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

Predicting extremely low body weight from 12-lead electrocardiograms using a deep neural network

Previous studies have successfully predicted overweight status by applying deep learning to 12-lead electrocardiogram (ECG); however, models for predicting underweight status remain unexplored. Here, we assessed the feasibility of deep learning in predicting extremely low body weight using 12-lead ECGs, thereby investigating the prediction rationale for highlighting the parts of ECGs that are associated with extremely low body weight. Using records of inpatients predominantly with anorexia nervosa, we trained a convolutional neural network (CNN) that inputs a 12-lead ECG and outputs a binary prediction of whether body mass index is ≤ 12.6 kg/m2. This threshold was identified in a previous study as the optimal cutoff point for predicting the onset of refeeding syndrome. The CNN model achieved an area under the receiver operating characteristic curve of 0.807 (95% confidence interval, 0.745-0.869) on the test dataset. The gradient-weighted class activation map showed that the model focused on QRS waves. A negative correlation with the prediction scores was observed for QRS voltage. These results suggest that deep learning is feasible for predicting extremely low body weight using 12-lead ECGs, and several ECG features, such as lower QRS voltage, may be associated with extremely low body weight in patients with anorexia nervosa.

The Psychological and Medical Landscape of Anorexia Nervosa over a Decade: A Retrospective Study of Possible Physical and Psychological Shifts

In recent years, the definition, clinical characteristics, and psychological aspects of anorexia nervosa (AN) have undergone notable changes, influenced by various factors such as biology, psychology, and the environment. The COVID-19 pandemic is one such external factor that has been preliminarily identified as affecting the clinical presentation of AN. This study specifically aims to assess the alterations in psychological and medical features observed in individuals with AN during the pandemic. This study is a retrospective case review of 252 people diagnosed with AN from two different cohorts: 2010-2012 and 2021. A comparison of psychological and medical data was conducted to identify specific differences in the initial clinical evaluation. Additionally, different effects of the pandemic on age cohorts were assessed, with a focus on distinctions between adolescents and adults. Results revealed that the pandemic cohort had a higher number of new cases, with patients being younger and experiencing more severe psychological symptoms. Hospitalization rates upon first access were also elevated, but no significant differences in medical values were observed. Adolescents during the pandemic showed increased episodes of binge eating, decreased obsessive-compulsive symptoms, and greater difficulty in interoceptive awareness. This study reveals distinct differences in symptomatology among patients, with a particular focus on psychological characteristics such as impulsive behaviors and interoceptive awareness. These behavioral and interoceptive changes could have potential considerations in the treatment pathway. Further investigations are warranted to gain a deeper understanding of the evolving clinical presentation of anorexia nervosa after the pandemic.

Economic costs for outpatient treatment of eating disorders in Japan

BACKGROUND

Few studies have examined the economic costs of outpatient care for eating disorders in Japan. This study aimed to clarify the reimbursement for outpatient treatment of eating disorders and compare the costs between the departments of Psychosomatic Medicine and Psychiatry in Japan.

METHOD

A multicenter, prospective, observational study of patients with an eating disorder was conducted in the Psychosomatic Medicine departments of three centers and the Psychiatry departments of another three centers in Japan. We analyzed medical reimbursement for an outpatient revisit, time of clinical interviews, and the treatment outcome measured by the Eating Disorder Examination Questionnaire (EDE-Q) global scores and body mass index (BMI) at 3 months. Multivariate linear regression models were performed to adjust for covariates.

RESULTS

This study included 188 patients in the Psychosomatic Medicine departments and 68 in the Psychiatry departments. The average reimbursement cost for an outpatient revisit was 4670 yen. Even after controlling for covariates, the Psychosomatic Medicine departments had lower reimbursement points per minute of interviews than the Psychiatry departments (coefficient = - 23.86; 95% confidence interval = - 32.09 to - 15.63; P < 0.001). In contrast, EDE-Q global scores and BMI at 3 months were not significantly different between these departments.

