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Chiccarelli E, North S, Pasternak RH. Innovative Strategies for Addressing Adolescent Health in Primary Care Through Telehealth. Pediatr Clin North Am 2024; 71:693-706. [PMID: 39003011 DOI: 10.1016/j.pcl.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
With recent gains in telehealth access across health sectors, this editorial explores adolescent-specific health issues where innovative use of virtual care is improving outcomes and access for adolescents. These include contraception, obesity, gender-affirming care, mental health, and eating disorder care. Clinicians caring for adolescents should be aware of advances in this field to maximize opportunities for their patients to receive evidence-based care in a manner that supports health equity and confidentiality concerns while understanding the evolving regulatory landscape of telehealth.
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Affiliation(s)
- Elvira Chiccarelli
- Brooke Army Medical Center, 3100 Schofield Road, Fort Sam Houston, TX 78234, USA.
| | - Steve North
- Center for Rural Health Innovation, 167 Locust Street, Spruce Pine, NC 28777, USA
| | - Ryan H Pasternak
- Louisiana State University School of Medicine, Childrens Mercy Kansas City, 3101 Broadway Boulevard, Kansas City, MO 64111, USA
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Dahlgren CL, Sundgot-Borgen C, Kvalem IL, Wennersberg AL, Wisting L. Further evidence of the association between social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in Norwegian adolescents. J Eat Disord 2024; 12:34. [PMID: 38424579 PMCID: PMC10905800 DOI: 10.1186/s40337-024-00992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth. METHODS In this study, 1558 girls (53%) and boys (47%), predominantly within the 16-19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure. RESULTS Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. CONCLUSION A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people's view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents' satisfaction and appreciation of their body and appearance. TRIAL REGISTRATION The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P ).
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Department of Psychology, Oslo New University College, Lovisenberggata 13, 0456, Oslo, Norway.
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway.
| | - Christine Sundgot-Borgen
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Anne-Louise Wennersberg
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Line Wisting
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway
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Meneguzzo P, Ajello A, Consolati MD, Ceccato E, Vita A, Sala A, Santonastaso P. Effects of the COVID-19 pandemic on youth mental health: a cross-sectional study on eating disorder patients and their unaffected siblings. Child Adolesc Psychiatry Ment Health 2024; 18:6. [PMID: 38184616 PMCID: PMC10771694 DOI: 10.1186/s13034-023-00698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Adolescence has emerged as a particularly vulnerable phase during the COVID-19 pandemic, with eating disorders (EDs) representing a prominent psychopathological challenge linked to the restrictions imposed by the pandemic. Emerging evidence suggests that not only individuals with EDs but also their healthy siblings (HS) may experience unique psychological effects in this context. However, the existing literature on this topic remains limited. This study seeks to examine and compare the effects of the pandemic on adolescents and adults, with a specific focus on the impact of containment measures, disruptions in daily routines, and alterations in life trajectories, for both individuals with EDs and their HS. METHODS We enrolled 273 individuals, including those diagnosed with EDs and their HS. Among the participants, 120 were under the age of 19. Multiple self-report questionnaires were administered to assess the psychological impact of 1 year of the COVID-19 pandemic. These assessments covered a range of psychological constructs, including posttraumatic symptoms, general psychopathology, and eating-related concerns. RESULTS Notably, adolescent patients with EDs demonstrated the highest psychopathological scores within our sample. They were the sole subgroup to surpass clinical cutoffs, exhibiting more pronounced issues concerning eating-related concerns and general psychological well-being. Our findings also shed light on the unique experiences of HS during the pandemic. CONCLUSION Our findings highlight the specific psychological burden endured by adolescents with EDs throughout the COVID-19 pandemic, emphasizing the vulnerability of this demographic. Moreover, the experiences of HS, often overlooked in the literature, warrant increased attention in future health programs and interventions.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Alessio Ajello
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mauro Domenico Consolati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Enrico Ceccato
