The psychological impact of COVID-19-related lockdown measures among a sample of Italian patients with eating disorders: a preliminary longitudinal study

Abstract

Purpose To explore the prevalence of symptoms of anxiety and depression, along with PTSD-and ED-related symptoms, across a sample of patients with Eating Disorders (EDs) compared to a group of healthy controls (HC) during the lockdown period in Italy; to assess whether patients' reported aforementioned psychiatric symptoms improved, remained stable or worsened with the easing of the lockdown measures. Methods t0 assessment (during lockdown): 59 ED patients and 43 HC completed an online survey, including the Depression, Anxiety and Stress Scale-21 items (DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale (PSS), and specific ad-hoc questions extracted from the Eating Disorder Examination-Questionnaire; t1 assessment (postlockdown): 40 EDs patients, a subset of the t0 sample, completed the same assessment 2 months after t0. Results EDs patients scored higher than HC at the DASS-21, IES-R and PSS. At t1, levels of stress, anxiety and depression were not different than at t0, but symptoms related to post-traumatic stress disorder (PTSD), patients' reported level of psychological wellbeing and specific EDs symptomatology improved. Discussion During the lockdown, EDs patients presented significantly higher levels of stress, anxiety, depression, PTSDand ED-related symptoms than HC. With the easing of the lockdown, PTSD-and ED-related symptoms improved, but high levels of stress, anxiety and depression persisted. Level of evidence Level I, experimental study.

COVID-19 Pandemic and Eating Disorders: What Can We Learn About Psychopathology and Treatment? A Systematic Review

“…These studies [ 26 •, 27 •] also highlighted that when ED-related cognitions were evaluated, the impairment was even more common than that of behavioral ED symptoms, occurring in 70%, 80%, and 87% of samples with AN [ 27 •], with BN [ 26 •], or with mixed ED diagnoses [ 41 ], respectively. A general worsening of ED-related cognitions was also found in other studies [ 33 •, 35 ]. Across ED-related aberrant behaviors, physical exercise is worth of a specific mention.…”

“…[ 33 ] 320 ED patients, 93.8% female 179 AN 63 BN 48 BED 22 OSFED 29.19 (12.05) Retrospective, no comparison with a control group Factors associated with ED psychopathology worsening during COVID-19 lockdown (self-developed survey with items selected and adapted from EDI-2, GAD-7, PHQ-9, PTSD Checklist for DSM-5, OCI) Factors associated with general psychopathology worsening during COVID-19 lockdown (self-developed survey with items selected and adapted from EDI-2, GAD-7, PHQ-9, PTSD Checklist for DSM-5, OCI) Positive association: heightened isolation and fear of contagion Negative association: perceived therapeutic relationship quality, satisfaction with family relationships and friends’ relationships Positive association: heightened isolation and fear of contagion Negative association: perceived therapeutic relationship quality, satisfaction with family relationships and friends’ relationship, entrusting of others Monteleone et al. [ 34 ] 320 ED patients, 93.8% female 179 AN 63 BN 48 BED 22 OSFED 29.19 (12.05) Retrospective, no comparison with a control group Psychopathology: before vs lockdown periods (self-developed survey with items selected and adapted from EDI-2, GAD-7, PHQ-9, PTSD Checklist for DSM-5, OCI) Psychopathology: lockdown vs post-lockdown periods (self-developed survey with items selected and adapted from EDI-2, GAD-7, PHQ-9, PTSD Checklist for DSM-5, OCI) Anxiety, depression, stress, post-traumatic stress symptoms, obsessive–compulsive symptoms, insomnia, panic symptoms, suicide ideation, ineffectiveness, impulsivity, social insecurity, body dissatisfaction, and self-induced vomiting were significantly higher during lockdown Anxiety was significantly higher in the post-lockdown Suicide ideation, social insecurity, binge eating, physical activity, and body dissatisfaction were significantly lower in the post-lockdown Nisticò et al [ 35 ] 59 ED patients, 96.6% female 22 AN 15 BN 22 BED 43 HC 30.1 (12.9) 34.7 (12.7) Longitudinal, comparison with a control group Psychopathology (DASS-21, IES-R, PSS, 5 questions from the EDE-Q) ED patients vs HC: higher eating symptoms, stress, anxiety, depression, avoidance, intrusion, hyperarousal, and perceived stress score Lockdown vs post-COVID-19: patients scoring significantly lower during post-COVID19 in intrusion, hyperarousal, losing control over food, thinking about body, seeing body. No change in stress, anxiety and depression scores Phillip...…”

“…The remaining studies adopted a cross-sectional design (e.g., asking participants if their symptoms had changed during the pandemic period), with the exception of 2 studies [ 33 •, 34 •] which conducted a retrospective evaluation of psychopathology. Only two studies [ 30 ••, 35 ] compared symptomatology levels between patients and healthy controls. Twelve studies reported that patients with EDs were in treatment, 5 did not report this data, and 3 studies were conducted in both treated and untreated patients and 2 in recently discharged patients.…”

“…Only two studies [ 30 ••, 35 ] compared ED symptom impairment between people with EDs and healthy controls by employing a longitudinal approach. Castellini et al [ 30 ••] found that the intensity of symptom (i.e., objective binge eating and physical exercise) worsening was significantly greater in patients than in controls.…”

“…Castellini et al [ 30 ••] found that the intensity of symptom (i.e., objective binge eating and physical exercise) worsening was significantly greater in patients than in controls. Nisticò et al [ 35 ] found that the severity of ED symptom decreased in the re-opening period following the first lockdown (March to May 2020). This was consistent with the results of another study [ 33 •] adopting a retrospective design and highlighting that in the re-opening period, the ED symptoms returned to the levels seen before the lockdown.…”