The impact of COVID-19 on eating disorder referrals and admissions in Waikato, New Zealand

Abstract

Background Several countries have reported increased demand for eating disorder services during the COVID-19 pandemic, particularly for adolescents. Within New Zealand, anecdotal and media reports suggest similar changes but are limited in scope and detail. We assessed eating disorder service demand in the Waikato district in relation to the COVID-19 pandemic. Methods We retrospectively analysed records of eating disorder admissions and referrals for both children (< 18 years) and adults (≥ 18 years) during 2019 and 2020 in the Waikato, a mixed urban–rural province in northern New Zealand (population 435,000). We analysed medical admission and outpatient referral rates, and referral acuity, in relation to the COVID-19 pandemic using Welch’s t- and chi-square tests. Results 106 medical admissions met inclusion criteria (n = 37 in 2019; 69 in 2020). Admissions for eating disorders increased markedly following nationwide lockdown in March 2020 (RR = 1.7, p = 0.01), largely driven by increases in adult admissions (RR 2.0, p = 0.005). The proportion of ‘new patient’ admissions showed comparable increases for both children (RR = 2.0, p = 0.02) and adults (RR = 2.3, p = 0.03). Following lockdown, outpatient referrals increased in acuity (RR = 1.8, p = 0.047) and volume (RR = 1.6, p = 0.076) for children but not for adults. Conclusions Our study confirms a pandemic-related increase in demand for eating disorder services in the Waikato region of New Zealand, consistent with findings reported overseas. We observed contrasting increases in admissions for adults and outpatient referrals for children, exacerbating resource constraints for already stretched services and compromising provision of timely care. Plain English summary The COVID-19 pandemic has been linked to increased numbers and worsening severity of eating disorders in several settings. In New Zealand, similar trends have been noted anecdotally. We assessed clinical records to calculate rates of eating disorder-related hospital admissions and outpatient referrals during 2019 and 2020. We found significant increases in hospital admissions related to COVID-19, particularly for adults, and greater proportions of both children and adults having a first-ever eating disorder-related admission. In outpatient services, young people were referred more frequently during the pandemic and were more physically unwell when referred. These results indicate increased demand for eating disorder services as a result of the pandemic and complement findings reported overseas.

Increased prevalence of eating disorders in Japan since the start of the COVID-19 pandemic

“…Second, the pandemic also influences eating behavior in the general population [5,6]. Finally, the number of adults with eating disorders has reportedly increased [7].…”

“…In the general population, eating behaviors and body image have been reportedly associated with several factors related to the COVID-19 pandemic, such as fear, anxiety, and intolerance of uncertainty [5,6]. Furthermore, a report suggested an increase in patients with eating disorders since the COVID-19 pandemic [7]. Although these reports, which are from Europe, the Middle East, New Zealand, and the United States, suggest that the COVID-19 pandemic may increase the prevalence of eating disorders, there have been few reports showing such an increase in eating disorders in the Asian region, including Japan.…”

The impact of the COVID‐19 pandemic on eating disorders: A systematic review

“… a Allowed for participants to indicate more than one lifetime or current ED; N adds to more than reported ED sample size. b Hansen et al ( 2021 ) counted participants identifying as dual ethnicities (four outpatients and one inpatient) twice, as per New Zealand census guidelines. c Kim et al (2021) (1) reported prevalence of both clinical and non‐clinical ED's in their sample.…”

“… b Hansen et al ( 2021 ) counted participants identifying as dual ethnicities (four outpatients and one inpatient) twice, as per New Zealand census guidelines. …”

“…Eleven studies compared the differences in admissions from before the pandemic to during the pandemic, the percent changes in admissions in individual studies varied from 0% to 123%, respectively (Ayton et al, 2021 ; Graell et al, 2020 ; Hansen et al, 2021 ; Haripersad et al, 2021 ; Jones et al, 2020 ; Lin et al, 2021 ; Matthews et al, 2021 ; Otto et al, 2021 ; Parsons et al, 2021 ; Spettigue et al, 2021 ; Springall et al, 2021 ). The pooled hospital admissions across the studies demonstrated on average a 48% (pre = 591, post = 876, n = 10 studies) increase in ED admissions during the pandemic compared to previous timepoints.…”