- Mental Health Department, Vicenza Eating Disorders Center, Azienda ULSS8 "Berica", Vicenza, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Sala
- Mental Health Department, Vicenza Eating Disorders Center, Azienda ULSS8 "Berica", Vicenza, Italy
| | - Paolo Santonastaso
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Xiao M, Luo Y, Ding C, Chen X, Liu Y, Tang Y, Chen H. Social support and overeating in young women: The role of altering functional network connectivity patterns and negative emotions. Appetite 2023; 191:107069. [PMID: 37837769 DOI: 10.1016/j.appet.2023.107069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
Research suggests that social support has a protective effect on emotional health and emotionally induced overeating. Women are especially more sensitive to benefits from social support when facing eating problems. Although it has been demonstrated that social support can affect the neural processes of emotion regulation and reward perception, it is unclear how social support alters synergistic patterns in large-scale brain networks associated with negative emotions and overeating. We used a large sample of young women aged 17-22 years (N = 360) to examine how social support influences the synchrony of five intrinsic networks (executive control network [ECN], default mode network, salience network [SN], basal ganglia network, and precuneus network [PN]) and how these networks influence negative affect and overeating. Additionally, we explored these analyses in another sample of males (N = 136). After statistically controlling for differences in age and head movement, we observed significant associations of higher levels of social support with increased intra- and inter-network functional synchrony, particularly for ECN-centered network connectivity. Subsequent chain-mediated analyses showed that social support predicted overeating through the ECN-SN and ECN-PN network connectivity and negative emotions. However, these results were not found in men. These findings suggest that social support influences the synergistic patterns within and between intrinsic networks related to inhibitory control, emotion salience, self-referential thinking, and reward sensitivity. Furthermore, they reveal that social support and its neural markers may play a key role in young women's emotional health and eating behavior.
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Affiliation(s)
- Mingyue Xiao
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing, China
| | - Yijun Luo
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing, China
| | - Cody Ding
- Department of Educational Psychology, Research, and Evaluation, University of Missouri, St. Louis, USA
| | - Ximei Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing, China
| | - Yong Liu
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing, China
| | - Yutian Tang
- Faculty of Arts, University of British Columbia, Canada
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing, China; Research Center of Psychology and Social Development, Southwest University, Chongqing, China.
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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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Napp AK, Kaman A, Erhart M, Westenhöfer J, Ravens-Sieberer U. Eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic. Front Psychiatry 2023; 14:1157402. [PMID: 37304440 PMCID: PMC10254422 DOI: 10.3389/fpsyt.2023.1157402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Background Disordered eating is highly prevalent among children and adolescents. Since the outbreak of the COVID-19 pandemic, hospitalizations due to eating disorders have peaked and overweight has risen. The aim of this study was to determine differences in the prevalence of eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic and to identify associated factors. Materials and methods Eating disorder symptoms and associated factors were examined in a sample of n = 1,001 participants of the nationwide population-based COPSY study in autumn 2021. Standardized and validated instruments were used to survey 11-17-year-olds along with a respective parent. To identify differences in prevalence rates, logistic regression was used to compare results with data from n = 997 participants of the prepandemic BELLA study. Multiple logistic regression analyses were performed to examine associations with relevant factors in the pandemic COPSY sample. Results Eating disorder symptoms were reported by 17.18% of females and 15.08% of males in the COPSY study. Prevalence rates were lower overall in the COPSY sample compared to before the pandemic. Male gender, anxiety, and depressive symptoms were associated with increased odds for eating disorder symptoms in the pandemic. Conclusion The pandemic underscores the importance of further research, but also prevention and intervention programs that address disordered eating in children and adolescents, with a focus on age - and gender-specific differences and developments. In addition, screening instruments for eating disorder symptoms in youths need to be adapted and validated.
