The impact of the COVID‐19 pandemic on eating disorders in U.S. military veterans

Abstract

Purpose The COVID‐19 pandemic has had a profound impact on mental health around the world. Although there have been reports that the incidence of eating disorders (EDs) has increased during the pandemic, few longitudinal studies have examined recent changes in EDs. Men and women with military histories may be particularly vulnerable to EDs, underscoring the importance of investigating the impact of the COVID‐19 pandemic on EDs in this population. Method We examined whether early‐pandemic (Time 1; T1) posttraumatic stress disorder, depression, anxiety, and stress symptoms were associated with change in probable ED diagnostic status 1 year later (T2). We also investigated relationships from early pandemic mental health symptoms to change in ED diagnostic status from T1 to T2 via pandemic‐related life circumstance pathways (health, financial, social, etc.). Participants included a population‐based sample of 372 U.S. veterans who completed the T1 and T2 surveys. Results Early pandemic mental health was significantly and positively associated with probable ED diagnostic status. Social and health satisfaction as well as physical health pandemic impacts mediated the associations between mental health symptoms and ED diagnostic status. Discussion Findings highlight the importance of bolstering social connection, health‐promoting behaviors, and access to ED treatment among veteran men and women impacted by the COVID‐19 pandemic. Public Significance The COVID‐19 pandemic has had a profound impact on mental health, including eating disorders (EDs). We found that early pandemic mental health symptoms were significantly associated with changes in U.S. veterans' ED diagnostic status 1 year later. Mental health symptoms increased ED diagnoses via their impact on social and health satisfaction, as well as physical health impacts of the pandemic. Findings highlight the importance of increasing social connection, health‐promoting behaviors, and ED treatment access among veteran men and women, who may be particularly vulnerable to EDs, during the COVID pandemic.

Identifying candidate mechanisms of comorbidity in disordered eating and posttraumatic stress disorder symptoms among U.S. veterans: A network analytic approach.

“…We administered the version of the PCL-5 that asks participants to provide information about their worst trauma, which is used to determine whether participants met PTSD Criterion A for trauma exposure. As previously reported (Mitchell et al, 2023), we created two PCL-5 scores, one for participants who endorsed Criterion A trauma exposure according to DSM-5 criteria, and a second sum score that included these participants and those endorsing exposures that may have qualified as trauma but had insufficient detail to confirm whether it met Criterion A. PCL-5 sum scores based on such strict and lenient coding were correlated at .91; we used the lenient scoring in this study to be more inclusive. Participants who did not report an index trauma exposure or reported a non-Criterion A trauma were excluded from the analyses.…”

Eating Disorder Risk and Common Mental Disorders in British Servicewomen: A Cross-Sectional Observational Study

“…Older age was associated with a lower risk, and heavier body mass was associated with a higher risk, of eating disorders. Common mental disorders are strongly associated with eating disorders (8–11) and may lead to eating disorders (12,13). Therefore, our data could be explained by the observation that older age was also associated with a lower risk, and heavier body mass was associated with a higher risk, of symptoms of anxiety, depression, and/or stress.…”

“…Common mental disorders were assessed using the 7-item Generalized Anxiety Disorder Assessment (GAD-7) (38), the 9-item Patient Health Questionnaire (PHQ-9) (39), the Perceived Stress Scale (40), and 10-item Connor-Davidson Resilience Scale (CD-RISC-10) (41). Anxiety and depression were scored according to severity using the respective GAD-7 (minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19)(20)(21)) and PHQ-9 scores (minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), severe (20)(21)(22)(23)(24)(25)(26)(27)). A participant was defined as having symptoms of anxiety if they scored ≥10 on the GAD-7 (38) and depression if they scored ≥10 on the PHQ-9 (39).…”

“…The Relative Energy Deficiency in Sport (RED-S) syndrome expands the Triad to include other physical and psychological outcomes affected by low energy availability, including mood disorders (2,7). Eating disorders are a predispositions for the Triad and RED-S (1,2), but eating disorders are strongly associated with (8–11), or are caused by (12,13), other common mental disorders. Common mental disorders refer to two main conditions: depression and anxiety, which are two of the largest contributors to disability worldwide (14).…”

The impact of stress and well‐being during the COVID‐19 pandemic on mental health in U.S. veterans

“…The EPII was designed to assess COVID-19 pandemic stressors with regard to different life domains. Given the lack of standard scoring metrics, we used a revised scoring procedure as outlined in Mitchell et al (2023), which included slight modifications to scoring of the education and training, physical health problems, and distancing and quarantine stressor domains. A list of the items included under each domain are in supplemental Table S1.…”