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Nagata JM, Chaphekar AV, Hur JO. Eating Disorders Across the Gender Spectrum: Clinical Presentation and Treatment Outcomes in Boys and Transgender and Gender-Expansive Youth. J Adolesc Health 2024; 75:209-210. [PMID: 39025587 DOI: 10.1016/j.jadohealth.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Anita V Chaphekar
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Jacqueline O Hur
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Madigan S, Vaillancourt T, Dimitropoulos G, Premji S, Kahlert SM, Zumwalt K, Korczak DJ, von Ranson KM, Pador P, Ganshorn H, Neville RD. A Systematic Review and Meta-Analysis: Child and Adolescent Healthcare Utilization for Eating Disorders During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00077-7. [PMID: 38431196 DOI: 10.1016/j.jaac.2024.02.009] [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: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age <19 years) eating disorders during compared to before the COVID-19 pandemic. METHOD PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses. RESULTS A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD = 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR] = 1.54, 95% CI = 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR = 1.48, 95% CI = 1.28-1.71) compared to boys (RR = 1.24, 95% CI = 1.06-1.45) and for adolescents (age ≥12 to 19 years) (RR = 1.53, 95% CI = 1.29-1.81) compared to children (RR = 0.87, 95% CI = 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR = 1.70, 95% CI = 1.48-1.97), inpatient (RR = 1.56, 95% CI = 1.33-1.84), and outpatient (RR = 1.62, 95% CI = 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR = 1.48, 95% CI = 1.24-1.75). CONCLUSION Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic. STUDY PREREGISTRATION INFORMATION Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
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Affiliation(s)
- Sheri Madigan
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | | | - Gina Dimitropoulos
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | | | - Daphne J Korczak
- Hospital for Sick Children, Toronto, Canada; and the University of Toronto, Toronto, Canada
| | - Kristin M von Ranson
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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Bracké K, Steegers C, van der Harst T, Pons R, Legerstee J, Dierckx B, de Nijs P, Bax-van Berkel M, van Elburg A, Hekkelaan M, Hokke J, de Jong-Zuidema H, Korthals Altes L, Lengton-van der Spil F, Luijkx J, Schuurmans F, Smeets C, van Wijk L, Woltering C, Vernooij M, Hillegers M, White T, Dieleman G. The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study. Eat Weight Disord 2024; 29:13. [PMID: 38347293 PMCID: PMC10861646 DOI: 10.1007/s40519-024-01640-0] [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: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE To examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN). METHOD In total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology. RESULTS Peri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group. CONCLUSION Overall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Katrien Bracké
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Cathelijne Steegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Tess van der Harst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Rozemarijn Pons
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Jeroen Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Pieter de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | | | - Annemarie van Elburg
- Altrecht-Rintveld, Mental Health Care Organisation for Eating Disorders, Zeist, The Netherlands
| | - Marion Hekkelaan
- Department of Pediatrics, Het Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Joke Hokke
- Emergis-Ithaka, Mental Health Care Organisation for Child and Adolescent Psychiatry, Kloetinge, The Netherlands
| | - Hetty de Jong-Zuidema
- GGZ Delfland, Mental Health Care Organisation for Child and Adolescent Psychiatry, Delft, The Netherlands
| | - Lucas Korthals Altes
- LUMC-Curium, Mental Health Care Organisation for Child and Adolescent Psychiatry, Leiden, The Netherlands
| | - Farida Lengton-van der Spil
- Department for Eating Disorders, Emergis, Organisation for Mental Health and Well-Being, Goes, The Netherlands
| | - Judith Luijkx
- GGZ Westelijk Noord Brabant, Mental Health Care Organisation for Child and Adolescent Psychiatry, Roosendaal and Bergen Op Zoom, Bergen Op Zoom, The Netherlands
| | - Femke Schuurmans
- Department of Pediatrics, The Bravis Hospital, Bergen Op Zoom, The Netherlands
| | - Carien Smeets
- Department of Pediatrics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lia van Wijk
- Department of Pediatrics, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Claire Woltering
- Department of Pediatrics, Het Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Meike Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Section on Social and Cognitive Developmental Neuroscience, National Institutes of Mental Health, Bethesda, MD, USA
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands.