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Affiliation(s)
- Ann-Kathrin Napp
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Sciences, Faculty of Life Sciences, Competence Center Health, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Erhart
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Public Health, Alice Salomon University of Applied Sciences, Berlin, Germany
- Department of Psychology, Apollon University of Applied Sciences, Bremen, Germany
| | - Joachim Westenhöfer
- Department of Health Sciences, Faculty of Life Sciences, Competence Center Health, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hallward L, Nagata JM, Rodgers RF, Ganson KT. Examination of eating disorder psychopathology across sexual and gender identities among a Canadian sample. Int J Eat Disord 2023; 56:604-615. [PMID: 36493406 DOI: 10.1002/eat.23872] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Eating disorders (EDs) disproportionately affect sexual and gender minorities, with majority of research conducted among samples in the United States. The purpose of this study was to examine ED psychopathology among adolescents and young adults in Canada with diverse gender and sexual identities. METHOD Data were collected from 2,714 Canadians, aged 16-30 years old, via an online survey at the end of 2021 during the COVID-19 pandemic. Participants responded to sociodemographic questions (including history of EDs) and reported on eating attitudes and behaviors. Descriptive statistics and multiple modified Poisson and linear regressions were conducted. RESULTS Over half the sample was heterosexual, 35% were sexual minority cisgender men and women, and 6.5% were transgender and gender non-conforming (TGNC) people. The sample overall reported elevated ED psychopathology based on their eating attitudes and behaviors. TGNC participants reported the most severe ED psychopathology. Generally, sexual minority cisgender women and cisgender men had elevated ED psychopathology compared to their heterosexual counterparts. Regression analyses revealed all gender and sexual minorities reported greater ED psychopathology compared to heterosexual cisgender men. DISCUSSION The Canadian sample reported elevated ED psychopathology compared to previous studies among various populations. Additional investigations are now needed to observe how ED psychopathology continues to change after the onset of the pandemic. Further research is needed among cisgender men, TGNC people, and sexual minorities to understand the unique stressors they face that lead to high ED psychopathology, and develop appropriate prevention and treatment tools. PUBLIC SIGNIFICANCE EDs affect people of all gender and sexual identities. People who identify as a gender and/or sexual minority often experience problematic eating attitudes and behaviors, particularly transgender and gender non-conforming people of all sexual identities. More research attention is needed among these populations, especially due to a paucity of research among Canadians, to develop effective diagnostic tools, prevention efforts, and treatment programs specific to gender and sexual identities.
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Affiliation(s)
- Laura Hallward
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Zhou C, Abbey S, Liu L, Sockalingam S. Managing complexity: Tips for consultation liaison psychiatrists managing patients with anorexia nervosa on the medical unit. Gen Hosp Psychiatry 2023; 81:82-83. [PMID: 36707348 DOI: 10.1016/j.genhosppsych.2023.01.001] [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: 12/04/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Affiliation(s)
- Carrol Zhou
- North York General Hospital, 4001 Leslie Street, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 250 College Street, Toronto, Ontario, Canada.
| | - Susan Abbey
- University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 250 College Street, Toronto, Ontario, Canada.
| | - Linda Liu
- University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada.
| | - Sanjeev Sockalingam
- North York General Hospital, 4001 Leslie Street, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 250 College Street, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario, Canada.