CONCLUSIONS

This study clarifies the economic costs of treating outpatients with eating disorders in Japan. The medical reimbursement points per interview minute were lower in Psychosomatic Medicine departments than in Psychiatry departments, while there were no apparent differences in the treatment outcomes. Addressing this issue is necessary to provide an adequate healthcare system for patients with eating disorders in Japan.

Trends in the effect of COVID-19 on consultations for persons with clinical and subclinical eating disorders

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of individuals developing eating disorders and has exacerbated existing eating disorders. This observational study investigated the impact of the COVID-19 pandemic on patients with clinical and subclinical eating disorders.

METHODS

This study was conducted over a period of four years: two years before and after the onset of the COVID-19 pandemic in Japan. We recorded the number and types of consultations provided by the Eating Disorder Treatment and Support Center coordinator. For subgroup analysis, data were classified by age, body mass index, and source of consultation, including patients, families, and personnel. The Seasonal Decomposition of Time Series by Loess was used for time series analysis.

RESULTS

The total number of consultations increased after the start of the pandemic and peaked around the beginning of 2022, before subsequently falling despite the increase in the number of COVID-19 infections. A similar trend was observed in patients aged 10-29 years. The study period coincided with social isolation and school/college/university closures.

CONCLUSIONS

The number of eating disorder consultations increased after the start of the pandemic. Although COVID-19 infections persisted, the pandemic's impact was transient.

HSE National Clinical Programme for Eating Disorders in Ireland: COVID-19 pandemic and eating disorder care in a new national eating disorder service

BACKGROUND

The COVID-19 pandemic experience was different in each country (e.g., prevalence, societal restrictions). There is limited data on eating disorder (ED) diagnosis and service activity trends within Ireland. The aim of this study is to describe the ED referral and hospitalization trends during COVID-19 in Ireland.

METHOD

Monthly data (2019-2021) from three regional community ED services (two-child and one-adult) were collected. National psychiatric and medical hospitalization data were analyzed. A descriptive and trend analysis was performed.

RESULTS

There was a trend of referrals to community ED services during the COVID-19 pandemic for children (p < .0001) and adults (p = .0019). Albeit the increase in child referrals was evident at an earlier point before adult referrals. There was a trend of a diagnosis for children and adults of anorexia nervosa (p < .0001; p = .0257) and other-specified-feeding-or-eating-disorder (OSFED) respectively (p = .0037; p = .0458). There was no trend in psychiatric co-morbidity. There was a trend of child (p = .0003) not adult (n = 0.1669) psychiatric hospitalization. There was a trend of medical hospitalization for child and adult combined (p < .0001).

CONCLUSION

This study adds to the growing literature on the association of the COVID-19 pandemic on ED trends and the need for future public health and service provision funding to be allocated for mental health services during periods of international crisis.

PUBLIC SIGNIFICANCE

This study illustrates the referral and hospitalization trend in young persons and adults with an ED in Ireland during the COVID-19 pandemic. This study highlights that there was a trend of Anorexia Nervosa and OSFED presentations during the COVID-19 pandemic.

Fear of COVID-19, insomnia, and eating disorder symptoms among Iranian college students

Objective

Eating disorders (EDs), fear of COVID-19, and insomnia have all increased during the COVID-19 pandemic in Western societies. Additionally, fear of COVID-19 and sleep disturbances relate to ED symptoms in Western societies. However, it is unknown whether fear of COVID-19 and insomnia relate to ED symptoms in non-Western countries, such as Iran. Thus, this study examined the relation between fear of COVID-19, insomnia, and ED symptoms among Iranian college students. Specifically, we hypothesized that insomnia and fear of COVID-19 would each uniquely relate to ED symptoms and the interaction between insomnia and fear of COVID-19 would also associate with increased ED symptoms.

