This study examines medical admission patterns among adolescents with restrictive eating disorders before and after the onset of the COVID-19 pandemic. What's Known on This SubjectLimited data suggest the COVID-19 pandemic has been associated with worsening mental health outcomes, including worsening symptoms of eating disorders. Little is known about the potential effects of the pandemic on medical admission patterns among adolescents with eating disorders. What This Study AddsMedical admissions among adolescents with eating disorders at our institution increased significantly during the COVID-19 pandemic, with the number of admissions during the first twelve months of the pandemic more than double the mean for the previous three years.
ImportanceThe 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.ObjectiveTo 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 ParticipantsUsing 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.ExposuresOnset of the COVID-19 pandemic.Main Outcomes and MeasuresMonthly number of patients seeking inpatient/outpatient ED-related care.ResultsAggregate 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 RelevanceIn 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.
Objective Though virtual outpatient psychotherapy for eating disorders is likely effective, less is known about virtual higher levels of care. The current study examined the clinical outcomes of a family‐based virtual intensive outpatient program (vIOP) for youth with eating disorders which was developed in response to the COVID‐19 pandemic, compared to the same institution's in‐person partial hospital program (PHP). Methods Treatment outcomes were assessed via chart review in 102 patients between the ages of 9–23 (M = 15.2, SD = 2.5) who were predominantly cisgender female (84.3%) and primarily diagnosed with anorexia nervosa (64.7%) or atypical anorexia (23.5%). Participants were either treated in the in‐person PHP before the pandemic (n = 49) or the vIOP during the pandemic (n = 53). Percent expected body weight (%EBW) was examined at baseline, end of treatment, 3‐months post‐treatment, and 6‐months post‐treatment, as well as the frequency of medical, psychiatric, and residential admissions before, during, and after vIOP or PHP participation. Results Linear mixed models demonstrated no effect of treatment modality (in‐person versus virtual) on %EBW over time. The duration of the vIOP was, on average, 12 calendar days longer, though the amount billed for the vIOP was lower. Survival analyses and Cox regression models did not suggest differences in the frequency of hospital and residential treatment admissions during treatment (vIOP: 9.4%, PHP: 10.0%) or post‐treatment (vIOP: 15.0%, PHP: 10.2%). Discussion Findings support virtual family‐based programs as suitable alternatives to in‐person treatment and underscore the potential cost‐effectiveness of a family‐based IOP versus PHP. Public Significance This study demonstrates that a virtual, family‐based, intensive outpatient program for youth with eating disorders had similar treatment outcomes to an in‐person partial hospitalization program. Specifically, the virtual and in‐person programs had similar weight restoration outcomes and rates of medical, psychiatric, or residential treatment admissions during or after treatment initiation. Findings support the use of virtual treatment, even for youth requiring a high level of intervention.
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