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Li TH, Kamin L, George J, Saiz FS, Meyer P. Impact of the COVID-19 pandemic on treatment for mental health needs: a perspective on service use patterns and expenditures from commercial medical claims data. BMC Health Serv Res 2023; 23:163. [PMID: 36797739 PMCID: PMC9932413 DOI: 10.1186/s12913-023-09080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE To examine changes in use patterns, cost of healthcare services before and after the outbreak of the COVID-19 pandemic, and their impacts on expenditures for patients receiving treatment for depression, anxiety, eating disorders, and substance use. METHODS This cross-sectional study employed statistical tests to analyze claims in MarketScan® Commercial Database in March 2020-February 2021 and quarterly from March 2020 to August 2021, compared to respective pre-pandemic periods. The analysis is based on medical episodes created by the Merative™ Medical Episode Grouper (MEG). MEG is a methodology that groups medical and prescription drug claims to create clinically relevant episodes of care. RESULTS Comparing year-over-year changes, proportion of patients receiving anxiety treatment among all individuals obtaining healthcare services grew 13.7% in the first year of the pandemic (3/2020-2/2021) versus 10.0% in the year before the pandemic (3/2019-2/2020). This, along with a higher growth in price per episode (5.5% versus 4.3%) resulted in a greater increase in per claimant expenditure ($0.61 versus $0.41 per month). In the same periods, proportion of patients receiving treatment for depression grew 3.7% versus 6.9%, but per claimant expenditure grew by same amount due to an increase in price per episode (4.8%). Proportion of patients receiving treatment for anorexia started to increase 21.1% or more in the fall of 2020. Patient proportion of alcohol use in age group 18-34 decreased 17.9% during the pandemic but price per episode increased 26.3%. Patient proportion of opioid use increased 11.5% in March-May 2020 but decreased or had no significant changes in subsequent periods. CONCLUSIONS We investigated the changes in use patterns and expenditures of mental health patients before and after the outbreak of the COVID-19 pandemic using claims data in MarketScan®. We found that the changes and their financial impacts vary across mental health conditions, age groups, and periods of the pandemic. Some changes are unexpected from previously reported prevalence increases among the general population and could underlie unmet treatment needs. Therefore, mental health providers should anticipate the use pattern changes in services with similar COVID-19 pandemic disruptions and payers should anticipate cost increases due, in part, to increased price and/or service use.
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Affiliation(s)
- Ta-Hsin Li
- IBM Thomas J. Watson Research Center, Yorktown Heights, NY, 10598-0218, USA.
| | - Leah Kamin
- IBM Watson Health, Cambridge, MA, 02142, USA
| | - Judy George
- IBM Watson Health, Cambridge, MA, 02142, USA
| | | | - Pablo Meyer
- IBM Thomas J. Watson Research Center, Yorktown Heights, NY, 10598-0218, USA
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Mental disorders at the beginning of adolescence: Prevalence estimates in a sample aged 11-14 years. PUBLIC HEALTH IN PRACTICE 2022; 4:100348. [PMID: 36545674 PMCID: PMC9761382 DOI: 10.1016/j.puhip.2022.100348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives This study aims to provide a deeper insight into mental disorders in early adolescence. We report prevalence rates (mental health problems, depressive symptoms, eating disorders, NSSI, STBs) to be used in future studies and clinical ventures. We also expected to find gender differences, with girls being be more affected than boys are. Study design 877 adolescents (M = 12.43, SD = 0.65) from seven German high schools completed a series of questionnaires assessing their mental health (SDQ, PHQ-9, SEED, DSHI-9, Paykel Suicide Scale, FAS III). Methods We calculated cut-off-based prevalence estimates for mental health issues for the whole sample and compared estimates between genders. Results 12.5% of the sample reported general mental health problems. The estimated prevalence of depressive symptoms lay at of 11.5%. Additionally, 12.1% and 1.3% of the participants displayed relevant symptoms of anorexia or bulimia nervosa, respectively. A total of 10.8% reported engaging in non-suicidal self-injury (NSSI) at least once in their lifetime, of whom 5.6% reported repetitive NSSI. 30.1% of the participants described suicidal thoughts, 9.9% suicide plans, and 3.5% at least one suicide attempt. Girls were generally more affected than boys, except for bulimia nervosa, suicidal behavior, and partly NSSI. Conclusion Our findings corroborate the established relevance of early adolescence for the development of mental health problems and suggest that a substantial proportion of young adolescents suffer from such problems early on. Considering the ongoing COVID-19 pandemic and reported negative mental health consequences, the current findings underline the importance of preventive interventions to avoid the manifestation of mental disorders during adolescence.
