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Roumeliotis N, Carwana M, Charland K, Trudeau O, Benigeri M, Diop M, Agostino H, Zinszer K, Amsdr I, Forgeot d’Arc B, Côté S, Basta NE, Fontela P, Gantt S, Klassen TP, Quach C, Doan Q. Pandemic Stringency Measures and Hospital Admissions for Eating Disorders. JAMA Pediatr 2024:2820958. [PMID: 38976259 PMCID: PMC11231909 DOI: 10.1001/jamapediatrics.2024.2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/06/2024] [Indexed: 07/09/2024]
Abstract
Importance Hospitalizations for eating disorders rose dramatically during the COVID-19 pandemic. Public health restrictions, or stringency, are believed to have played a role in exacerbating eating disorders. Few studies of eating disorders during the pandemic have extended to the period when public health stringency restrictions were lifted. Objective To assess the association between hospitalization rates for eating disorders and public health stringency during the COVID-19 pandemic and after the easing of public health restrictions. Design, Setting, and Participants This Canadian population-based cross-sectional study was performed from April 1, 2016, to March 31, 2023, and was divided into pre-COVID-19 and COVID-19-prevalent periods. Data were provided by the Canadian Institute for Health Information and the Institut National d'Excellence en Santé et Services Sociaux for all Canadian provinces and territories. Participants included all children and adolescents aged 6 to 20 years. Exposure The exposure was public health stringency, as measured by the Bank of Canada stringency index. Main Outcomes and Measures The primary outcome was hospitalizations for a primary diagnosis of eating disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F50), stratified by region, age group, and sex. Interrupted time series analyses based on Poisson regression were used to estimate the association between the stringency index and the rate of hospitalizations for eating disorders. Results During the study period, there were 11 289 hospitalizations for eating disorders across Canada, of which 8726 hospitalizations (77%) were for females aged 12 to 17 years. Due to low case counts in other age-sex strata, the time series analysis was limited to females within the 12- to 17-year age range. Among females aged 12 to 17 years, a 10% increase in stringency was associated with a significant increase in hospitalization rates in Quebec (adjusted rate ratio [ARR], 1.05; 95% CI, 1.01-1.07), Ontario (ARR, 1.05; 95% CI, 1.03-1.07), the Prairies (ARR, 1.08; 95% CI, 1.03-1.13), and British Columbia (ARR, 1.11; 95% CI, 1.05-1.16). The excess COVID-19-prevalent period hospitalizations were highest at the 1-year mark, with increases in all regions: Quebec (RR, 2.17), Ontario (RR, 2.44), the Prairies (RR, 2.39), and British Columbia (RR, 2.02). Conclusion and Relevance In this cross-sectional study of hospitalizations for eating disorders across Canada, hospitalization rates for eating disorders in females aged 12 to 17 years were associated with public health measure stringency. The findings suggest that future pandemic preparedness should consider implications for youths at risk for eating disorders and their resource and support needs.
