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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.

Abstract

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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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.

References
1.
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/
2.
Herpertz-Dahlmann  B , Bonin  E , Dahmen  B .  Can you find the right support for children, adolescents and young adults with anorexia nervosa: access to age-appropriate care systems in various healthcare systems.   Eur Eat Disord Rev. 2021;29(3):316-328. doi:10.1002/erv.2825PubMedGoogle ScholarCrossref
3.
Herpertz-Dahlmann  B .  Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity.   Child Adolesc Psychiatr Clin N Am. 2015;24(1):177-196. doi:10.1016/j.chc.2014.08.003PubMedGoogle ScholarCrossref
4.
Hudson  JI , Hiripi  E , Pope  HG  Jr , Kessler  RC .  The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.   Biol Psychiatry. 2007;61(3):348-358. doi:10.1016/j.biopsych.2006.03.040PubMedGoogle ScholarCrossref
5.
Galmiche  M , Déchelotte  P , Lambert  G , Tavolacci  MP .  Prevalence of eating disorders over the 2000-2018 period: a systematic literature review.   Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342PubMedGoogle ScholarCrossref
6.
Hornberger  LL , Lane  MA ; COMMITTEE ON ADOLESCENCE.  Identification and management of eating disorders in children and adolescents.   Pediatrics. 2021;147(1):e2020040279. doi:10.1542/peds.2020-040279PubMedGoogle ScholarCrossref
7.
Lin  JA , Jhe  G , Vitagliano  JA ,  et al.  The Association of Malnutrition, illness duration, and pre-morbid weight status with anxiety and depression symptoms in adolescents and young adults with restrictive eating disorders: a cross-sectional study.   J Eat Disord. 2021;9(1):60. doi:10.1186/s40337-021-00415-7PubMedGoogle ScholarCrossref
8.
Nielsen  S , Vilmar  JW .  What can we learn about eating disorder mortality from eating disorder diagnoses at initial assessment? a Danish nationwide register follow-up study using record linkage, encompassing 45 years (1970-2014).   Psychiatry Res. 2021;303:114091. doi:10.1016/j.psychres.2021.114091PubMedGoogle ScholarCrossref
9.
Smink  FRE , van Hoeken  D , Hoek  HW .  Epidemiology of eating disorders: incidence, prevalence and mortality rates.   Curr Psychiatry Rep. 2012;14(4):406-414. doi:10.1007/s11920-012-0282-yPubMedGoogle ScholarCrossref
10.
Hossain  MM , Tasnim  S , Sultana  A ,  et al.  Epidemiology of mental health problems in COVID-19: a review.   F1000Res. 2020;9:636. doi:10.12688/f1000research.24457.1PubMedGoogle ScholarCrossref
11.
Wu  T , Jia  X , Shi  H ,  et al.  Prevalence of mental health problems during the COVID-19 pandemic: a systematic review and meta-analysis.   J Affect Disord. 2021;281:91-98. doi:10.1016/j.jad.2020.11.117PubMedGoogle ScholarCrossref
12.
Termorshuizen  JD , Watson  HJ , Thornton  LM ,  et al.  Early impact of COVID-19 on individuals with self-reported eating disorders: a survey of ~1,000 individuals in the United States and the Netherlands.   Int J Eat Disord. 2020;53(11):1780-1790. doi:10.1002/eat.23353PubMedGoogle ScholarCrossref
13.
Phillipou  A , Meyer  D , Neill  E ,  et al.  Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project.   Int J Eat Disord. 2020;53(7):1158-1165. doi:10.1002/eat.23317PubMedGoogle ScholarCrossref
14.
Scharmer  C , Martinez  K , Gorrell  S , Reilly  EE , Donahue  JM , Anderson  DA .  Eating disorder pathology and compulsive exercise during the COVID-19 public health emergency: examining risk associated with COVID-19 anxiety and intolerance of uncertainty.   Int J Eat Disord. 2020;53(12):2049-2054. doi:10.1002/eat.23395PubMedGoogle ScholarCrossref
15.
Schlegl  S , Maier  J , Meule  A , Voderholzer  U .  Eating disorders in times of the COVID-19 pandemic: results from an online survey of patients with anorexia nervosa.   Int J Eat Disord. 2020;53(11):1791-1800. doi:10.1002/eat.23374PubMedGoogle ScholarCrossref
16.
Rodgers  RF , Lombardo  C , Cerolini  S ,  et al.  The impact of the COVID-19 pandemic on eating disorder risk and symptoms.   Int J Eat Disord. 2020;53(7):1166-1170. doi:10.1002/eat.23318PubMedGoogle ScholarCrossref
17.
Zeiler  M , Wittek  T , Kahlenberg  L ,  et al.  Impact of covid-19 confinement on adolescent patients with anorexia nervosa: a qualitative interview study involving adolescents and parents.   Int J Environ Res Public Health. 2021;18(8):4251. doi:10.3390/ijerph18084251PubMedGoogle ScholarCrossref
18.
Nutley  SK , Falise  AM , Henderson  R , Apostolou  V , Mathews  CA , Striley  CW .  Impact of the COVID-19 pandemic on disordered eating behavior: qualitative analysis of social media posts.   JMIR Ment Health. 2021;8(1):e26011. doi:10.2196/26011PubMedGoogle ScholarCrossref
