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Schmidt K, Fitzgerald E, Keel P. Suicidal thoughts and attempts in a transdiagnostic eating disorder sample: Do diagnostic severity criteria predict risk? EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38760944 DOI: 10.1002/erv.3104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full-threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. METHOD We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). RESULTS SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full-threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. CONCLUSIONS OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full-threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice.
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Affiliation(s)
| | | | - Pamela Keel
- Florida State University, Tallahassee, Florida, United States
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2
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Lebow J, Billings M, Mattke A, Partain P, Gewirtz O'Brien J, Narr C, Breland R, Jacobson RM, Loeb K, Sim L. Does embedding pediatric eating disorder treatment in primary care bridge the access gap? Eat Disord 2024; 32:283-296. [PMID: 38206038 DOI: 10.1080/10640266.2023.2299592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Given the numerous barriers to accessing child and adolescent eating disorder treatment, there is a need for innovation in how this care is delivered. Primary care-based eating disorder treatment has established proof-of-concept, yet it is unclear whether this model can bridge the treatment-access gap. This retrospective chart review study compared demographic and illness characteristics of 106 adolescents (M age = 15.1 years) SD = 1.8 consecutively evaluated in a primary care-based eating disorder clinic with 103 adolescent patients (M age = 15.2 years) SD = 2.2 seen consecutively in a specialty eating disorder clinic at the same medical center. Relative to adolescents in specialty care, those in the primary care group presented at a significantly higher BMI percentile, had less weight suppression, a shorter illness duration, lower rates of amenorrhea and lower scores on the EDE-Q Dietary Restraint subscale. In addition, more patients in the primary care group identified as non-white and had government/public assistance insurance compared to those in the specialty group. The results suggest that, compared to traditional specialty care clinics, embedded eating disorder treatment in primary care may reach a more racially and socioeconomically diverse group of adolescents when they are earlier in the course of their illness. Future research determining the relative effectiveness of this model as compared to interventions delivered in specialty care is needed.
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Affiliation(s)
- Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Marcie Billings
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Angela Mattke
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Paige Partain
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | | | - Cassandra Narr
- Department of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Renee Breland
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Quantitative Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine Loeb
- Chicago Center for Evidence, Based Treatment, Chicago, IL, USA
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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3
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Feldman MA, Agoston AM, Burnside AN, Emerson ND, Mudd E, Koehn KZ, Gallanis LE. Management of High Acuity Patients in Pediatric Medical Settings: The Role of Consultation/Liaison Psychologists During the Growing Mental Health Crisis. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10010-y. [PMID: 38615279 DOI: 10.1007/s10880-024-10010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/15/2024]
Abstract
Since the onset of the COVID-19 pandemic, consultation/liaison (C/L) psychologists had to drastically shift their practices to care for psychiatrically acute pediatric patients admitted to medical settings. The aim of the current study was to provide an updated state of the field surrounding these changes and their implications for clinical practice. Psychologists and psychology post-doctoral fellows completed an anonymous, 51-item survey distributed via a national professional organization listserv. The results review responses, by percentages, about C/L team composition and practice patterns, as they relate to suicide risk assessments, transfers to inpatient psychiatric and other levels of care, intervention for boarding patients, and disposition and safety planning. Thematically coded qualitative responses regarding impact and management of high acuity patients are also summarized. The state of the field outlined by this survey suggests an increase in C/L assessments and interventions delivered to pediatric patients with acute psychiatric needs, as well as a reverberating effects on provider wellness. Ensuring providers establish competency for this subset of patients is vital to the continued provision of optimal patient care and to sustained provider wellness. Considerations for the field are explored.
