1
|
Meneguzzo P, Ceccato E, Sala A, Santonastaso P. When time worsens framing: a longitudinal analysis of the psychological effects of the COVID-19 pandemic in women with an eating disorder and their healthy sisters. Arch Womens Ment Health 2024; 27:191-199. [PMID: 37964120 PMCID: PMC10933162 DOI: 10.1007/s00737-023-01398-x] [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: 07/16/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023]
Abstract
The COVID-19 pandemic has profoundly affected individuals with eating disorders (ED), leading to an exacerbation of symptoms worldwide in 2020. However, there is a lack of longitudinal analyses of the psychological burdens experienced by this population. This study aims to longitudinally assess the psychological effects of the COVID-19 pandemic in people with ED and their healthy sisters (HS) 1 and 2 years after the onset of the crisis. A sample of 148 individuals, consisting of 73 with ED and 45 HS, was evaluated in spring 2021 and spring 2022 regarding their current psychological and behavioral states. Participants were also asked to reflect on their feelings and behaviors during the 2020 lockdown. General psychopathology, eating disorders, and trauma-related symptoms were evaluated using validated questionnaires. Both groups showed an overall improvement in psychopathological symptoms with time. Individuals with ED exhibited greater improvement compared to their HS, which may be attributed to their initially higher burden. Individuals with ED reported a negative reframe, characterized by internalizing negative emotions and behaviors related to the 2020 lockdown. This longitudinal evaluation revealed two distinct and contrasting effects. Both ED patients and their HS demonstrated psychological improvement over time. However, people with ED experienced a negative reframe that affected their memory of specific life events, subsequently affecting their psychological well-being. These findings shed light on the clinical severity observed in people with ED during these pandemic years.
Collapse
Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - Enrico Ceccato
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 "Berica", Vicenza, Italy
| | - Alessandra Sala
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 "Berica", Vicenza, Italy
| | - Paolo Santonastaso
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| |
Collapse
|
2
|
Ameri A, Farashahinejad M, Davoodian P, Safa O, Kusha A, Dadvand H, Hassanipour S, Fathalipour M. Efficacy and safety of licorice (Glycyrrhiza glabra) in moderately ill patients with COVID-19: a randomized controlled trial. Inflammopharmacology 2023; 31:3037-3045. [PMID: 37847472 DOI: 10.1007/s10787-023-01352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
Licorice extract (glycyrrhizin), a potent antiviral, anti-inflammatory, and antioxidant remedy, is a potential therapeutic option for COVID-19. We evaluated the efficacy and safety of licorice in patients with moderate COVID-19. In this study, 60 patients with confirmed COVID-19 were randomly assigned in a 1:1 ratio to receive licorice (at a dose of 760 mg three times a day for seven days) or control groups. The primary outcomes were SPO2, body temperature, and respiratory rate (RR) after the end of the intervention. The findings indicated that SPO2, body temperature, and RR had no significant difference between the groups at the end of the intervention. However, CRP and ALT improved in the licorice group toward the baseline. The number of patients with worse prognoses, LOS, mortality, and the incidence of adverse events were not different between the groups at the end of the study. Licorice had no beneficial effect on the clinical symptoms of COVID-19. Moreover, this intervention demonstrated a safe profile of adverse events. The confirmation of the results of this preparatory trial requires more detailed multiple-center trials with a larger sample size.
Collapse
Affiliation(s)
- Ali Ameri
- Student Research Committee, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Farashahinejad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Parivash Davoodian
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Omid Safa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Kusha
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Habib Dadvand
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Fathalipour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| |
Collapse
|
3
|
Convertino AD, Mendoza RR. Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. Int J Eat Disord 2023. [PMID: 36916450 DOI: 10.1002/eat.23933] [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: 09/23/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs. METHOD A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review. RESULTS Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment. DISCUSSION Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes. PUBLIC SIGNIFICANCE Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
Collapse
Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Rebecca R Mendoza
- Department of Psychology, College of Sciences, San Diego State University, San Diego, California, USA
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Schreyer CC, Vanzhula IA, Guarda AS. Evaluating the impact of COVID-19 on severity at admission and response to inpatient treatment for adult and adolescent patients with eating disorders. Int J Eat Disord 2023; 56:182-191. [PMID: 36394170 DOI: 10.1002/eat.23855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has been associated with increased hospitalization rates and worsened symptom severity in patients with eating disorders (ED), but most studies focused exclusively on adolescents. Further, research evaluating the impact of COVID-19 on response to inpatient treatment for ED is limited. This study aimed to compare demographic characteristics, symptom severity at admission, and discharge outcomes for adult and adolescent inpatients with EDs admitted before and after onset of the COVID-19 pandemic. We expected the post-COVID cohort would report elevated symptomatology and poorer response to treatment compared to the pre-COVID cohort and that this effect would be amplified for adolescents. METHOD Patients were consecutively hospitalized adults and adolescents treated in a specialized behavioral integrated inpatient-partial hospitalization program for eating disorders between March 2018 and March 2022 (N = 261). RESULTS The effect of COVID-19 on symptomatology was moderated by age group such that adolescents in the post-COVID cohort, but not adults, reported higher levels of eating disorder and depressive symptoms compared to the pre-COVID cohort. No group differences were observed for discharge outcomes (rate of weight gain, length of stay, or percent target weight). DISCUSSION Findings with respect to elevated symptomatology in adolescents but not adults may reflect the particularly negative impact of social isolation on adolescents. Future research is needed to assess the impact of COVID-19 on long-term treatment outcomes including relapse at 1-year, as well as the potential impact of COVID-19 on treatment availability for chronically ill adults or those with public insurance. PUBLIC SIGNIFICANCE Patients with eating disorders (ED) admitted to a specialty inpatient program after the start of the COVID-19 pandemic were younger and more likely to be male than those admitted pre-pandemic. Adolescents admitted post-COVID, but not adults, reported elevated ED and depressive symptoms compared to the pre-COVID cohort. Group differences were not observed for treatment response. Future research should evaluate the impact of COVID-19 on relapse risk in EDs.