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Affiliation(s)
- Nadia Roumeliotis
- Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Matthew Carwana
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Katia Charland
- School of Public Health, Université de Montreal, Montreal, Quebec, Canada
| | - Ofélie Trudeau
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Mike Benigeri
- Institut National d’Excellence en Santé et en Services Sociaux, Montreal, Quebec, Canada
| | - Mamadou Diop
- Institut National d’Excellence en Santé et en Services Sociaux, Montreal, Quebec, Canada
| | - Holly Agostino
- Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Kate Zinszer
- School of Public Health, Université de Montreal, Montreal, Quebec, Canada
- Centre for Public Health Research, Université de Montreal, Montreal, Quebec, Canada
| | - Isra Amsdr
- Ontario College of Art and Design University, Toronto, Ontario, Canada
| | | | - Sylvana Côté
- School of Public Health, Université de Montreal, Montreal, Quebec, Canada
| | - Nicole E. Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Patricia Fontela
- Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Soren Gantt
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
- Department of Microbiology, Infectious Diseases & Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caroline Quach
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
- Department of Microbiology, Infectious Diseases & Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
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Roumeliotis N, Carwana M, Trudeau O, Charland K, Zinszer K, Benigeri M, Diop M, Papenburg J, Ali S, Yaskina M, Wahi G, Forgeot d’Arc B, Côté S, Sadarangani M, Basta NE, Fontela PS, Gantt S, Klassen TP, Quach C, Doan Q. Mental Health Hospitalizations in Canadian Children, Adolescents, and Young Adults Over the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2422833. [PMID: 38976264 PMCID: PMC11231797 DOI: 10.1001/jamanetworkopen.2024.22833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/17/2024] [Indexed: 07/09/2024] Open
Abstract
Importance The COVID-19 pandemic resulted in multiple socially restrictive public health measures and reported negative mental health impacts in youths. Few studies have evaluated incidence rates by sex, region, and social determinants across an entire population. Objective To estimate the incidence of hospitalizations for mental health conditions, stratified by sex, region, and social determinants, in children and adolescents (hereinafter referred to as youths) and young adults comparing the prepandemic and pandemic-prevalent periods. Design, Setting, and Participants This Canadian population-based repeated ecological cross-sectional study used health administrative data, extending from April 1, 2016, to March 31, 2023. All youths and young adults from 6 to 20 years of age in each of the Canadian provinces and territories were included. Data were provided by the Canadian Institute for Health Information for all provinces except Quebec; the Institut National d'Excellence en Santé et en Services Sociaux provided aggregate data for Quebec. Exposures The COVID-19-prevalent period, defined as April 1, 2020, to March 31, 2023. Main Outcomes and Measures The main outcome measures were the prepandemic and COVID-19-prevalent incidence rates of hospitalizations for anxiety, mood disorders, eating disorders, schizophrenia or psychosis, personality disorders, substance-related disorders, and self-harm. Secondary measures included hospitalization differences by sex, age group, and deprivation as well as emergency department visits for the same mental health conditions. Results Among Canadian youths and young adults during the study period, there were 218 101 hospitalizations for mental health conditions (ages 6 to 11 years: 5.8%, 12 to 17 years: 66.9%, and 18 to 20 years: 27.3%; 66.0% female). The rate of mental health hospitalizations decreased from 51.6 to 47.9 per 10 000 person-years between the prepandemic and COVID-19-prevalent years. However, the pandemic was associated with a rise in hospitalizations for anxiety (incidence rate ratio [IRR], 1.11; 95% CI, 1.08-1.14), personality disorders (IRR, 1.21; 95% CI, 1.16-1.25), suicide and self-harm (IRR, 1.10; 95% CI, 1.07-1.13), and eating disorders (IRR, 1.66; 95% CI, 1.60-1.73) in females and for eating disorders (IRR, 1.47; 95% CI, 1.31-1.67) in males. In both sexes, there was a decrease in hospitalizations for mood disorders (IRR, 0.84; 95% CI, 0.83-0.86), substance-related disorders (IRR, 0.83; 95% CI, 0.81-0.86), and other mental health disorders (IRR, 0.78; 95% CI, 0.76-0.79). Conclusions and Relevance This cross-sectional study of Canadian youths and young adults found a rise in anxiety, personality disorders, and suicidality in females and a rise in eating disorders in both sexes in the COVID-19-prevalent period. These results suggest that in future pandemics, policymakers should support youths and young adults who are particularly vulnerable to deterioration in mental health conditions during public health restrictions, including eating disorders, anxiety, and suicidality.
