Clinical characteristics linked to persistent and emerging eating disorder risk trajectories in young people seeking mental health care

Eating disorders (EDs) are serious mental health conditions with peak onset during adolescence and young adulthood. While early intervention services frequently encounter young people at-risk of EDs, little is known about the trajectories and factors associated with ED risk among those engaged in services over time. The sample includes 494 young people (aged 12–25 years) who presented to youth mental health services in Australia between 2011 and 12, primarily for emerging mood disorders. ED risk was assessed at baseline and 12-month follow-up using the SCOFF questionnaire, with scores ≥ 2 (range 0–5) indicating high risk status. Participants were classified into four trajectory groups: persistent (high risk at both timepoints; n = 92, 18.62%), remitting (high to low risk; n = 69, 13.97%), emerging (low to high risk; n = 51, 10.32%), or low risk (low risk at both timepoints; n = 282, 57.09%). Clinical factors included depression, anxiety, deliberate self-harm, functioning, and rumination. Logistic regression analyses were used to identify factors associated with persistent risk (vs. remitting risk) and emerging risk (vs. low risk). ED risk status showed significant individual stability over time (75.71% maintained their baseline status, p<.001). Greater rumination was associated with worse outcomes in both regression analyses (i.e., persistence vs. remitting risk, and emergence vs. low risk; all p<.05). These findings suggest that rumination may represent a key modifiable risk factor that could inform targeted interventions in youth mental health services. The substantial proportion of young people with persistent or emerging ED risk highlights a significant unmet need in youth mental health services and intervention strategies are needed to improve long-term outcomes for this population.