Method

College students (N =1,043) filled out measures assessing fear of COVID-19, insomnia, and ED symptoms. We ran moderation analyses using linear regression for global ED symptoms and negative binomial regressions for binge eating and purging.

Results

Fear of COVID-19 and insomnia had unique effects on global ED symptoms and binge eating. Insomnia, but not fear of COVID-19, had a unique effect on purging. No significant interaction effect was found.

Discussion

This study was the first to examine the association between fear of COVID-19 and insomnia on ED symptoms in Iran. Fear of COVID-19 and insomnia should be incorporated into novel assessments and treatments for EDs.

A nationwide questionnaire survey of physicians regarding the impact of the COVID-19 pandemic on patients and treatment system of psychosomatic medicine

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected the treatment system of medical institutions across the world. Studies of the populations and patients have reported mental health problems caused by the pandemic. However, there are few large-scale studies that have examined the effects of the COVID-19 on diseases from the perspective of psychosomatic medicine. The purpose of this study was to examine changes made to the psychosomatic treatment system of Japan during the COVID-19 pandemic and the impact of the pandemic on patients with diseases treated in psychosomatic medicine.

METHODS

We conducted a nationwide questionnaire survey of members of the Japanese Society of Psychosomatic Medicine and the Japanese Society of Psychosomatic Internal Medicine from December 24, 2021 to January 31, 2022.

RESULTS

Of the 325 respondents, 23% reported restrictions in initial outpatient admissions, 66% implemented telemedicine, 46% reported a decrease in outpatient admissions, and 31% working in facilities with inpatient units reported decreased inpatient admissions. To reduce in-person visits, 56% of the respondents decreased the frequency of patient visits and 66% introduced telemedicine. Seventy-eight percent of the respondents reported that the COVID-19 pandemic affected the onset or exacerbation of diseases treated in psychosomatic medicine, including psychosomatic disorders, anxiety disorders, mood disorders, adjustment disorders, and eating disorders.

CONCLUSIONS

This study revealed that the COVID-19 pandemic might have affected the practice of psychosomatic treatment in Japan and that various alternative measures were taken to prevent infection. In addition, although the items in this study were not compared to pre-pandemic data, the COVID-19 pandemic, it could have significant psychosocial effects on Japanese patients requiring psychosomatic care. Furthermore, respondents believed that numerous psychosocial factors were behind the impact of the COVID-19 pandemic on patients with diseases treated in psychosomatic medicine.

Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire

PURPOSE

Weight bias internalization (WBI) is significantly associated with negative physiological and psychological consequences. Given its negative effects, appropriate measurement of WBI is required for weight management and mental and physical health in people with weight problems. One of the most reliable and frequently used questionnaires to assess WBI is the Weight Self-Stigma Questionnaire (WSSQ). However, a Japanese version of the WSSQ has not yet been developed. Thus, the current study aimed to develop a Japanese version of the WSSQ (WSSQ-J) and validate its psychometric properties in the Japanese context.

METHODS

A total of 1454 Japanese participants (age 34.44 ± 6.92; male = 498) with diverse weight statuses (Body mass index: 21.44 ± 3.52, 13.79-41.40 kg/m²) completed an online survey for the WSSQ-J. The internal consistency of the WSSQ-J was estimated by calculating Cronbach's α. Confirmatory factor analysis (CFA) was then carried out to confirm that the factor structure of the WSSQ-J was the same as that of the subscales of the original WSSQ.

RESULTS

The WSSQ-J had a Cronbach's α of 0.917, indicating good internal consistency. In CFA, the comparative fit index was 0.945, the root mean square error of approximation was 0.085, and the standardized root mean square residual was 0.040, indicating that the two-factor model showed satisfactory goodness-of-fit.

CONCLUSION

This study replicated the original findings related to the WSSQ, showing that the WSSQ-J is a reliable WBI questionnaire consisting of two factors. Therefore, the WSSQ-J would be a reliable tool for assessing WBI among Japanese.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent anorexia nervosa during the COVID-19 pandemic

Family-Based Treatment (FBT)-the most widely supported treatment for pediatric eating disorders-transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists' readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.