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Affiliation(s)
- Nadia Roumeliotis
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Matthew Carwana
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Ofélie Trudeau
- Centre Hospitalier Universitaire Sainte-Justine Hospital Research Centre, Montreal, Quebec, Canada
| | - Katia Charland
- Centre for Public Health Research, University of Montreal, Montreal, Quebec, Canada
| | - Kate Zinszer
- Centre for Public Health Research, University of Montreal, Montreal, Quebec, Canada
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Mike Benigeri
- Institut National d’Excellence en Santé et en Services Sociaux, Montreal, Quebec, Canada
| | - Mamadou Diop
- Institut National d’Excellence en Santé et en Services Sociaux, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gita Wahi
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Baudoin Forgeot d’Arc
- Department of Psychiatry, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Sylvana Côté
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Nicole E. Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Patricia S. Fontela
- Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Soren Gantt
- Centre Hospitalier Universitaire Sainte-Justine Hospital Research Centre, Montreal, Quebec, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caroline Quach
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
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Liu L, Pollock NJ, Contreras G, Xu Y, Thompson W. Hospitalizations and emergency department visits for self-harm in Canada during the first two years of the COVID-19 pandemic: A time series analysis. J Affect Disord 2024; 355:505-512. [PMID: 38548198 DOI: 10.1016/j.jad.2024.03.123] [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] [Received: 07/12/2023] [Revised: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Rates of hospitalizations and emergency department (ED) visits due to self-harm are important indicators for understanding the impact of the COVID-19 pandemic on mental health. The objective of this study was to assess changes in self-harm hospitalizations and ED visits in Canada during the first two years of the pandemic. METHODS Rates of self-harm hospitalizations and ED visits during the pandemic were predicted based on regression analyses that modeled trends over a 5-year pre-pandemic period from fiscal year 2015 to 2019. The ratios of observed and model predicted (expected) rates in 2020 and 2021 were estimated separately to assess changes during the pandemic. RESULTS Overall, rates of self-harm hospitalizations and ED visits were lower than expected during the pandemic, especially in 2020. In 2021, rates for females returned to near-expected levels; but they remained lower than expected for males. Females aged 10-14 years had higher than expected rates. The rate ratio of observed rate over expected rate was 1.2 in 2020 but further increased to 1.8 in 2021 for both hospitalizations and ED visits. Higher than expected rates were also observed among females aged 15-19 years in 2021 only. LIMITATIONS Suicide attempts and non-suicidal self-harm cases could not be distinguished. CONCLUSIONS We observed lower than or close to expected rates of self-harm hospitalizations and ED visits during the pandemic for most population groups. The increased rates for young females highlights the importance of continued surveillance post-pandemic and targeted mental health services and suicide prevention programs.
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Affiliation(s)
- Li Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Nathaniel J Pollock
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada; Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Gisèle Contreras
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Yuan Xu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Jones PM, Sweeny A, Branjerdporn G, Keijzers G, Marshall AP, Huang YL, Hall EJ, Ranse J, Palipana D, Teng YD, Crilly J. The impact of COVID-19 on emergency department presentations for mental health disorders in Queensland, Australia: A time series analysis. Asia Pac Psychiatry 2024; 16:e12553. [PMID: 38467558 DOI: 10.1111/appy.12553] [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: 10/11/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data. METHODS This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 29, 2020-June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts. RESULTS Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). CONCLUSIONS Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.
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Affiliation(s)
- Philip M Jones
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Amy Sweeny
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Grace Branjerdporn
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Intensive Care Unit, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ya-Ling Huang
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia
| | - Emma J Hall
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Dinesh Palipana
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Yang D Teng
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Centre for Mental Health, Griffith University, Gold Coast, Queensland, Australia
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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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6
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Cappelletto P, Luca LD, Taddei B, Taddei S, Nocentini A, Pisano T. COVID-19 pandemic impact among adolescents with eating disorders referred to Italian psychiatric unit. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12440. [PMID: 37737719 DOI: 10.1111/jcap.12440] [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: 02/09/2023] [Revised: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
PROBLEM The COVID-19 pandemic has triggered or exacerbated eating disorders (EDs), especially in adolescents. This study examined the prevalence of admissions of patients with EDs at the Child and Adolescent Psychiatry Unit from the pre-COVID-19 pandemic to March 2023 and explored the differences in dimensions of ED's symptomatology according to the year of access. METHODS We included 174 children and adolescents, 94.3% females and 5.7% males, with a diagnosis of ED (Mage = 14.87; SD = 1.72). The Eating Disorder Inventory-3 (EDI-3), the Body Uneasiness Test (BUT) and Youth Self Report ASEBA (YSR) were assessed. A one-way analysis of variance test was performed. FINDINGS EDs' hospitalization prevalence was higher in the years 2020 and 2021 compared to pre-COVID-19 and the year 2022. Considering the ED psychopathology (EDI-3), findings showed a higher score in the dimension of the push to thinness, body dissatisfaction, asceticism, and fear of maturity in the year 2021 compared to pre-pandemic. Regarding the discomfort related to the image of one's own body (BUT), results showed an increase in the global severity index in the year 2022 compared to pre-pandemic and in weight phobia in the year 2021 compared to the year 2020. Concerning the internalizing symptoms (YSR), a tendency was found for withdrawal/depression, with higher levels in the year 2022 compared to the year 2020. CONCLUSIONS Our study highlighted the increase of different types of EDs symptomatology related to concerns about weight, especially 2 and 3 years after the outbreak of the pandemic, on which the literature is still scarce, especially in the Italian context.
