Disease Characteristics and Psychiatric Comorbidities in Adolescents with Anorexia Nervosa Hospitalized During COVID-19 Pandemic

Abstract

Background: Since the beginning of COVID-19 pandemic, an increase in new diagnoses and pediatric hospital admission for anorexia nervosa (AN) or atypical AN in adolescents have been reported, suggesting an adverse effect of COVID-19 on youth mental health. We hypothesized possible differences in prevalence of hospitalization and/or disease severity, related to socio-economic status and/or ethnicity. Methods: Retrospectively, patients were divided into two subgroups and compared according to the date of first hospital admission: "pre SARS-COV2 era" group (n. 45, 8th March 2016-8th March 2020) and "SARS-COV2 era" group (n. 43, 9th March 2020-8th March 2022). Results: During the two years of the SARS-COV2 era, we reported an increase in hospital admission incidence more than doubled respect to the "pre-SARS-COV2 era". The "SARS-COV2 era group" showed a more rapid weight loss (p = 0.005), a minor duration of weight loss from lifetime maximum to admission (p = 0.019) and needed most frequently treatments with intravenous fluids (p < 0.0001), oral dietetic supplements (p < 0.001) and enteral nutrition by nasogastric tube (p = 0.002). The same group presented higher prevalence of psychiatric comorbidities (63% vs. 22%, p < 0.0001) and required most frequently treatments with psychotropic drugs (56% vs. 24%, p = 0.002). We found higher family socioeconomic status (SES) in our patients with AN in both the periods and we did not find a shift in social class distribution over time. Conclusions: Our study confirms a significant increase in incidence of hospitalization and of psychiatric comorbidity in the pediatric population with AN during the second year of COVID-19 pandemic, regardless of SES or ethnic background. Further studies are needed to understand potential mechanisms that during COVID-19 pandemic trigger eating disorder symptoms.

Pediatric acute hospitalization for anorexia nervosa: an economic evaluation

“…Our results are in contrast with Girardi M et al who found out more intravenous fluids, oral dietetic supplements and enteral nutrition by nasogastric tube in post Covid-19 period than before the onset of pandemic. Moreover, the same group presented higher prevalence of psychiatric comorbidities and required most frequently treatments with psychotropic drugs [ 15 ]. Nevertheless, our result is in line with Goldberg et al who reported a 35% reduction in median hospitalization duration even if there was a significant increase in the number of adolescents hospitalized with AN [ 16 ].…”

Family and Community Nurses as a Resource for the Inclusion of Youths with Type 1 Diabetes at School

“…(i) Socio-demographic characteristics: Age, sex, working status, child's age, and nationality. The working status was classified according to the Italian National Institute of Statistics criteria, which is entirely cross-linkable with the International Standard Classification of Occupations (as we previously reported [22]) and was grouped into two levels: low (unoccupied, unskilled, and semi-skilled workers, manual workers, and craftsmen) and high (legislators, senior officials and managers, professionals, technicians, associate professionals, sales workers, small business and farm owners, administrators, and higher executives). (ii) IHP implementation was evaluated in terms of daily practices at school by using closed (yes/no) and multiple choice questions.…”

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

“…This underlines the necessity for further research on ED in children and youth in the context of the COVID-19 pandemic. Local studies found increases in pediatric hospital admissions for ED in Canada ( 19–21 ), North America ( 22–24 ), Australia ( 25 ), Israel ( 26 ), Italy ( 27 , 28 ), Norway ( 29 ), and the Netherlands ( 30 ) following the onset of the COVID-19 pandemic. Findings concerning symptom severity or clinical characteristics of children and youth admitted for ED treatment during the COVID-19 pandemic have been diverse: North-American, Canadian and Italian pediatric departments at tertiary care hospitals with special ED-treatment programs registered more critical somato-medical problems ( 19 , 20 , 23 , 24 , 28 ), whereas similar medical facilities in Australia ( 25 ) and Israel ( 26 ) found clinical characteristics to be unchanged to pre-COVID-19 samples.…”

“…Local studies found increases in pediatric hospital admissions for ED in Canada ( 19–21 ), North America ( 22–24 ), Australia ( 25 ), Israel ( 26 ), Italy ( 27 , 28 ), Norway ( 29 ), and the Netherlands ( 30 ) following the onset of the COVID-19 pandemic. Findings concerning symptom severity or clinical characteristics of children and youth admitted for ED treatment during the COVID-19 pandemic have been diverse: North-American, Canadian and Italian pediatric departments at tertiary care hospitals with special ED-treatment programs registered more critical somato-medical problems ( 19 , 20 , 23 , 24 , 28 ), whereas similar medical facilities in Australia ( 25 ) and Israel ( 26 ) found clinical characteristics to be unchanged to pre-COVID-19 samples. Shortened length of stay (LOS) was found at pediatric hospitals in Israel and Italy ( 26 , 27 ), yet prolonged LOS was observed at a large pediatric hospital with a specialized ED-treatment program in North America and at some Departments of Child and Adolescent Psychiatry in European Countries ( 31 ).…”

“…Shortened length of stay (LOS) was found at pediatric hospitals in Israel and Italy ( 26 , 27 ), yet prolonged LOS was observed at a large pediatric hospital with a specialized ED-treatment program in North America and at some Departments of Child and Adolescent Psychiatry in European Countries ( 31 ). Most of the few available studies found an increase in co-occurring mental health disorders in children and youth with ED ( 28 , 32 , 33 ). German studies investigating the impact of the COVID-19 pandemic on ED, and especially AN, in children and youth are scarce, but mostly concur with international data, indicating an increase of youth hospitalized for ED during the COVID-19 pandemic ( 18 , 34 , 35 ).…”