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Affiliation(s)
- Marissa A Feldman
- Department of Psychology, Johns Hopkins All Children's Hospital, 880 Sixth Street South, Suite 460, Saint Petersburg, FL, 33713, USA.
| | | | - Amanda N Burnside
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Natacha D Emerson
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Emily Mudd
- Center for Pediatric Behavioral Health, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Kate Z Koehn
- Mental Health Services, Children's Minnesota, Minneapolis, MN, USA
| | - Lauren E Gallanis
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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4
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Cappelletto P, Luca LD, Taddei B, Taddei S, Nocentini A, Pisano T. COVID-19 pandemic impact among adolescents with eating disorders referred to Italian psychiatric unit. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12440. [PMID: 37737719 DOI: 10.1111/jcap.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
PROBLEM The COVID-19 pandemic has triggered or exacerbated eating disorders (EDs), especially in adolescents. This study examined the prevalence of admissions of patients with EDs at the Child and Adolescent Psychiatry Unit from the pre-COVID-19 pandemic to March 2023 and explored the differences in dimensions of ED's symptomatology according to the year of access. METHODS We included 174 children and adolescents, 94.3% females and 5.7% males, with a diagnosis of ED (Mage = 14.87; SD = 1.72). The Eating Disorder Inventory-3 (EDI-3), the Body Uneasiness Test (BUT) and Youth Self Report ASEBA (YSR) were assessed. A one-way analysis of variance test was performed. FINDINGS EDs' hospitalization prevalence was higher in the years 2020 and 2021 compared to pre-COVID-19 and the year 2022. Considering the ED psychopathology (EDI-3), findings showed a higher score in the dimension of the push to thinness, body dissatisfaction, asceticism, and fear of maturity in the year 2021 compared to pre-pandemic. Regarding the discomfort related to the image of one's own body (BUT), results showed an increase in the global severity index in the year 2022 compared to pre-pandemic and in weight phobia in the year 2021 compared to the year 2020. Concerning the internalizing symptoms (YSR), a tendency was found for withdrawal/depression, with higher levels in the year 2022 compared to the year 2020. CONCLUSIONS Our study highlighted the increase of different types of EDs symptomatology related to concerns about weight, especially 2 and 3 years after the outbreak of the pandemic, on which the literature is still scarce, especially in the Italian context.
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Affiliation(s)
- Pietro Cappelletto
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Lisa De Luca
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Benedetta Taddei
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Silvia Taddei
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Annalaura Nocentini
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Tiziana Pisano
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Meyer Children's Hospital IRCCS, Florence, Italy
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5
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Lawson ML, Hisle-Gorman E, Susi A, Dorr M, Nylund CM, Chokshi B. Impact of the COVID-19 pandemic on care for anorexia and bulimia nervosa in US military-connected adolescents and young adults. Int J Eat Disord 2024; 57:376-387. [PMID: 38069451 DOI: 10.1002/eat.24105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study examined the impact of the COVID-19 pandemic on healthcare engagement for anorexia nervosa (AN) and bulimia nervosa (BN) in a large, geographically diverse population. METHOD This repeated monthly, cross-sectional study queried Military Health System records of individuals aged 10-21 before and during the pandemic (February 2019-January 2022). ICD-10 codes identified encounters for AN and BN. Monthly rates of care were modeled as the number of unique individuals with an ICD-10-identified eating disorder-related encounter per month divided by the enrolled population. Poisson regression analysis evaluated rates of care stratified by eating disorder, clinical setting, and sex. RESULTS In a population of 1.76 million adolescents and young adults, 1629 individuals with AN or BN received care during the pre-pandemic period; 3256 received care during the pandemic. The monthly rate of care for females with AN during the pandemic increased in inpatient settings (adjusted relative risk [aRR]: 1.31 [1.16-1.49]) and outpatient settings (aRR: 1.42 [1.37-1.47]); monthly care rates in males with AN increased in the outpatient setting (aRR: 1.46 [1.28-1.67]). Females with BN had increased engagement in outpatient settings (aRR: 1.09 [1.03-1.16]); BN care for males showed no significant monthly changes during the pandemic period in either healthcare setting. DISCUSSION With increased rates of AN and BN disorder-related care during the pandemic, screening for eating disorder symptomatology may allow for timely diagnosis and intervention in periods of heightened stress. Pandemic-related increases in healthcare engagement may strain limited resources, emphasizing a need to expand accessibility of clinical expertise. PUBLIC SIGNIFICANCE This study indicates that monthly rates of healthcare engagement during the COVID-19 pandemic for AN and BN varied based on clinical setting and sex in an adolescent and young adult population. The increased number of individuals seeking eating disorder-related care, especially outpatient care, attributed to heightened stressors necessitates accessible professionals with eating disorder clinical expertise.