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Hartman-Munick SM, Lin JA, Milliren CE, Braverman PK, Brigham KS, Fisher MM, Golden NH, Jary JM, Lemly DC, Matthews A, Ornstein RM, Roche A, Rome ES, Rosen EL, Sharma Y, Shook JK, Taylor JL, Thew M, Vo M, Voss M, Woods ER, Forman SF, Richmond TK. Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume. JAMA Pediatr 2022; 176:1225-1232. [PMID: 36342721 PMCID: PMC9641596 DOI: 10.1001/jamapediatrics.2022.4346] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
IMPORTANCE The 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. OBJECTIVE To 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 PARTICIPANTS Using 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. EXPOSURES Onset of the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Monthly number of patients seeking inpatient/outpatient ED-related care. RESULTS Aggregate 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 RELEVANCE In 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.
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Affiliation(s)
- Sydney M. Hartman-Munick
- Boston Children’s Hospital, Boston, Massachusetts,UMass Memorial Children’s Medical Center, Worcester, Massachusetts,UMass Chan Medical School, Worcester, Massachusetts
| | - Jessica A. Lin
- Boston Children’s Hospital, Boston, Massachusetts,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | | | - Paula K. Braverman
- Baystate Children’s Hospital, Springfield, Massachusetts,UMass Chan Medical School-Baystate, Springfield, Massachusetts
| | - Kathryn S. Brigham
- MassGeneral Hospital for Children, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Diana C. Lemly
- MassGeneral Hospital for Children, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Abigail Matthews
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Ellen S. Rome
- Cleveland Clinic Children’s Hospital, Cleveland, Ohio,Cleveland Clinic Lerner College of Medicine at Case, Cleveland, Ohio
| | | | - Yamini Sharma
- UCLA Mattel Children’s Hospital, Los Angeles, California
| | | | - Jaime L. Taylor
- Beaumont Children’s Hospital, Royal Oak, Michigan,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Margaret Thew
- Children’s Wisconsin, Milwaukee,Medical College of Wisconsin, Milwaukee
| | - Megen Vo
- Lucile Packard Children’s Hospital Stanford, Palo Alto, California
| | - Michaela Voss
- Children’s Mercy Hospital, Kansas City, Missouri,University of Missouri–Kansas City, Kansas City
| | - Elizabeth R. Woods
- Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Sara F. Forman
- Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Tracy K. Richmond
- Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
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12
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Leith T, Brieger K, Malas N, McCaffery H, Monroe K, Kullgren KA, Rappaport L. Increased prevalence and severity of psychiatric illness in hospitalized youth during COVID-19. Clin Child Psychol Psychiatry 2022; 27:804-812. [PMID: 35236147 PMCID: PMC8894913 DOI: 10.1177/13591045221076889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have demonstrated an increase in mental health emergencies among youth seen in ambulatory and emergency room settings during the COVID-19 pandemic. This study investigates rates of mental health-related consultation and markers of illness severity since the start of the pandemic. METHODS We evaluated all pediatric patients admitted to a single children's hospital from March 2019 to March 2021 who received psychiatry and/or psychology consults. We report the absolute number of these patients, as well as the proportion of all study site admissions who received such consults. Severity of psychiatric illness was described in terms of LOS, disposition, and use of restraints and psychotropic medications. RESULTS The number and proportion of pediatric patients receiving psychiatry and/or psychology consults rose during the pandemic. Participants also became proportionally more female and older. The study population had higher odds of requiring restraints and antipsychotics during the pandemic. CONCLUSIONS More pediatric inpatients at the study site have required psychiatric care during the pandemic. The severity of mental illness in this population appears to have worsened based on increased utilization of as-needed psychotropic medications and restraints. These findings highlight the changes experienced by patients and providers during the pandemic and merit further study.