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Affiliation(s)
- Pietro Cappelletto
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Lisa De Luca
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Benedetta Taddei
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Silvia Taddei
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Annalaura Nocentini
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Tiziana Pisano
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Meyer Children's Hospital IRCCS, Florence, Italy
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7
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Toigo S, Katzman DK, Vyver E, McFaull SR, Iynkkaran I, Thompson W. Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data. J Eat Disord 2024; 12:3. [PMID: 38167164 PMCID: PMC10763198 DOI: 10.1186/s40337-023-00957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are severe mental illnesses associated with significant morbidity and mortality. EDs are more prevalent among females and adolescents. Limited research has investigated Canadian trends of ED hospitalizations prior to the COVID-19 pandemic, however during the pandemic, rates of ED hospitalizations have increased. This study examined rates of ED hospitalizations among children and youth in Canada from 2010 to 2022, by sex, age, province/territory, length of stay, discharge disposition and ED diagnosis. METHODS Cases of ED hospitalizations among children and youth, ages 5 to 17 years, were identified using available ICD-10 codes in the Discharge Abstract Database from the 2010/11 to 2022/23 fiscal years. The EDs examined in this study were anorexia nervosa (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa (F50.2), other EDs (F50.3, F50.8) and unspecified EDs (F50.9). Both cases of total and first-time ED hospitalizations were examined. Descriptive statistics and trend analyses were performed. RESULTS Between 2010/11 and 2022/23, 18,740 children and youth were hospitalized for an ED, 65.9% of which were first-time hospitalizations. The most frequent diagnosis was anorexia nervosa (51.3%). Females had significantly higher rates of ED hospitalization compared to males (66.7/100,000 vs. 5.9/100,000). Youth had significantly higher rates compared to children. The average age of ED hospitalization was 14.7 years. Rates of ED hospitalizations were relatively stable pre-pandemic, however during the pandemic (2020-2021), rates increased. INTERPRETATION Rates of pediatric ED hospitalizations in Canada increased significantly during the pandemic, suggesting that there may have been limited access to alternative care for EDs or that ED cases became more severe and required hospitalization. This emphasizes the need for continued surveillance to monitor how rates of ED hospitalizations evolve post-pandemic.
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Affiliation(s)
- Stephanie Toigo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada.
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Steven R McFaull
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Ithayavani Iynkkaran
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
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8
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Rappaport DI, O'Connor M, Reedy C, Vo M. Clinical Characteristics of US Adolescents Hospitalized for Eating Disorders 2010-2022. Hosp Pediatr 2024; 14:52-58. [PMID: 38124532 DOI: 10.1542/hpeds.2023-007381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Eating disorders (EDs) affect a substantial number of American adolescents, with an increasing number seeking care for EDs during the coronavirus disease 2019 pandemic. We assessed the prevalence and clinical characteristics of adolescents hospitalized with EDs during 2010 to 2022. METHODS We used data from a national database of 12 children's hospitals (PEDSnet). Adolescents aged 12 to 21 years hospitalized for ED, disordered eating, binge ED, anorexia nervosa, bulimia nervosa, avoidant-restrictive food intake disorder (ARFID), or other EDs were included. Patients with complex or chronic illness or with EDs hospitalized for another reason were excluded. We analyzed demographic data, clinical characteristics, cardiac manifestations, coexistence of psychiatric conditions, and hospital stay characteristics. RESULTS We included 13 403 hospitalizations by 8652 patients in this study. We found a gradual increase in hospitalizations for patients with EDs before the pandemic and a large increase during the pandemic. Mean age was 15.8 years with 85.9% described as female and 71.8% as white. Anorexia nervosa was the most common ED (57.5%), though hospitalization for patients with ARFID is increasing. Patients' median BMI percentage was 90.3%. Patients' malnutrition was classified as none (50.9%), mild (25.0%), moderate (18.6%), or severe (5.4%). Significant numbers of patients had a diagnosis of depression (58.5%) or anxiety (57.0%); 21.9% had suicidal thoughts. Nearly one-quarter (23.6%) required rehospitalization for ED treatment within 1 year. CONCLUSIONS Hospitalizations for EDs among American adolescents are increasing, with a spike during the coronavirus disease 2019 pandemic. Significant numbers of patients hospitalized with EDs have suicidal thoughts. Trends in patients with ARFID require monitoring.