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Hudson C, Branjerdporn G, Hughes I, Todd J, Bowman C, Randall M, Stapelberg NJC. Using machine learning to mine mental health diagnostic groups from emergency department presentations before and during the COVID-19 pandemic. DISCOVER MENTAL HEALTH 2023; 3:22. [PMID: 37930489 PMCID: PMC10628018 DOI: 10.1007/s44192-023-00047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The COVID-19 pandemic had a profound negative effect on mental health worldwide. The hospital emergency department plays a pivotal role in responding to mental health crises. Understanding data trends relating to hospital emergency department usage is beneficial for service planning, particularly around preparing for future pandemics. Machine learning has been used to mine large volumes of unstructured data to extract meaningful data in relation to mental health presentations. This study aims to analyse trends in five mental health-related presentations to an emergency department before and during, the COVID-19 pandemic. METHODS Data from 690,514 presentations to two Australian, public hospital emergency departments between April 2019 to February 2022 were assessed. A machine learning-based framework, Mining Emergency Department Records, Evolutionary Algorithm Data Search (MEDREADS), was used to identify suicidality, psychosis, mania, eating disorder, and substance use. RESULTS While the mental health-related presentations to the emergency department increased during the COVID-19 pandemic compared to pre-pandemic levels, the proportion of mental health presentations relative to the total emergency department presentations decreased. Several troughs in presentation frequency were identified across the pandemic period, which occurred consistently during the public health lockdown and restriction periods. CONCLUSION This study implemented novel machine learning techniques to analyse mental health presentations to an emergency department during the COVID-19 pandemic. Results inform understanding of the use of emergency mental health services during the pandemic, and highlight opportunities to further investigate patterns in presentation.
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Affiliation(s)
- Carly Hudson
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia.
| | - Grace Branjerdporn
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Ian Hughes
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - James Todd
- Centre for Data Analytics, Bond Business School, Bond University, Gold Coast, Queensland, Australia
| | - Candice Bowman
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Marcus Randall
- Centre for Data Analytics, Bond Business School, Bond University, Gold Coast, Queensland, Australia
| | - Nicolas J C Stapelberg
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Todisco P, Meneguzzo P, Garolla A, Antoniades A, Vogazianos P, Tozzi F. Preparing for the next pandemic by understanding the impact of COVID-19 mitigation measures on patients with eating Disorders: observations from an inpatient setting. Int J Psychiatry Clin Pract 2023; 27:323-329. [PMID: 37293936 DOI: 10.1080/13651501.2023.2221318] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The COVID-19 pandemic overwhelmed eating disorder (ED) services worldwide. Data suggests a worsening of psychopathology and an increased request for specialised treatments. Still, the studies are mostly based on experimental protocols with underpowered short-term opportunistic experimental designs. Thus, this study aims to assess the clinical and psychological differences between patients admitted to a specialised ED Unit before and after the COVID-19 breakout. METHODS Consecutive patients admitted from June 2014 to February 2022 in a specialised EDs Unit were enrolled. A total sample of 498 individuals was enrolled in this retrospective study, collecting demographic and psychopathological data at admission. RESULTS An increase in the admission of patients with anorexia nervosa has been reported, with lower age and higher levels of specific and general psychopathology, especially linked to body uneasiness. CONCLUSIONS Results are put into the context of the preparation for the next pandemic that may require similar mitigation measures as COVID-19 to ensure the impact on existing and new patients. Covering an extended period with validated tools, our results might help psychiatric services to reassess their treatment pathways after the pandemic, helping clinicians to delineate future treatment interventions.KEYPOINTSAfter the COVID-19 breakdown, there was an increase in the admission of patients with anorexia nervosa to specialised services.More severe psychopathology was not accompanied by lower body mass index.Specialised eating disorders services should face sudden changes in patients' requests for treatment.Understanding the impact of the Covid-19 pandemic and the resulting mitigation measures taken can lead to better preparations for the next pandemic.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, VI, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, VI, Italy
| | | | - Paris Vogazianos