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Affiliation(s)
- Michelle L Lawson
- Department of Pediatrics, Division of Adolescent Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
| | - Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Madeline Dorr
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Cade M Nylund
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Binny Chokshi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Silber AS, Platte S, Kumar A, Arora S, Kadioglu D, Schmidt M, Storf H, Chiocchetti AG, Freitag CM. Admission rates and clinical profiles of children and youth with eating disorders treated as inpatients before and during the COVID-19 pandemic in a German university hospital. Front Public Health 2023; 11:1281363. [PMID: 38098830 PMCID: PMC10720619 DOI: 10.3389/fpubh.2023.1281363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Children and youth at risk for mental health disorders, such as eating disorders (ED), were particularly affected by the COVID-19 pandemic, yet evidence for the most seriously affected and thus hospitalized youth in Germany is scarce. Methods This crosssectional study investigated anonymized routine hospital data (demographic information, diagnoses, treatment modalities) of patients admitted (n = 2,849) to the Department of Child and Adolescence Psychiatry, Psychosomatics and Psychotherapy (DCAPPP) of a German University Hospital between 01/2016 and 02/2022. Absolute and relative number of inpatients with or without ED prior to (01/2016-02/2020) and during the COVID-19 pandemic (03/2020-02/2022) were compared. The effect of school closures as part of social lockdown measures for COVID-19 mitigation on inpatient admission rate was explored as it has been discussed as a potential risk factor for mental health problems in youth. Results During the COVID-19 pandemic, ED inpatient admission rate increased from 10.5 to 16.7%, primarily driven by Anorexia Nervosa (AN). In contrast to previous reports, we found no change in somatic and mental disorder comorbidity, age or sexratio for hospitalized youth with ED. However, we did observe a shortened length of hospital stay (LOS) for hospitalized youth with and without ED. In addition, non-ED admissions presented with an increased number of mental disorder comorbidities. In contrast to our hypothesis, school closures were not related to the observed increase in ED. Discussion In summary, the COVID-19 pandemic was associated with an increased rate of inpatient treatment for youth suffering from AN, and of youth affected by multiple mental disorders. Accordingly, we assume that inpatient admission was prioritized for individuals with a higher burden of disease during the COVID-19 pandemic. Our findings pinpoint the need for adequate inpatient mental health treatment capacities during environmental crises, and a further strengthening of child and adolescence psychiatry services in Germany.