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Affiliation(s)
- Thomas Leith
- 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Nasuh Malas
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Psychiatry, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Harlan McCaffery
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kimberly Monroe
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristin A Kullgren
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Leah Rappaport
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Werling AM, Walitza S, Eliez S, Drechsler R. Impact of the COVID-19 pandemic on mental health and family situation of clinically referred children and adolescents in Switzerland: results of a survey among mental health care professionals after 1 year of COVID-19. J Neural Transm (Vienna) 2022; 129:675-688. [PMID: 35652976 PMCID: PMC9160518 DOI: 10.1007/s00702-022-02512-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022]
Abstract
The aim of this study was to assess the impact of the COVID-19 pandemic on mental well-being of clinically referred children and adolescents and on their families from the perspective of mental health care professionals in Switzerland during the first year of the pandemic. Psychiatrists and psychologists for children and adolescents participated in an anonymous survey conducted online in April/May 2021. The survey was completed by 454 mental health care professionals, most of them working in outpatient clinics for child and adolescent psychiatry or in independent practices. Most participants indicated an important increase of referrals for depression (86.8% of respondents), anxiety disorders (81.5%), crisis interventions (76.2%), psychosomatic disorders (66.1%), suicidality (63.8%), and behavioral addictions, e.g., excessive gaming (64.6%). In contrast, referrals or treatment demands for disorders such as autism spectrum disorder or psychosis showed no substantial change or a slight decrease, respectively. According to 69% of respondents, patients experienced the highest psychological burden in January/February/March 2021. Family problems very frequently reported by mental health professionals were parents' worries about loneliness/isolation of the child (49%), child's education and academic future (33%), increased media use due to missing options of recreational activities (37.6%), as well as multiple stresses of mothers (36.3%). To conclude, the pandemic has substantially changed the pattern of disorders and the number of clinical referrals of children and adolescents with mental health problems, which has serious consequences for the treatment supply in Switzerland.
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Affiliation(s)
- Anna Maria Werling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008 Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008 Zurich, Switzerland
- Swiss Society for Child and Adolescent Psychiatry and Psychotherapy, Bern, Switzerland
| | - Stephan Eliez
- Swiss Society for Child and Adolescent Psychiatry and Psychotherapy, Bern, Switzerland
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008 Zurich, Switzerland
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14
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Reed J, Ort K. The Rise of Eating Disorders During COVID-19 and the Impact on Treatment. J Am Acad Child Adolesc Psychiatry 2022; 61:349-350. [PMID: 34780989 PMCID: PMC8617347 DOI: 10.1016/j.jaac.2021.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
Since the beginning of the COVID-19 pandemic, our daily lives have changed drastically. The United States has gone through multiple iterations of lockdowns, mandates, and re-openings that have varied throughout the country. The impact of the pandemic on our social, economic, physical, and mental health is still being determined. One area that we are starting to recognize is the impact of the pandemic on eating disorders (ED) in children and adolescents. The treatment of ED has had a long history of treatment barriers that has worsened with the pandemic, making finding care for patients in need significantly more difficult.
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Affiliation(s)
- Jace Reed
- New York University Langone Health, New York.
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15
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Crooks N, Sosina W, Debra A, Donenberg G. The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective. J Pediatr Psychol 2022; 47:270-278. [PMID: 35182154 PMCID: PMC8903447 DOI: 10.1093/jpepsy/jsab139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the impact of the COVID-19 pandemic on Black adolescent girls’ physical, psychological, and sexual development. Methods Semistructured interviews were conducted with 25 girls (9–18 years old) primarily across the Midwestern United States. Interviews were conducted until theoretical saturation was reached. We conducted a conventional content analysis by reviewing transcripts, coding data, and developing themes. Results Utilizing the social-ecological model findings revealed themes related to the individual-, interpersonal-, institutional-, and community-level changes that Black girls experienced during the COVID-19 pandemic. Conclusions Black adolescent girls need opportunities to discuss the changes, receive relevant resources, and have spaces to support their physical, psychological, and sexual development. Systems such as families, schools, and clinics should implement programming to facilitate discussions around the impact of COVID-19 on Black girls.