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Affiliation(s)
- David I Rappaport
- Nemours Children's Hospital of Delaware, Wilmington, Delaware
- Sidney Kimmel Medical College/Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael O'Connor
- Sidney Kimmel Medical College/Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cara Reedy
- Nemours Children's Hospital of Delaware, Wilmington, Delaware
| | - Megen Vo
- Stanford University School of Medicine, Palo Alto, California
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Piątkowska-Chmiel I, Krawiec P, Ziętara KJ, Pawłowski P, Samardakiewicz M, Pac-Kożuchowska E, Herbet M. The Impact of Chronic Stress Related to COVID-19 on Eating Behaviors and the Risk of Obesity in Children and Adolescents. Nutrients 2023; 16:54. [PMID: 38201884 PMCID: PMC10780384 DOI: 10.3390/nu16010054] [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: 11/16/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
During the COVID-19 pandemic, an increase in the incidence of overweight and obesity in children was observed. It appears that unhealthy food choices, an unbalanced diet, and a sedentary lifestyle, as well as experiencing stress related to the pandemic, may be contributing to this disturbing trend. Chronic stress is a significant factor contributing to eating disorders and obesity in youngsters, involving medical, molecular, and psychological elements. Individuals under chronic stress often focus on appearance and weight, leading to negative body image and disrupted relationships with food, resulting in unhealthy eating behaviors. Chronic stress also impacts hormonal balance, reducing the satiety hormone leptin and elevating the appetite-stimulating hormone ghrelin, fostering increased hunger and uncontrolled snacking. Two systems, the hypothalamic-pituitary-adrenal axis and the sympathetic system with the adrenal medulla, are activated in response to stress, causing impaired secretion of noradrenaline and cortisol. Stress-related obesity mechanisms encompass oxidative stress, neuroinflammation, insulin resistance, and neurohormonal and neurotransmission disorders. Stress induces insulin resistance, elevating obesity risk by disrupting blood sugar regulation and fat storage. Stress also affects the gut microbiome, potentially influencing chronic inflammation and metabolic processes linked to obesity. In conclusion, chronic stress is a multifaceted risk factor for eating disorders and obesity in children, necessitating a comprehensive understanding of effective preventive and intervention strategies amid the escalating prevalence of childhood overweight and obesity.
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Affiliation(s)
- Iwona Piątkowska-Chmiel
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8b Street, 20-090 Lublin, Poland;
| | - Paulina Krawiec
- Department of Paediatrics and Gastroenterology, Medical University of Lublin, Al. Racławickie 1 Street, 20-059 Lublin, Poland; (P.K.); (E.P.-K.)
| | - Karolina Joanna Ziętara
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (K.J.Z.); (P.P.)
| | - Piotr Pawłowski
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (K.J.Z.); (P.P.)
| | - Marzena Samardakiewicz
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, Chodźki 7 Street, 20-093 Lublin, Poland;
| | - Elżbieta Pac-Kożuchowska
- Department of Paediatrics and Gastroenterology, Medical University of Lublin, Al. Racławickie 1 Street, 20-059 Lublin, Poland; (P.K.); (E.P.-K.)
