Academic journal article Shanghai Archives of Psychiatry

Prevalence of Eating Disorders in the General Population: A Systematic Review

Academic journal article Shanghai Archives of Psychiatry

Prevalence of Eating Disorders in the General Population: A Systematic Review

Article excerpt

1. Introduction

Eating disorders are common conditions that have gained increasing attention over the last two decades. A growing body of literature has demonstrated their association with decreased quality of life, [1] substantial disease burden, [2,3] and an increased risk of depression, substance abuse and suicide. [4-7] Both the types of conditions included in this category of disorders and the diagnostic criteria for the specific disorders have changed over time: 'anorexia nervosa' (AN) and 'bulimia nervosa' (BN)--the most important types of eating disorders--are included in all diagnostic classifications of eating disorders, but the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) [8,9] also includes 'binge eating disorder' (BED) and 'eating disorder not otherwise specified'; the International Classification of Diseases (ICD) [10] also includes 'atypical anorexia nervosa', 'atypical bulimia nervosa' and several other eating disorders; and the Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD) [11] also includes 'psychogenia nervosa' (pathological vomiting) and some other eating disorders.

The prevalence of these conditions is rising in many countries [12,13] and is typically higher in young females [14-16] and in high-income countries, [17,18] possibly due to cultural and economic factors. There is an 18-fold difference in the reported overall prevalence of eating disorders in the general population; estimates range from 0.2% [19] to 3.7% [20] in community-based surveys. But there has been little systematic research focused on understanding the reasons for such large variations in prevalence. To address this issue, the current study uses meta-analysis methods to pool data from community surveys from around the world and analyzes these pooled data to estimate the global prevalence of these conditions and to identify factors that may help explain the large differences in reported prevalence.

2. Methods

2.1 Data retrieval strategies

The process of identifying articles for inclusion in the analysis is shown in Figure 1. The following key words (in both English and Chinese) were used to search PubMed/Medline (1966-2013), PsycINFO (1966-2013), ISI web of knowledge (1994-2013), Ovid (1970-2013), Chinese National Knowledge Infrastructure (1979-2013), Chongqing VIP database for Chinese Technical Periodicals (1989-2013), WANFANG DATA (1990-2013), and China BioMedical Literature Services System (SinoMed)(19782013): 'eating disorders', 'anorexia nervosa', 'bulimia nervosa', 'prevalence', and 'epidemiology'. All articles published before April 30, 2013 were included in the search.

After removal of duplicates using Endnote X5 software, two authors (QJ and HQ) evaluated all articles independently. Full-text of articles were downloaded when either the reviewers believed the title or abstract of the article met inclusion criteria or when there was no clear indication whether or not the article met the inclusion criteria. The reference lists of 720 articles were hand-checked to identify any other potential articles that had not been identified during the screening of databases. These two authors then read the full-text articles and screened them according to pre-defined inclusion and exclusion criteria. A third author (WY) was consulted when these two authors disagreed about an article, which occurred for 10 of the 375 full-text articles reviewed.

2.2 Inclusion and exclusion criteria

All studies included in this meta-analysis (a) were epidemiological studies about the prevalence of eating disorders in the general population; (b) used DSM, ICD, or CCMD diagnostic criteria; (c) used validated assessment tools (primarily the Composite International Diagnostic Interview [CIDI] or the Schedules for Clinical Assessment in Neuropsychiatry [SCAN]); (d) had information about prevalence and sample size; and (e) were written in English or Chinese. …

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