- Behavioral Sciences Department, European University, Egkomi, Cyprus
| | - Federica Tozzi
- Research & Development, Stremble Ventures LTD, Limassol, Cyprus
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Fortea A, Fortea L, Gómez-Ramiro M, Fico G, Giménez-Palomo A, Sagué-Vilavella M, Pons MT, Vázquez M, Baldaquí N, Colomer L, Fernández TM, Gutiérrez-Arango F, Llobet M, Pujal E, Lázaro L, Vieta E, Radua J, Baeza I. Upward trends in eating disorders, self-harm, and suicide attempt emergency admissions in female adolescents after COVID-19 lockdown. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00036-4. [PMID: 38591827 DOI: 10.1016/j.sjpmh.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Increased mental health problems have been reported in children and adolescents related to the COVID-19 lockdown and its immediate aftermath, especially among adolescent females. However, the longer-term impact of persistent quarantine measures and social restrictions on this population is yet to be further explored. MATERIALS AND METHODS We compared the number of children/adolescents admissions to the psychiatric emergency department (ED) of Hospital Clínic de Barcelona during the COVID-19 lockdown and the following year with the numbers of admissions the year before lockdown, adjusting for variations in the population. We also conducted separate analyses by gender, age group, and diagnostic categories. Finally, we also repeated the analyses considering the cumulated deficit/excess since the start of the lockdown. Statistical significance was estimated using binomial tests with Bonferroni correction. RESULTS A total of 2425 admissions were recorded. Globally, admission rates decreased during the lockdown (46%) and progressively increased during the one-year aftermath (43% by spring 2021). This increase was particularly high in adolescent females (85%) while unclear in children and/or males. The main diagnostic categories involved were anxiety, depressive, and eating disorders, as well as self-harm behavior, suicidal ideation, and suicide attempts. The increase in eating disorders, self-harm behavior, and suicide attempts admissions in female adolescents remained statistically significant when considering the cumulated deficit/excess. CONCLUSIONS We found increased ED admissions during the aftermath of the COVID-19 lockdown among adolescent females. We recommend strengthening the attention to this population to provide adequate specialized care and prevention strategies.
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Affiliation(s)
- Adriana Fortea
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain; Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain
| | - Lydia Fortea
- Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain
| | - Marta Gómez-Ramiro
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain; Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Department of Psychiatry, Hospital Alvaro Cunqueiro, Servizo Galego de Saúde (SERGAS), 341 Estrada de Clara Campoamor, Vigo 36312, Spain; Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), 341 Estrada de Clara Campoamor, Vigo 36312, Spain
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain; Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Anna Giménez-Palomo
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Maria Sagué-Vilavella
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Maria Teresa Pons
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Mireia Vázquez
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Nuria Baldaquí
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Lluc Colomer
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Tábatha Maria Fernández
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Felipe Gutiérrez-Arango
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Maria Llobet
- Department of Child and Adolescent Psychiatry and Psychology, SGR-2021-01319, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Ester Pujal
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Luisa Lázaro
- Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Department of Child and Adolescent Psychiatry and Psychology, SGR-2021-01319, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain; Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
| | - Joaquim Radua
- Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain.
| | - Inmaculada Baeza
- Medicina i Recerca Translacional, Institute of Neuroscience, University of Barcelona, 143 Casanova St., Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 3-5, Monforte de Lemos Av., Madrid 28029, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 153 Roselló St., Barcelona 08036, Spain; Department of Child and Adolescent Psychiatry and Psychology, SGR-2021-01319, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona 08036, Spain
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Bachner-Melman R, Rom R, Lev-Ari L, Shachar-Lavie I, Krispin O, Tolmacz R. Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa. J Eat Disord 2023; 11:166. [PMID: 37737193 PMCID: PMC10515418 DOI: 10.1186/s40337-023-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel.