| | - Mariola Herbet
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8b Street, 20-090 Lublin, Poland;
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10
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Struik L, Christianson K, Khan S, Yang Y, Werstuik ST, Dow-Fleisner S, Ben-David S. Factors that influence decision-making among youth who vape and youth who don't vape. Addict Behav Rep 2023; 18:100509. [PMID: 37519860 PMCID: PMC10382621 DOI: 10.1016/j.abrep.2023.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Vaping rates among Canadian youth are significantly higher compared to adults. While it is acknowledged that various personal and socio-environmental factors influence the risk of school-aged youth for vaping uptake, we don't know which known behavior change factors are most influential, for whom, and how. The Unified Theory of Behavior (UTB) brings together theoretically-based behavior change factors that influence health risk decision making. We aimed to use this framework to study the factors that influence decision making around vaping among school-aged youth. Qualitative interviews were conducted with 25 youth aged 12 to 18 who were either vaped or didn't vape. We employed a collaborative and directed content analysis approach and the UTB constructs served as the coding framework for analysis. Gender differences were explored in the analysis. We found that multiple intersecting factors play a significant role in youth decision making to vape. Youth who vaped and those who did not vape reported similar mediating determinants that either reinforced or challenged their decision-making, such as easy access to vaping, constant exposure to vaping, and the temptation of flavors. Youth who didn't vape reported individual determinants that strengthened their intentions to not vape, including more negative behavioral beliefs (e.g., vaping is harmful) and normative beliefs (e.g., family disapproves), and strong self-efficacy (e.g. self-confidence). Youth who did vape, however, reported individual determinants that supported their intentions to vape, such as social identity, coolness, and peer endorsement. The findings revealed cohesion across multiple determinants, suggesting that consideration of multiple determinents when developing prevention messages would be beneficial for reaching youth.
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Affiliation(s)
- Laura Struik
- School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Kyla Christianson
- School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Shaheer Khan
- Interdisciplinary Studies, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Youjin Yang
- School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Saige-Taylor Werstuik
- Interdisciplinary Studies, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sarah Dow-Fleisner
- School of Social Work, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Shelly Ben-David
- School of Social Work, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
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11
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Smith S, Charach A, To T, Toulany A, Fung K, Saunders N. Pediatric Patients Hospitalized With Eating Disorders in Ontario, Canada, Over Time. JAMA Netw Open 2023; 6:e2346012. [PMID: 38048130 PMCID: PMC10696484 DOI: 10.1001/jamanetworkopen.2023.46012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Importance Understanding the evolving characteristics of pediatric patients hospitalized for eating disorders is important to ensure that services and treatments align with patient needs. Objective To examine temporal trends in the rates of hospitalizations for pediatric eating disorders by clinical and demographic characteristics in Ontario, Canada, over a 17-year period. Design, Setting, and Participants This population-based, repeated, cross-sectional study used linked health administrative and demographic databases in Ontario, Canada, to identify individuals aged 5 to 17 years hospitalized with eating disorder diagnoses from April 1, 2002, to March 31, 2020. Data analyses were performed from May 2021 to June 2023. Exposure Fiscal year (April 1-March 31) of eating disorder hospitalization. Main Outcomes and Measures Outcomes of interest were absolute and relative changes in pediatric eating disorder hospitalization rates overall and stratified by patient sex, age groups, and eating disorder diagnostic groups. Results Over the study period, there were 11 654 pediatric eating disorder hospitalizations, of which 5268 (45.2%) were for anorexia nervosa and 1374 (11.8%) were for bulimia nervosa. There were a total of 10 648 hospitalizations (91.4%) among female patients, and the median (IQR) age was 15.0 (14-0-16.0) years. Hospitalization rates increased 139% from 2002 to 2019, from 2.0 per 10 000 population to 4.8 per 10 000 population. The largest relative changes were observed among male patients (416%; from 0.2 per 10 000 population to 1.1 per 10 000 population), individuals aged 12 to 14 years (196%; from 2.2 per 10 000 population to 6.6 per 10 000 population), and individuals with eating disorders other than anorexia or bulimia nervosa (255%; from 0.6 per 10 000 population to 2.1 per 10 000 population). Male patients, younger adolescents, and individuals with other eating disorders also represented larger proportions of hospitalizations by fiscal 2019. Conclusions and Relevance In this cross-sectional study of eating disorder hospitalizations, pediatric hospitalizations increased over time, particularly among populations traditionally considered atypical. Existing eating disorder programs must adapt to accommodate changing patient presentations and increased volumes to ensure effective care delivery.
