The effect of COVID-19 pandemic on hospitalizations and disease characteristics of adolescents with anorexia nervosa

Goldberg, Lotem; Ziv, Adi; Vardi, Yoav; Hadas, Shai; Zuabi, Tarek; Yeshareem, Lital; Gur, Tomer; Steinling, Shelly; Scheuerman, Oded; Levinsky, Yoel

doi:10.1007/s00431-021-04350-2

Cited by 32 publications

(36 citation statements)

References 11 publications

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“…This raises the question of whether it was only the most severe cases that came to the hospital. In our study, in line with the results reported by Goldberg et al [ 17 ], this increase in hospitalizations for AN did not seem to be associated with increased medical severity (i.e., ICU admission and lethality). Moreover, bearing in mind the overall decreases in psychological health, we found that admissions for self-harm in young patients with AN increased in the post-lockdown period, with a peak in the winter of 2020–2021.…”

Section: Discussionsupporting

confidence: 93%

“…However, there are conflicting data with respect to the impact of the pandemic on eating disorders. Several reports showed clinical improvements and reductions in hospitalizations after lockdown for patients with AN [ 16 , 17 ], whereas other research suggests deleterious effects on young patients with AN [ 18 , 19 , 20 ]. It thus seemed relevant to further investigate the influence of the COVID-19 pandemic on people with AN [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study

Chauvet-Gélinier

Roussot

Vergès

et al. 2022

JCM

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The COVID-19 pandemic has had a detrimental impact on mental health, including on food-related behaviors. However, little is known about the effect of the pandemic on anorexia nervosa (AN). We sought to assess an association between the COVID-19 pandemic and a potential increase in hospitalizations for AN in France. We compared the number of hospitalizations with a diagnosis of AN during the 21-month period following the onset of the pandemic with the 21-month period before the pandemic using Poisson regression models. We identified a significant increase in hospitalizations for girls aged 10 to 19 years (+45.9%, RR = 1.46[1.43–1.49]; p < 0.0001), and for young women aged 20 to 29 (+7.0%; RR = 1.07[1.04–1.11]; p < 0.0001). Regarding markers of severity, there was an increase in hospitalizations for AN associated with a self-harm diagnosis between the two periods. Multivariate analysis revealed that the risk of being admitted for self-harm with AN increased significantly during the pandemic period among patients aged 20–29 years (aOR = 1.39[1.06–1.81]; p < 0.05 vs. aOR = 1.15[0.87–1.53]; NS), whereas it remained high in patients aged 10 to 19 years (aOR = 2.40[1.89–3.05]; p < 0.0001 vs. aOR = 3.12[2.48–3.98]; p < 0.0001). Furthermore, our results suggest that the pandemic may have had a particular effect on the mental health of young women with AN, with both a sharp increase in hospitalizations and a high risk of self-harming behaviors.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study

Chauvet-Gélinier

Roussot

Vergès

et al. 2022

JCM

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“…Haripersad et al [ 5 ] and Hansen et al [ 6 ] reported a large increase in hospital admissions because of AN in adolescents during the COVID-19 pandemic in Western Australia and in a mixed urban–rural area in New Zealand, respectively. Similar trends for adolescents with AN were observed in Canada, with higher admission rates in regions with higher infection rates [ 7 ], and an Israelian study reported a 2.4-fold increase in admission rates of adolescents to the largest Israeli paediatric tertiary care hospital during the COVID-19 pandemic compared with the period 2015–2019 [ 8 ]. A study from the US demonstrated a large increase in admissions of 10- to 23-year-old patients with eating disorders (ED) during the first 12 months of the pandemic, which was more than double the mean number of admissions per year for the same timeframe for the previous 3 years [ 9 ].…”

Section: Introductionmentioning

confidence: 52%

Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries

Gilsbach

Plana

Castro‐Fornieles

et al. 2022

Child Adolesc Psychiatry Ment Health

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Background The COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce. Methods We asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists’ estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals. Results Four out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived “loss of control”, and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology. Conclusions The COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived “loss of control”, and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

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“…This period is parallel with our study period. During the pandemic there was an increase in hospital mental health related admissions among children and adolescents [16,17]. The information on triggers for PFAPA attacks is scarce.…”

Section: Discussionmentioning

confidence: 99%

PFAPA flares observed during COVID outbreak: can emotional stress trigger PFAPA attacks? A multicenter cohort study

et al. 2022

Self Cite

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Objective It is common knowledge among clinicians who treat PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) patients that emotional stress can trigger PFAPA attacks similarly to other autoinflammatory diseases. However, it has never been proved scientifically. Our aim was to examine whether emotional stress serves as a trigger for PFAPA attacks. Methods Patients aged 3-12 years, with active PFAPA, from two Israeli medical centers were enrolled to this study. Patient's parents were reached via phone calls in two occasions: a stressful period related to the COVID-19 pandemic restrictions and a less stressful period. In both times they were asked to report occurrence of PFAPA attacks in the preceding 2 weeks. The relative stress levels of the two periods were validated by an emotional distress scale questionnaire. The significance level was set at 0.05. Results Mean age was 7.28 ± 2.7 for the 99 paediatric patients enrolled in the study. Scores for the mean emotional distress questionnaire were statistically significant higher in the stressful period compared to the less stressful period (35.6 ± 8.1 vs. 32.1 ±7.7, respectively, P = 0.047). In the stressful period, 41 (38.7%) reported at least one attack during the preceding 2 weeks, compared to 24 (22.6%) in the less stressful period (p = 0.017). Conclusion PFAPA flares during COVID-19 outbreak are described. This study is the first to suggest that emotional stress is associated with PFAPA attacks.

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The effect of COVID-19 pandemic on hospitalizations and disease characteristics of adolescents with anorexia nervosa

Cited by 32 publications

References 11 publications

Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study

Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study

Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries

PFAPA flares observed during COVID outbreak: can emotional stress trigger PFAPA attacks? A multicenter cohort study

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