- School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Roni Rom
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Iris Shachar-Lavie
- Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Orit Krispin
- Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rami Tolmacz
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
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Schlissel AC, Richmond TK, Eliasziw M, Leonberg K, Skeer MR. Anorexia nervosa and the COVID-19 pandemic among young people: a scoping review. J Eat Disord 2023; 11:122. [PMID: 37474976 PMCID: PMC10360262 DOI: 10.1186/s40337-023-00843-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The extent to which the recent global COVID-19 Pandemic has impacted young people with restrictive eating disorders [i.e., anorexia nervosa (AN) and atypical anorexia nervosa (AAN)] is unclear. We conducted a scoping review of the literature to identify how the pandemic has impacted this population and to identify gaps in the current literature to inform future research efforts. MAIN BODY We searched PubMed, EMBASE, the Web of Science, The Cochrane Library, PsycInfo, ProQuest Dissertations and Theses Global, LitCovid, Google Scholar, and relevant agency websites from 2019 to 2022. We included studies that focused on young people with AN/AAN globally. Of the 916 unduplicated articles screened, 17 articles met the inclusion criteria, reporting on 17 unique studies including 4,379 individuals. Three key findings were identified. First, an increase in hospitalizations related to eating disorders was found during COVID-19 among young people with AN and AAN. Multiple studies cited increased medical instability, even though the overall duration of disease was shorter compared to pre-pandemic levels. Second, changes in eating disorder-related symptomology during the pandemic were reported in this population, as well as poorer overall behavioral and mental health. Suggested reasons behind changes included boredom or minimal distraction from pathological thoughts, increased social isolation, increased social media and online use (e.g., reading blogs or watching YouTube), gym and school closures, changes in routines due to lockdowns and quarantines, and worries over gaining the "Quarantine 15". Third, there was an increase in the use of telemedicine as a treatment modality for the treatment of AN. Challenges were reported by both clinicians and patients regardless of past experience using telemedicine. When compared to no treatment, telemedicine was recognized as the best option during COVID-19 lockdowns; however some individuals expressed the preference for in-person treatment and planned to return to it once it became available. CONCLUSION The pandemic significantly impacted young people with restrictive eating disorders as seen by increased hospitalizations and requests for outpatient care. A primary driver of the changes in eating disorder symptomatology may be lockdowns and quarantines. Further research investigating how the series of lockdowns and re-openings impacted individuals with AN/AAN is warranted.
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Affiliation(s)
- Anna C. Schlissel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Tracy K. Richmond
- Division of Adolescent Medicine, Boston Children’s Hospital, 6th Floor, 333 Longwood Avenue, Boston, MA 02115 USA
- Harvard Medical School, Pediatrics, 25 Shattuck Street, Boston, MA 02115 USA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Kristin Leonberg
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Jaharis Family Center for Biomedical and Nutrition Sciences, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Margie R. Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
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Abstract
This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.
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Roden RC, Billman M, Lane-Loney S, Essayli J, Mahr F, Vrana K, Ryan S. An experimental protocol for a double-blind placebo-controlled evaluation of the effectiveness of oral naltrexone in management of adolescent eating disorders. Contemp Clin Trials 2022; 122:106937. [PMID: 36167287 DOI: 10.1016/j.cct.2022.106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND This double-blind, placebo-controlled study evaluates the effectiveness of oral naltrexone in adolescents and young adults with eating disorders (EDs) characterized by purging with or without binge-eating behaviors. We hypothesize that participants receiving oral naltrexone will demonstrate greater improvements in body mass index in underweight participants and self-reported ED symptomatology compared to placebo. METHODS Thirty individuals receiving treatment in a partial hospitalization program for EDs with diagnoses of anorexia nervosa binge-eating/purging type, bulimia nervosa, or purging disorder will receive six weeks of either placebo or oral naltrexone. Participants will complete a battery of self-report measures and laboratory safety monitoring every three weeks in addition to standard of medical care for treatment environment. RESULTS Analysis will compare outcomes at weeks three and six, and follow-up at nine weeks and six-months across the oral naltrexone and placebo groups. Main effects for time will examine improvements over the course of treatment for all participants, while group × time interactions will examine differences in the rate of change over time between study arms. CONCLUSIONS We hypothesize that participants receiving oral naltrexone will experience more rapid improvements in symptom severity and weight restoration compared to placebo across study time points. There are very few medications with high-quality data demonstrating both safety and efficacy in the treatment of eating disorders. The authors theorize this study will demonstrate a clinically significant effect of oral naltrexone on impulsive-type EDs and support its use as an effective option for treatment augmentation.
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Affiliation(s)
- Rosemary Claire Roden
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Marley Billman
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Susan Lane-Loney
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Jamal Essayli
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States
| | - Fauzia Mahr
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States; Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Health, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Kent Vrana
- Department of Pharmacology, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Sheryl Ryan
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
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