19.
Cooper  M , Reilly  EE , Siegel  JA ,  et al.  Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention.   Eat Disord. 2020;30(1):54-76. doi:10.1080/10640266.2020.1790271PubMedGoogle ScholarCrossref
20.
Simone  M , Emery  RL , Hazzard  VM , Eisenberg  ME , Larson  N , Neumark-Sztainer  D .  Disordered eating in a population-based sample of young adults during the COVID-19 outbreak.   Int J Eat Disord. 2021;54(7):1189-1201. doi:10.1002/eat.23505PubMedGoogle ScholarCrossref
21.
Haripersad  YV , Kannegiesser-Bailey  M , Morton  K ,  et al.  Outbreak of anorexia nervosa admissions during the COVID-19 pandemic.   Arch Dis Child. 2021;106(3):e15. doi:10.1136/archdischild-2020-319868PubMedGoogle ScholarCrossref
22.
Otto  AK , Jary  JM , Sturza  J ,  et al.  Medical admissions among adolescents with eating disorders during the COVID-19 pandemic.   Pediatrics. 2021;148(4):e2021052201. doi:10.1542/peds.2021-052201PubMedGoogle ScholarCrossref
23.
Schwartz  MD , Costello  KL .  Eating disorder in teens during the COVID-19 pandemic.   J Adolesc Health. 2021;68(5):1022. doi:10.1016/j.jadohealth.2021.02.014PubMedGoogle ScholarCrossref
24.
Asch  DA , Buresh  J , Allison  KC ,  et al.  Trends in US patients receiving care for eating disorders and other common behavioral health conditions before and during the COVID-19 pandemic.   JAMA Netw Open. 2021;4(11):e2134913. doi:10.1001/jamanetworkopen.2021.34913PubMedGoogle ScholarCrossref
25.
Lin  JA , Hartman-Munick  SM , Kells  MR ,  et al.  The impact of the COVID-19 pandemic on the number of adolescents/young adults seeking eating disorder-related care.   J Adolesc Health. 2021;69(4):660-663. doi:10.1016/j.jadohealth.2021.05.019PubMedGoogle ScholarCrossref
26.
Forman  SF , McKenzie  N , Hehn  R ,  et al.  Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative.   J Adolesc Health. 2014;55(6):750-756. doi:10.1016/j.jadohealth.2014.06.014PubMedGoogle ScholarCrossref
27.
Forman  SF , Grodin  LF , Graham  DA ,  et al; National Eating Disorder QI Collaborative.  An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses.   J Adolesc Health. 2011;49(6):594-600. doi:10.1016/j.jadohealth.2011.04.023PubMedGoogle ScholarCrossref
28.
Moreland  A , Herlihy  C , Tynan  MA ,  et al; CDC Public Health Law Program; CDC COVID-19 Response Team, Mitigation Policy Analysis Unit.  Timing of state and territorial COVID-19 stay-at-home orders and changes in population movement: United States, March 1-May 31, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(35):1198-1203. doi:10.15585/mmwr.mm6935a2PubMedGoogle ScholarCrossref
29.
Nourazari  S , Davis  SR , Granovsky  R ,  et al.  Decreased hospital admissions through emergency departments during the COVID-19 pandemic.   Am J Emerg Med. 2021;42:203-210. doi:10.1016/j.ajem.2020.11.029PubMedGoogle ScholarCrossref
30.
Pelletier  JH , Rakkar  J , Au  AK , Fuhrman  D , Clark  RSB , Horvat  CM .  Trends in US pediatric hospital admissions in 2020 compared with the decade before the COVID-19 pandemic.   JAMA Netw Open. 2021;4(2):e2037227. doi:10.1001/jamanetworkopen.2020.37227PubMedGoogle ScholarCrossref
31.
Mehrotra  A , Chernew  ME , Linetsky  D , Hatch  H , Cutler  DA , Schneider  EC .  The impact of COVID-19 on outpatient visits in 2020: visits remained stable, despite a late surge in cases.  The Commonwealth Fund. Published February 22, 2021. Accessed November 15, 2021. https://www.commonwealthfund.org/publications/2021/feb/impact-covid-19-outpatient-visits-2020-visits-stable-despite-late-surge
32.
Hartnett  KP , Kite-Powell  A , DeVies  J ,  et al; National Syndromic Surveillance Program Community of Practice.  Impact of the COVID-19 pandemic on emergency department visits: United States, January 1, 2019-May 30, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(23):699-704. doi:10.15585/mmwr.mm6923e1PubMedGoogle ScholarCrossref
33.
Datta  N , Derenne  J , Sanders  M , Lock  JD .  Telehealth transition in a comprehensive care unit for eating disorders: challenges and long-term benefits.   Int J Eat Disord. 2020;53(11):1774-1779. doi:10.1002/eat.23348PubMedGoogle ScholarCrossref
34.
Shaw  H , Robertson  S , Ranceva  N .  What was the impact of a global pandemic (COVID-19) lockdown period on experiences within an eating disorder service? a service evaluation of the views of patients, parents/carers and staff.   J Eat Disord. 2021;9(1):14. doi:10.1186/s40337-021-00368-xPubMedGoogle ScholarCrossref
35.
Brothwood  PL , Baudinet  J , Stewart  CS , Simic  M .  Moving online: young people and parents’ experiences of adolescent eating disorder day programme treatment during the COVID-19 pandemic.   J Eat Disord. 2021;9(1):62. doi:10.1186/s40337-021-00418-4PubMedGoogle ScholarCrossref
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