Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries

Abstract

Background The COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce. Methods We asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists’ estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals. Results Four out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived “loss of control”, and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology. Conclusions The COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived “loss of control”, and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

The youngest are hit hardest: The influence of the COVID-19 pandemic on the hospitalization rate for children, adolescents, and young adults with anorexia nervosa in a large German representative sample

“…According to previous studies [ 7 ], young patients with AN reported that they had lost their daily life structure, especially during school closures [ 32 ]; according to Zeiler et al [ 7 ], they complained of participating in fewer outdoor activities, including sports, during the lockdowns, which then triggered weight phobia. In addition, they had more spare time and experienced more boredom, which led to increased activity in social media, especially on websites glorifying slimness and a well-trained body [ 33 ].…”

“…Several studies point to a lockdown-induced weight gain in children and adolescents [ 35 ]. In a previous investigation, we reported that patients had assumed to have put on weight during the first lockdown and felt bullied because of “fatness” after their return to school, thus leading to increased efforts to lose weight [ 32 ]. Accordingly, it is well known that intended weight loss may lead to reduced eating and exaggerated participation in sports with the consequence of starvation.…”

Long-term effects of the COVID-19 pandemic on five mental and psychological disorders: in terms of the number of disease visits, drug consumption, and scale scores.

“…A study has reported a sharp rise in hospital admissions for eating-excretion disorders across Europe during the CQVID-19 pandemic. 29 Another study reported elevated levels of abnormal disorders-related behaviors in patients with eating disorders, showing marked worsening of symptoms. [30][31][32] However, there was also evidence that some people with eating disorders didn't show signi cant worsening of symptoms due to lack of work and social stress during isolation.…”

COVID-19 related familial economic disruptions and eating disorder patients’ mental health concerns and motivation to recover

“…Prior research has demonstrated that family support is important to aid ED treatment outcomes and greater likelihood of patient recovery [ 12 , 13 ]. Additionally, the alleviation of stress on the family unit has been shown to be an important factor in the success of ED-related treatment and recovery [ 12 ].…”

“…Prior research has demonstrated that family support is important to aid ED treatment outcomes and greater likelihood of patient recovery [ 12 , 13 ]. Additionally, the alleviation of stress on the family unit has been shown to be an important factor in the success of ED-related treatment and recovery [ 12 ]. Nonetheless, the COVID-19 pandemic has led to increased economic burden and thus stress on families due to factors such as a decrease in working hours, loss of job, or loss of insurance.…”