Collapse
Affiliation(s)
| | - Irina A Vanzhula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angela S Guarda
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Meneguzzo P, Sala A, Merlino L, Ceccato E, Santonastaso P. One year of COVID-19 pandemic on patients with eating disorders, healthy sisters, and community women: evidence of psychological vulnerabilities. Eat Weight Disord 2022; 27:3429-3438. [PMID: 36125663 PMCID: PMC9485014 DOI: 10.1007/s40519-022-01477-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has been a psychological burden worldwide, especially for individuals with eating disorders (EDs). In addition, the healthy sisters of patients with EDs are known to present specific psychological vulnerabilities. This study evaluates differences between the general population, patients with EDs, and their healthy sisters. METHOD A group of 233 participants (91 patients with EDs, 57 of their healthy sisters and 85 community women) was enrolled in an online survey on general and specific psychopathology 1 year after the beginning of the COVID-19 pandemic. The survey examined associations between posttraumatic symptoms and depression, anxiety, obsessive-compulsiveness, interpersonal sensitivity, and eating-related concerns. RESULTS Clinically relevant scores for posttraumatic disorders were found in patients with EDs. Healthy sisters scored similarly to patients for avoidance. Regression analysis showed specific associations between interpersonal sensitivity and posttraumatic symptomatology in patients and healthy sisters, but not in community women. CONCLUSION The psychological burden in patients with EDs is clinically relevant and linked to interpersonal sensitivity, obsessive-compulsiveness, and global symptom severity. Differences between patients, healthy sisters, and community women are discussed regarding vulnerability factors for EDs. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies.
Collapse
Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128 Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Alessandra Sala
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 “Berica”, Vicenza, Italy
| | - Laura Merlino
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 “Berica”, Vicenza, Italy
| | - Enrico Ceccato
- Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 “Berica”, Vicenza, Italy
| | - Paolo Santonastaso
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128 Padua, Italy
| |
Collapse
|
8
|
Meier K, van Hoeken D, Hoek HW. Review of the unprecedented impact of the COVID-19 pandemic on the occurrence of eating disorders. Curr Opin Psychiatry 2022; 35:353-361. [PMID: 35903873 PMCID: PMC9594124 DOI: 10.1097/yco.0000000000000815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the recent literature on the impact of the coronavirus disease-2019 (COVID-19) pandemic on incidence and severity of symptoms of eating disorders (EDs). RECENT FINDINGS A worrying increase of EDs in- and outpatients has been reported since the COVID-19 pandemic began in 2019/2020. Restrictions implemented during the pandemic to protect populations against COVID-19 increased the risk for onset and for worsening of EDs by disrupting eating and exercise routines, social isolation, lack of support, and limited access to healthcare. Substantial increases since the start of the pandemic have been reported for overall incidence (15%), hospital admissions (48%) and emergency department visits (11%) for EDs, with even higher increases among women and children or adolescents with an ED. During the pandemic, ED patients reported increased severity of ED-specific symptoms and increased anxiety, depression and suicidal ideations and -attempts. Treatments shifted largely toward online methods for continuity of care, despite concerns about the quality of care provided and difficulties in self-monitoring. Our review provides preliminary evidence for a similar effectiveness of online treatment to prepandemic face-to-face treatment. In-person assessment remains essential for detecting EDs and for those requiring medical admission. SUMMARY Although the ongoing COVID-2019 pandemic affected mental health globally, research shows that it particularly affected individuals with an ED diagnosis or at risk for an ED, especially women, children and adolescents, and those with anorexia nervosa.
Collapse
Affiliation(s)
- Karien Meier
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | | | - Hans W. Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, New York, USA
| |
Collapse
|