Experiences of parents and patients hospitalised in a child psychiatric unit for anorexia nervosa after reorganisation of care imposed by the COVID-19 Pandemic in France: a qualitative study—The QUALICOVID study

Abstract

Background Anorexia nervosa is a serious, albeit common mental illness that generally occurs during adolescence. Although outpatient care is recommended, hospitalisation is sometimes required. There is a dedicated hospitalisation unit caring for children and adolescents presenting with anorexia nervosa in Nancy, France. However, on 16 March 2020, a national lockdown was declared by the French government as the COVID-19 pandemic escalated in France. This resulted in the adjustment of hospital admissions accompanied by premature discharge and an intensive outpatient care programme. In the light of such changes, consideration should be given to the potential impact of changes in the care pattern for anorexic patients and their parents. The purpose of our study was to explore the experiences of anorexia nervosa patients hospitalised in the unit, and their parents, following changes in the care strategy. Methods The study was conducted between weeks four and eight after lockdown was announced. The study cohort included all the patients treated for anorexia nervosa and hospitalised in the treatment unit before 16 March 2020 and their parents. A qualitative method was used and every subject was offered a semi-structured interview. Data were analysed by means of inductive thematic analysis. Results Seven superordinate themes were identified: positive aspects, concerns, preparation, loss of landmarks and hospital security, gradual return to a “normal” life, relational aspects and the likelihood of disease progression. Moreover, all the parents and patients were satisfied with the intensive outpatient care offered on discharge. Conclusion Despite initial ambivalence, all patients and their parents viewed this unexpected hospital discharge positively in these exceptional conditions. This suggests that restructuring the care programme could prove beneficial with increasing use of outpatient management, thereby reducing the length of the hospital stay and adjusting the return to school. Trial registration: ID-RCB 2020-A01101-38—This project was approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée IV [South Mediterranean IV Ethics Committee (EC)] on 5 May 2020.

Parents’ perspectives of anorexia nervosa treatment in adolescents: a systematic review and metasynthesis of qualitative data

“…Will he be able to handle himself? We keep thinking, ‘Is he going to grow out of it?’” [ 43 ] “I thought the transition was a bit sudden, you know, with her coming home and having to return to school and then having to cope with everything.” [ 38 ] Experience of relapse “…deteriorating before our eyes…” “I find it quite depressing…” [ 21 ] “…taking one step forward and then three back…” [ 32 ] “… to accept relapses was difficult. To accept that it didn’t go according to the pace I had hoped…” [ 44 ] …”

“…“She’s been very relaxed over the past week… whereas she wasn’t at all before, she was self-centred” [ 38 ]…”

“…“I thought the transition was a bit sudden, you know, with her coming home and having to return to school and then having to cope with everything.” [ 38 ]…”

Psychological distress and caregiving experience during the first two years of the COVID‐19 pandemic among parents of an offspring with anorexia nervosa

“…Furthermore, studies are pointing to increased practical demands for parents caused by disruptions of daily routines both for their children (e.g., school closures) and for themselves (e.g., working‐at‐home‐orders) as well as related to COVID‐measures in the inpatient treatment setting (visiting restrictions) (Clark Bryan et al., 2020; Zeiler, Wittek, et al., 2021). Parents from UK and France also expressed worries and fears related to early discharge of patients and the anticipated resurgence of symptoms (Clark Bryan et al., 2020; Sourlier et al., 2022). Two qualitative studies found that parents felt relieved having more time to provide practical and emotional support for their affected child while caregiving tasks were also experienced more intense and exhausting (Shaw et al., 2021; Sourlier et al., 2022).…”

“…Parents from UK and France also expressed worries and fears related to early discharge of patients and the anticipated resurgence of symptoms (Clark Bryan et al., 2020; Sourlier et al., 2022). Two qualitative studies found that parents felt relieved having more time to provide practical and emotional support for their affected child while caregiving tasks were also experienced more intense and exhausting (Shaw et al., 2021; Sourlier et al., 2022). This ambiguity is somehow reflected by a quantitative survey conducted in Ireland between September 2020 and March 2021 showing that approximately the same percentage of parents and other caregivers (one third to a half depending on the time point) agreed and disagreed with the statement that the pandemic has made it harder for them to provide support for the person with the eating disorder (Parsons et al., 2021).…”