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Affiliation(s)
- Ann-Sophie Silber
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Simeon Platte
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Afsheen Kumar
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Sukhdeep Arora
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Dennis Kadioglu
- Institute of Medical Informatics (IMI), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Marvin Schmidt
- Institute of Medical Informatics (IMI), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Holger Storf
- Institute of Medical Informatics (IMI), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Andreas G. Chiocchetti
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Christine M. Freitag
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
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Mathisen TF, Pettersen G, Rosenvinge JH, Schmidt U, Sundgot-Borgen J. Effectiveness and acceptability of the physical exercise and dietary therapy in a healthy life center. Int J Eat Disord 2023; 56:1931-1940. [PMID: 37458357 DOI: 10.1002/eat.24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The high burden of eating disorders (EDs) and limited availability of treatment speaks of a need to explore new avenues for treatment delivery. To understand if new treatment avenues are helpful and acceptable to patients, we investigated the effectiveness of Physical Exercise and Dietary Therapy (PED-t) in participants with bulimia nervosa or binge-eating disorder, and acceptability when the PED-t was implemented in a Healthy Life Center in a municipal primary healthcare service. METHOD Exercise physiologists and one dietitian were trained in ED literacy and to run PED-t, before screening women for eligibility. Effectiveness (n = 16) of PED-t and participants' experiences (n = 8) were evaluated by a mixed methods study design. Results were analyzed by relevant statistics and reflexive thematic analysis. RESULTS Of 19 eligible participants, 16 completed treatment. At post-treatment, the Eating Disorder Examination Questionnaire global score, binge-eating frequency, and symptoms of depression were lower, and nine (56% of completers) were in remission. Participants' treatment experiences were classified into two overarching themes: "competence" and "emotional support." Participants reported high acceptance for PED-t, the local venue and group format, and felt that PED-t provided them with coping tools and increased mental strength. However, many also spoke of an unmet need to address emotional eating. DISCUSSION Findings point to a potential for making an effective ED therapy more accessible, and that participants find the local low-threshold delivery within a group-format helpful. With small adjustments, the PED-t could emerge as a promising first-line treatment for bulimic EDs. PUBLIC SIGNIFICANCE STATEMENT Limited access to treatment for EDs, patients' high barriers to help-seeking, and the high rates of limited efficacy from psychotherapy speak of a need to explore new therapies and avenues for delivery. In this study, we build on findings from a controlled ED treatment trial and replicate the beneficial effects and find a high patient acceptance of "physical exercise and diet therapy" implemented in a real, non-clinical setting.
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Affiliation(s)
- Therese Fostervold Mathisen
- Department of Nursing, Health and laboratory science, Faculty of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
| | - Gunn Pettersen
- Faculty of Health Sciences, Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Faculty of Health Sciences, Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, London, UK
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8
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Schlapfer L, Gettis MA, Dutreuil V, Cherven B. Hospitalization patterns for adolescents with eating disorders during COVID-19. J Eat Disord 2023; 11:137. [PMID: 37587528 PMCID: PMC10433551 DOI: 10.1186/s40337-023-00867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE The purpose of this study was to examine differences in clinical characteristics and hospital length of stay (LOS) for adolescents with eating disorders (EDs) requiring medical stabilization during the pre-COVID-19 and COVID-19 time periods. METHODS Medical record data were abstracted for patients with EDs hospitalized for medical stabilization between 1/1/2019-2/29/2020 (pre-COVID-19) and 3/1/2020-12/31/2021 (during COVID-19). Patient demographics, clinical characteristics and LOS were compared between COVID-19 eras. Patients were categorized as boarding if they remained hospitalized ≥ 1 day after medical stabilization. Multivariate negative binomial linear regression models were performed to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors related to increased LOS. RESULTS Of the 467 admissions during this study, 120 were pre-COVID-19 and 347 were during COVID-19. Monthly admissions for EDs were higher during COVID-19 versus pre-COVID-19 (15.8 vs. 8.6, p = 0.001). On multivariate analysis, factors associated with increased LOS included admission during COVID-19 (IRR 1.27, 95% CI 1.15-1.40), p = 0.001), boarding (IRR 1.77, 95% CI 1.63-1.93, p = 0.001), public insurance (IRR 1.12, 95% CI 1.01-1.23, p = 0.032), nasogastric tube usage (IRR 1.62, 95% CI 1.48-1.76, p = 0.001), heart rate < 40 beats per minute (IRR 1.21, 95% CI 1.11-1.33, p = 0.001) and abnormal electrocardiogram (IRR 1.25, 95% CI 1.14-1.37, p = 0.001). CONCLUSION In addition to clinical factors, we found that admission during COVID-19, boarding, and public insurance were associated with increased LOS among patients with EDs. There is a need for greater availability of ED treatment centers to care for patients with EDs after medical stabilization.