Effect of Mid-Adolescent Dietary Practices on Eating Behaviors and Attitudes in Adulthood

This paper aimed to clarify the association of mid-adolescent dietary practices and experiences with adult eating behavior and attitudes using individual data from the "Survey of Attitudes toward Shokuiku (food and nutrition education), 2019" put forth by the Ministry of Agriculture, Forestry and Fisheries of Japan. We applied conditional mixed-process models to estimate the parameters simultaneously, and used them to predict current eating consciousness, current eating behaviors in a balanced diet, dietary behavior, and attitudes toward preventing or improving lifestyle-related diseases as dependent variables. As a result, compared to those who did not have good dietary practices and experiences in mid-adolescence, participants who had good dietary practices and experiences in the same period displayed greater interest in practicing a healthier diet. These participants frequently consumed a combination of staple foods, main dishes, and side dishes, and were more concerned about preventing or improving lifestyle-related diseases. In conclusion, mid-adolescent dietary practices and experiences had a lasting influence on adult eating behaviors and attitudes in Japanese participants.

A Multicenter Network Analysis Examining the Psychological Effects of the COVID-19 Pandemic on Patients with Eating Disorders versus Their Healthy Siblings

(1) Background: The impact of the COVID-19 pandemic on individuals with eating disorders (EDs) has been recorded all over the world; the traumatic effects of COVID-19 have exacerbated specific and general psychopathologies in those with EDs. Comparing patients' and their healthy siblings' responses might help one evaluate whether there are significant differences between healthy individuals and those struggling with EDs in regard to posttraumatic psychological symptoms. (2) Methods: A sample of 141 ED patients and 99 healthy siblings were enrolled in this study in two different centers specializing in ED treatment. All participants completed the posttraumatic stress disorder (PTSD) checklist and an eating and general psychopathological self-report questionnaire. Network analysis was then applied to evaluate the differences between the populations. (3) Results: No significant differences emerged between the network structures despite the significant differences between patients and their healthy siblings in regard to posttraumatic symptoms, eating, and general psychopathology. (4) Conclusion: The complex nature of the interaction between environmental and personal factors should be evaluated further in individuals with EDs due to how they respond to traumatic events, which exacerbate patients' psychopathology.

Changes in the Mean of Medical Visits Due to Psychiatric Disease in Korean Children and Adolescents before and during the COVID-19 Pandemic

The COVID-19 pandemic has been suggested to have adverse impacts on psychiatric disorders. This study aimed to investigate the changes in medical visits due to a wide range of psychiatric disorders in children during the COVID-19 pandemic. The medical visits of all Korean children and adolescents (0−19 years old) due to the 12 following psychiatric disorders were investigated: autism; attention-deficit/hyperactivity disorder (ADHD); depressive disorder; bipolar disorder; primary insomnia; schizophrenia; panic disorder; hypochondriasis; posttraumatic stress disorder (PTSD); anxiety disorder; anorexia nervosa; and adephagia. The mean medical visits before and during the COVID-19 pandemic were compared. The mean number of clinical visits due to autism, ADHD, depressive disorder, bipolar disorder, panic disorder, hypochondriasis, PTSD, anxiety disorder, and anorexia nervosa was higher during the COVID-19 pandemic than before the COVID-19 pandemic (all p < 0.05). The higher mean number of medical visits due to psychiatric disorders was maintained in age and sex subgroups. The female and adolescent groups demonstrated a higher mean number of medical visits due to psychiatric disorders during the COVID-19 pandemic. The medical visits due to many psychiatric disorders were higher during the COVID-19 pandemic than before COVID-19 in children and adolescents in Korea. Women and adolescents were more susceptible to psychiatric disorders during the COVID-19 pandemic.