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Affiliation(s)
- Sarah Smith
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Alice Charach
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Alene Toulany
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | | | - Natasha Saunders
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
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12
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Toulany A, Vigod S, Kurdyak P, Stukel TA, Strauss R, Fu L, Guttmann A, Guan J, Cohen E, Chiu M, Hepburn CM, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. New and continuing physician-based outpatient mental health care among children and adolescents during the COVID-19 pandemic in Ontario, Canada: a population-based study. Front Psychiatry 2023; 14:1063203. [PMID: 38025438 PMCID: PMC10657868 DOI: 10.3389/fpsyt.2023.1063203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess physician-based mental health care utilization during the COVID-19 pandemic among children and adolescents new to care and those already engaged with mental health services, and to evaluate differences by sociodemographic factors. Study design We performed a population-based repeated cross-sectional study using linked health and administrative databases in Ontario, Canada among all children and adolescents 3-17 years. We examined outpatient visit rates per 1,000 population for mental health concerns for those new to care (no physician-based mental healthcare for ≥1 year) and those with continuing care needs (any physician-based mental healthcare <1 year) following onset of the pandemic. Results Among ~2.5 million children and adolescents (48.7% female, mean age 10.1 ± 4.3 years), expected monthly mental health outpatient visits were 1.5/1,000 for those new to mental health care and 5.4/1,000 for those already engaged in care. Following onset of the pandemic, visit rates for both groups were above expected [adjusted rate ratio (aRR) 1.22, 95% CI 1.17, 1.27; aRR 1.10, 95% CI 1.07, 1.12] for new and continuing care, respectively. The greatest increase above expected was among females (new: aRR 1.33, 95% CI 1.25, 1.42; continuing: aRR 1.22 95% CI 1.17, 1.26) and adolescents ages 13-17 years (new: aRR 1.31, 95% CI 1.27, 1.34; continuing: aRR 1.15 95% CI 1.13, 1.17). Mood and anxiety concerns were prominent among those new to care. Conclusion In the 18 months following onset of the pandemic, outpatient mental health care utilization increased for those with new and continuing care needs, especially among females and adolescents.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | - Simone Vigod
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Hospital, Women’s College Research Institute, Toronto, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Therese A. Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | | | - Eyal Cohen
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | - Maria Chiu
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | | | - William Gardner
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
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13
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Moin JS, Vigod SN, Plumptre L, Troke N, Asaria M, Papanicolas I, Wodchis WP, Brail S, Anderson G. Sex differences among children, adolescents and young adults for mental health service use within inpatient and outpatient settings, before and during the COVID-19 pandemic: a population-based study in Ontario, Canada. BMJ Open 2023; 13:e073616. [PMID: 37914301 PMCID: PMC10626835 DOI: 10.1136/bmjopen-2023-073616] [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: 03/14/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The pandemic and public health response to contain the virus had impacts on many aspects of young people's lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates. DESIGN Population-based repeated cross-sectional study. SETTING Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada. PARTICIPANTS All children 6-12 years of age (n=2 043 977), adolescents 13-17 years (n=1 708 754) and young adults 18-24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021. PRIMARY OUTCOME MEASURES Outpatient mental health visits to family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems. Inpatient mental health visits to emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex. RESULTS During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries. CONCLUSIONS Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.