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Affiliation(s)
- Leslie Schlapfer
- Children’s Healthcare of Atlanta, 1001 Johnson Ferry Rd NE, Atlanta, GA USA
| | - Margaret A. Gettis
- Children’s Healthcare of Atlanta, 1001 Johnson Ferry Rd NE, Atlanta, GA USA
| | - Valerie Dutreuil
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA USA
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9
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Baenas I, Neufeld CB, Ramos R, Munguía L, Pessa RP, Rodrigues T, Jiménez-Murcia S, Gonçalves S, Teodoro MC, Pinto-Bastos A, Almeida NO, Granero R, Etxandi M, Soares SRS, Fernández-Aranda F, Machado PPP. Eating disorders during lockdown: the transcultural influence on eating and mood disturbances in Ibero-Brazilian population. J Eat Disord 2023; 11:39. [PMID: 36906672 PMCID: PMC10008014 DOI: 10.1186/s40337-023-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/23/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has implied exceptional restrictive measures to contain its widespread, with adverse consequences on mental health, especially for those people with a background of mental illness, such as eating disorders (EDs). In this population, the influence of socio-cultural aspects on mental health has been still underexplored. Then, the main aim of this study was to assess changes in eating and general psychopathology in people with EDs during lockdown regarding the ED subtype, age, and provenance, and considering socio-cultural aspects (e.g., socioeconomical factors such as work and financial losses, social support, restrictive measures, or health accessibility, among others). METHODS The clinical sample was composed of 264 female participants with EDs (74 anorexia nervosa (AN), 44 bulimia nervosa (BN), 81 binge eating disorder (BED), and 65 other specified feeding and eating disorder (OSFED)), with a mean age of 33.49 years old (SD = 12.54), from specialized ED units in Brazil, Portugal, and Spain. The participants were evaluated using the COVID-19 Isolation Eating Scale (CIES). RESULTS A global impairment in mood symptoms and emotion regulation was reported in all the ED subtypes, groups of age, and countries. Spanish and Portuguese individuals seemed more resilient than Brazilian ones (p < .05), who reported a more adverse socio-cultural context (i.e., physical health, socio-familial, occupational, and economic status) (p < .001). A global trend to eating symptoms worsening during lockdown was observed, regardless of the ED subtype, group of age, and country, but without reaching statistical significance. However, the AN and BED groups described the highest worsening of the eating habits during lockdown. Moreover, individuals with BED significantly increased their weight and body mass index, similarly to BN, and in contrast to the AN and OSFED groups. Finally, we failed to find significant differences between groups of age although the younger group described a significant worsening of the eating symptoms during lockdown. CONCLUSIONS This study reports a psychopathological impairment in patients with EDs during lockdown, being socio-cultural aspects potential modulatory factors. Individualized approaches to detect special vulnerable groups and long-term follow-ups are still needed.
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Affiliation(s)
- Isabel Baenas
- Eating Disorders Unit, Department of Psychology, Bellvitge University Hospital-IDIBELL, 08907, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029, Barcelona, Spain.,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Carmem Beatriz Neufeld
- Department of Psychology, Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rita Ramos
- Psychotherapy and Psychopathology Lab-Psychology Research Center, School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Lucero Munguía
- Eating Disorders Unit, Department of Psychology, Bellvitge University Hospital-IDIBELL, 08907, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029, Barcelona, Spain.,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Rosane P Pessa
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| | - Tânia Rodrigues
- Psychotherapy and Psychopathology Lab-Psychology Research Center, School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Susana Jiménez-Murcia
- Eating Disorders Unit, Department of Psychology, Bellvitge University Hospital-IDIBELL, 08907, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029, Barcelona, Spain.,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907, Barcelona, Spain
| | - Sónia Gonçalves
- Psychotherapy and Psychopathology Lab-Psychology Research Center, School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Marília C Teodoro
- Department of Psychology, Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Ana Pinto-Bastos
- Psychotherapy and Psychopathology Lab-Psychology Research Center, School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Nazaré O Almeida
- Department of Psychology, Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Roser Granero
- Eating Disorders Unit, Department of Psychology, Bellvitge University Hospital-IDIBELL, 08907, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029, Barcelona, Spain.,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08193, Barcelona, Spain
| | - Mikel Etxandi
- Eating Disorders Unit, Department of Psychology, Bellvitge University Hospital-IDIBELL, 08907, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Germans Trias I Pujol, IGTP Campus Can Ruti, Badalona, Spain
| | - Shauana R S Soares
- Program Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Fernando Fernández-Aranda
- Eating Disorders Unit, Department of Psychology, Bellvitge University Hospital-IDIBELL, 08907, Barcelona, Spain. .,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029, Barcelona, Spain. .,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907, Barcelona, Spain.
