70 patients with 96 admissions.

 

Mean: 49 days.

Preadmissions: IT 3.9 ± 3.4, VT 1.7 ± 2.3,

  

IT: 23 (33%)

 

40% <3 weeks.

Psychiatric comorbidity: IT 2 ± 1.6, VT 1 ± 0.9

  

VT: 47 (67%)

     

3. Griffiths et al. [[14]] , Australia

Age 16–44 years

Guardianship.

IT: 15 weeks

BMI: IT 13.41 ± 1.76, VT 14.3 ± 2.2

BMI: IT 18.05 ± 2.14, VT 17.2 ± 2.9

3 of 15 IT patients reached at follow-up – 1 of 15 died, 4 not located.

Naturalistic,

Total N = 88

Otherwise not defined.

VT: 9 weeks

Binge/purge type: IT 60%, VT 43%

Weight gain: IT 10 kg, VT 8.7

 

IT cases from 4 units compared to VT

IT: 15 (17%)

  

Residence - metropolitan: IT 67%, VT 50%

Reached target weight: IT 26.7%, VT 42%

 

from one of the units.

VT: 73 (83%)

  

SES: IT 40%, VT 11%

 

4. Kondo et al. [[22]]

Age 12–44 years

Involuntary admission for treatment and protection.

IT: 216 days

BMI: IT 15.3 ± 5.1,

Good outcome BMI:

 

Japan

Total N = 70

 

VT: 70 days

VT 14.6 ± 8.0

IT 75%, VT 55%

 

Naturalistic

IT: 8 (13%)

     
 

VT: 62

     

5. Laakman et al. [[17]]

Age 16-39

Guardianship, forced feeding by tube until BMI = 17.5

Total 158 days

BMI:

BMI:

 

Germany

Total N = 25

 

IT: 183 days

IT: 11.8

IT: 16.6

 

Naturalistic, all patients from 1 unit.

IT: 11 (44%)

 

P: 166 days

P: 11.9

P: 16.7

 
 

Persuaded (P):

 

PC: 145 days

PC: 14.6

PC: 17.8

 

7 (28%)

 

VT: 98 days

VT: 12.1

VT: 18.8

 

Parental consent (PC): 2 (8%)

     

VT: 5 (20%)

     

6. Ramsay et al. [[15]]

Adults

7/81 involuntary admitted, 30/81

IT: 113 days

BMI: IT 14.2 ± 2.7, VT 14.3 ± 2.4),

BMI: IT 18.7 ± 2.3,

5.7 years follow-up:

UK

Total N = 162

Detained after voluntary admission, 35/81 detained in other hospital before transfer to unit.

VT: 88 days

Bingeing history: IT 41%, VT 44%

VT 18.5 ± 2.0.

Deaths: IT 12.7% vs. VT 2.6%

Time matched controls

IT: 81 (50%)

No tube-feeding or physical restraint.

 

Vomiting history: IT 51%, VT 44%

Days to target weight (equal to treatment length:

9 out of 12 death certificates included AN

 

VT: 81 (50%)

  

Laxative history: IT 49%, VT 49%

IT 113 days, VT 88 days

 
    

Preadmissions: IT 3.3, VT 1.8 Childhood abuse: IT 24%, VT 10%

  
    

Self-harm: IT 59% vs. VT 33%

  

7. Serfaty & McCluskey [[23]]

Adults

Involuntary admitted only

Not specified

Mean BMI: 12.7

Mean BMI: 18.6

Mean Follow-up time 1 year

UK

Total N = 11

7/11 Nasogastric feeding.

 

Duration of illness 14.1 year

BMI >17.5 = 27%

Mean BMI: 17.9

Naturalistic cases Patients in IT only

All treated involuntary

    

BMI >17.5 = 45.5%

8. Watson et al. [[16]]

Adults

Involuntary admitted.

IT: 58 days

BMI: IT 17.4 ± 4.7, VT 18.4 ± 4.7 Preadmissions: IT 3, VT 1.4

BMI: IT 20.5 ± 3.8, VT 20.7 ± 3.6

 

USA

Total N = 397

 

VT: 41 days

IQ: IT 91, VT 98

Weight gain: IT 18.8 ± 15.9, VT 13.9 ± 14.5 pounds

 

Naturalistic

IT: 66 (17%)

  

Equal eating disorder symptoms, depression, and substance abuse.

Days to restored weight: IT: 58 days

 

7 years inclusion

VT: 331 (83%)

   

VT: 41 days (Equal to treatment length)

 
  1. IT = Involuntary Treatment; VT = Voluntary Treatment; BMI = Body Mass Index; HONOSCA = Health of the Nation Outcome Scale for Children and Adolescents; CGAS = Children’s Global Assessment Scale: IQ = Intelligence quotient from the WAIS-R; SES = Socioeconomic Status; M-R = Morgan – Russell scale (eating disorder psychopathology).