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Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Did the volume of adolescent and young adult patients seeking care for eating disorders change after onset of the COVID-19 pandemic?

Findings  In this case series study, before and after onset of the COVID-19 pandemic eating disorder care volume, both inpatient and outpatient, across 14 geographically diverse academic adolescent medicine sites were compared. A significant increase in both inpatient and outpatient eating disorder volume after onset of the pandemic that surpassed prepandemic patient care trends was found, particularly through the first year.

Meaning  Programs throughout the US saw a significant, pandemic-associated increase in the number of patients seeking eating disorder–related care in both inpatient and outpatient settings.


Importance  The COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking.

Objective  To compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic.

Design, Setting, and Participants  Using an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospital-based adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were compared separately for inpatient and outpatient settings. Demographic data such as race and ethnicity were not collected because this study used monthly summary data.

Exposures  Onset of the COVID-19 pandemic.

Main Outcomes and Measures  Monthly number of patients seeking inpatient/outpatient ED-related care.

Results  Aggregate total inpatient ED admissions were 81 in January 2018 and 109 in February 2020. Aggregate total new outpatient assessments were 195 in January 2018 and 254 in February 2020. Before the COVID-19 pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month (95% CI, 0.2%-1.3%). After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month (95% CI, 4.8%-9.7%) through April 2021, then a decrease of 3.6% per month (95% CI, −6.0% to −1.1%) through December 2021. Prepandemic, pooled data showed relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline (95% CI, −50.4% to −26.7%) in April 2020. Subsequently, new assessments increased by 8.1% (95% CI, 5.3%-11.1%) per month through April 2021, then decreased by 1.5% per month (95% CI, −3.6% to 0.7%) through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 (95% CI, 6.2-10.2) additional inquiries for care per month in the first year after onset of the pandemic.

Conclusions and Relevance  In this study, there was a significant COVID-19 pandemic-related increase in both inpatient and outpatient volume of patients with EDs across sites, particularly in the first year of the pandemic. Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.

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Article Information

Accepted for Publication: August 17, 2022.

Published Online: November 7, 2022. doi:10.1001/jamapediatrics.2022.4346

Corresponding Author: Sydney M. Hartman-Munick, MD, Division of Adolescent/Young Adult Medicine, UMass Memorial Children's Medical Center, 55 Lake Ave North, Worcester, MA 01604 (sydney.hartman-munick@umassmemorial.org).

Author Contributions: Drs Richmond and Forman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Forman and Richmond are co–senior authors.

Concept and design: Hartman-Munick, Lin, Milliren, Braverman, Fisher, Golden, Rome, Sharma, Vo, Woods, Forman, Richmond.

Acquisition, analysis, or interpretation of data: Hartman-Munick, Lin, Milliren, Braverman, Brigham, Fisher, Golden, Jary, Lemly, Matthews, Ornstein, Roche, Rome, Rosen, Sharma, Shook, Taylor, Thew, Vo, Voss, Forman, Richmond.

Drafting of the manuscript: Hartman-Munick, Lin, Milliren, Matthews, Forman, Richmond.

Critical revision of the manuscript for important intellectual content: Hartman-Munick, Lin, Milliren, Braverman, Brigham, Fisher, Golden, Jary, Lemly, Ornstein, Roche, Rome, Rosen, Sharma, Shook, Taylor, Thew, Vo, Voss, Woods, Forman, Richmond.

Statistical analysis: Milliren, Taylor, Voss.

Administrative, technical, or material support: Lin, Brigham, Roche, Taylor, Voss, Forman.

Supervision: Lin, Rome, Sharma, Voss, Woods, Forman, Richmond.

Conflict of Interest Disclosures: Drs Hartman-Munick and Lin were supported by the Maternal and Child Health Bureau (LEAH training grant T71MC00009). Dr Golden was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant R01HD082166). No other disclosures were reported.

Additional Contributions: We acknowledge Amanda Dietz, APRN (Children's Mercy, Kansas City, Missouri), and Wallis Slater, BA (Boston Children's Hospital, Boston, Massachusetts; now with Harvard School of Public Health,Harvard School of Public Health), for their extensive help with data collection at their respective sites; compensation was not received.

Harvard T.H. Chan School of Public Health. Report: economic costs of eating disorders. Published June 2020. Accessed October 3, 2022. https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
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