| | - Paulo P P Machado
- Psychotherapy and Psychopathology Lab-Psychology Research Center, School of Psychology, University of Minho, 4710-057, Braga, Portugal.
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10
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Tanner AB. Unique considerations for the medical care of restrictive eating disorders in children and young adolescents. J Eat Disord 2023; 11:33. [PMID: 36864525 PMCID: PMC9980853 DOI: 10.1186/s40337-023-00759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The medical complications of eating disorders are often approached through an age-neutral lens. However, children and young adolescents may have unique medical complications related to the energy needs and timing of growth and development. Providers caring for patients in this vulnerable age range should understand how to identify, approach, and manage these potential age-related complications. REVIEW Evidence continues to accumulate that increasingly younger patients are being diagnosed with eating disorders. These children and young adolescents have significant risk for unique and potentially irreversible medical complications. Without early identification and treatment, restrictive eating disorders may negatively impact linear growth, bone development and brain maturation in children and young adolescents. Additionally, due to the energy needs of growth and development, unique considerations exist for the use of acute medical stabilization and the identification of patients at risk for refeeding syndrome with initial nutritional rehabilitation. This review presents an approach to the evaluation and management of children and young adolescents with eating disorders. CONCLUSION Children and young adolescents with restrictive eating disorders may have unique medical complications related to the energy needs and timing of linear growth and pubertal development. Significant risk exists for irreversible medical complications of impaired growth, bone, and brain health. Increased awareness of the energy needs for growth and development may improve early recognition, appropriate intervention, and future outcomes for children and young adolescents with restrictive eating disorders.
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Affiliation(s)
- Anna B Tanner
- Department of Pediatrics, Emory University, 30322, Atlanta, GA, Georgia. .,, Dunwoody, Georgia.
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11
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Güzel Â, Mutlu NL, Molendijk M. COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses. Eat Weight Disord 2023; 28:19. [PMID: 36805344 PMCID: PMC9941242 DOI: 10.1007/s40519-023-01547-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has been a leading cause of stress and feelings of loss of control, both of which have been related to eating disorder (ED) pathology onset and deterioration. We aim to estimate the magnitude of changes in the prevalence rates of, and indicators for, ED psychopathology in the face of the COVID-19 pandemic. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Searches for eligible studies were performed in PubMed, Web of Science and pre-print servers until January 15 2023. RESULTS Our searches yielded 46 eligible studies reporting on a total of 4,688,559 subjects. These data provide strong evidence indicating increased rates of diagnosed and self-reported ED's and a concordant increased need for care in the face of the pandemic. ED symptom severity scores in patients were not elevated during the pandemic, except for those related to anorexia nervosa. On average, people in the general population report relatively high levels of emotional and binge eating during the pandemic, although the evidential strength for these associations is only anecdotal to moderate. Moderators of between-study heterogeneity were not detected. CONCLUSIONS Altogether, our results suggest that the COVID-19 pandemic is associated with a wide spread negative effect on ED pathology in patient samples and the general population. The development of online prevention and intervention programs for EDs during stressful times like a pandemic is encouraged. A limitation is that the results reported here may be prone to biases, amongst others, self-report bias. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis. PREREGISTRATION Prospero [ https://www.crd.york.ac.uk/prospero ] ID: CRD42022316105.
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Affiliation(s)
- Âmine Güzel
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Naz Lâl Mutlu
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Marc Molendijk
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands.
- Leiden Institute of Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands.
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