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Affiliation(s)
- Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, USA
- All correspondence concerning this article should be addressed to Natasha Crooks, PhD, Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL 60612, USA. E-mail:
| | | | - Alyssa Debra
- College of Medicine, University of Illinois Chicago, USA
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois Chicago, USA
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16
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Monteleone P. Eating Disorders in the Era of the COVID-19 Pandemic: What Have We Learned? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312381. [PMID: 34886107 PMCID: PMC8657195 DOI: 10.3390/ijerph182312381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
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17
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Otto AK, Jary JM, Sturza J, Miller CA, Prohaska N, Bravender T, Van Huysse J. Medical Admissions Among Adolescents With Eating Disorders During the COVID-19 Pandemic. Pediatrics 2021; 148:peds.2021-052201. [PMID: 34244452 DOI: 10.1542/peds.2021-052201] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Emerging data suggest the coronavirus disease 2019 (COVID-19) pandemic has been associated with worsening symptoms of eating disorders (EDs) among both adults and adolescents. With this study, we sought to determine if medical admission patterns among adolescents admitted to our institution for restrictive EDs changed during the pandemic, relative to prepandemic counts of admissions per month. METHODS We performed a chart review of patients aged 10 to 23 years admitted to our children's hospital for restrictive EDs from March 2017 through March 2021 and completed an interrupted time series analysis of admission counts per month. Demographic variables for admitted patients were compared by using χ2, Fisher's exact, and 2-sample t tests. RESULTS ED-related medical admissions at our institution increased significantly during the COVID-19 pandemic. The total number of admissions during the first 12 months of the COVID-19 pandemic (April 1, 2020, through March 31, 2021, n = 125) was more than double the mean number of admissions per year for the same time frame (April 1 through March 31) for the previous 3 years (mean = 56). Patient demographics were similar before and during the pandemic, with the exception that patients admitted during the COVID-19 pandemic were less likely than those admitted before the pandemic to have public insurance. CONCLUSIONS Medical admissions related to restrictive EDs among adolescents increased significantly during the COVID-19 pandemic. Pediatric providers in a variety of settings should be prepared to care for adolescents with restrictive EDs during the pandemic.
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Affiliation(s)
| | | | | | | | - Natalie Prohaska
- Division of Adolescent Medicine.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Terrill Bravender
- Division of Adolescent Medicine.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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18
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Monteleone AM, Cascino G, Barone E, Carfagno M, Monteleone P. COVID-19 Pandemic and Eating Disorders: What Can We Learn About Psychopathology and Treatment? A Systematic Review. Curr Psychiatry Rep 2021; 23:83. [PMID: 34674064 PMCID: PMC8528944 DOI: 10.1007/s11920-021-01294-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This systematic review aims to collect evidence regarding the impact of the SarsCov-2 pandemic on people affected by eating disorders (EDs) targeting the following variables: psychopathology changes, mechanisms of vulnerability or resilience, and perception of treatment modifications during the pandemic. RECENT FINDINGS Since the beginning of the pandemic, a mental health deterioration has been detected in the general population and especially in people affected by pre-existing psychiatric conditions. Furthermore, mental healthcare has moved toward online treatment. ED people showed a trend toward worsening of ED-specific psychopathology and impairment in general psychopathology. The most common vulnerability mechanisms were social isolation and feelings of uncertainty, while heightened self-care and reduced social pressure were resilience factors. The online treatment, although raising many concerns related to its quality, was considered the best alternative to the face-to-face approach. These findings may support the idea that stressful events contribute to the exacerbation of ED psychopathology and highlight the relevance of internalizing symptoms in EDs. The identification of putative risk and resilience variables as well as of subjective factors affecting online treatment perception may inform healthcare professionals and may promote more personalized approaches.
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Affiliation(s)
| | - Giammarco Cascino
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana,’ Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Eugenia Barone
- grid.9841.40000 0001 2200 8888Department of Psychiatry, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Marco Carfagno
- grid.9841.40000 0001 2200 8888Department of Psychiatry, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Palmiero Monteleone
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana,’ Section of Neurosciences, University of Salerno, Salerno, Italy
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