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Affiliation(s)
- John S Moin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | - Miqdad Asaria
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Irene Papanicolas
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shauna Brail
- Institute for Management & Innovation, University of Toronto Mississauga, Toronto, Ontario, Canada
| | - Geoff Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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14
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Raffagnato A, Miscioscia M, Bruni G, Del Col L, Traverso A, Ferrarese M, Ancora C, Zanato S, Gatta M. The impact of the two-year COVID-19 pandemic on hospital admission and readmissions of children and adolescents because of mental health problems. Front Public Health 2023; 11:1152876. [PMID: 38026409 PMCID: PMC10643213 DOI: 10.3389/fpubh.2023.1152876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This study aimed to investigate the specific risk factors and psycho-social and clinical features of hospitalized neuropsychiatric patients during the COVID pandemic and to analyze the hospital readmission phenomenon, which, according to recent studies, increased in frequency during the first pandemic period. Patients and methods This observational retrospective cohort study examined 375 patients aged between 0 and 17 years who were hospitalized between 1 February 2018 and 31 March 2022 due to neuropsychiatric issues. The majority of the patients were girls: there were 265 girls compared to 110 boys (M = 13.9 years; SD 2.30 years). The total sample was divided into two groups: the pre-COVID-19 group (160 inpatients hospitalized between February 2018 and February 2020) and the COVID-19 group (215 inpatients hospitalized between March 2020 and March 2022). To explore the readmission phenomenon (second aim), we selected from the two groups of patients with at least one hospital readmission within 365 days after the first discharge. Multiple variables (sociodemographic, clinical, psychological, and related to hospitalization) were collected for each patient by reviewing their medical records. Results The risk factors for mental health disorders were similar between the two groups, except for the significantly increased use of electronic devices in the COVID-19 group, increasing from 8.8% in the pre-COVID-19 group to 29.2% in the COVID-19 group. Patients suffering from eating disorders increased from 11.3% in the pre-COVID-19 group to 23.8% in the COVID-19 group. Hospital readmissions nearly increased from 16.7% in the 2-year pre-COVID-19 period to 26.2% in the 2-year COVID-19 period. A total of 75% of patients hospitalized three or more times in the last 2 years and 85.7% of the so-called "revolving door" patients (with relapse within 3 months after discharge) were identified in the COVID-19 group. However, the comparison between the two groups of patients readmitted before and during the COVID-19 pandemic did not show any differences in terms of sociodemographic and clinical characteristics. Conclusion In conclusion, there was a significant increase in hospital readmissions, but these results suggest the need for better coordination between hospital and territorial services in managing the complexity of mental health problems related to situations arising from the COVID-19 pandemic and the necessity to implement prevention strategies and services.
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Affiliation(s)
- Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialisation, University of Padua, Padova, Italy
| | - Gaia Bruni
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Lara Del Col
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Annalisa Traverso
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Martina Ferrarese
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Caterina Ancora
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Silvia Zanato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
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15
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Toulany A, Saunders NR, Kurdyak P, Strauss R, Fu L, Joh-Carnella N, Chen S, Guttmann A, Stukel TA. Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada. CMAJ 2023; 195:E1291-E1299. [PMID: 37788846 PMCID: PMC10637328 DOI: 10.1503/cmaj.221318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic. METHODS We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10-105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age. RESULTS Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10-17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17-2.26), young adults aged 18-26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10-1.16) and older adults aged 41-105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07-1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54-1.54) but decreased for all adult age groups, especially older adults aged 41-105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64-0.80). INTERPRETATION Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.
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Affiliation(s)
- Alene Toulany
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.
| | - Natasha R Saunders
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Paul Kurdyak
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Rachel Strauss
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Longdi Fu
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Nicolette Joh-Carnella
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Simon Chen
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Therese A Stukel
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
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Castellini G, Cassioli E, Rossi E, Marchesoni G, Cerini G, Pastore E, De Bonfioli Cavalcabo' N, Rotella F, Mezzani B, Alterini B, Lucarelli S, Magazzini S, Corazzesi P, Caini S, Ricca V. Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it? Psychiatry Res 2023; 328:115427. [PMID: 37647700 DOI: 10.1016/j.psychres.2023.115427] [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: 04/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Lucarelli
- Eating Disorders Unit, Central Tuscany Local Health Authority, Florence, Italy
| | - Simone Magazzini
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Patrizia Corazzesi
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
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17
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Bang L, Bahrami S, Hindley G, Smeland OB, Rødevand L, Jaholkowski PP, Shadrin A, Connell KSO, Frei O, Lin A, Rahman Z, Cheng W, Parker N, Fan CC, Dale AM, Djurovic S, Bulik CM, Andreassen OA. Genome-wide analysis of anorexia nervosa and major psychiatric disorders and related traits reveals genetic overlap and identifies novel risk loci for anorexia nervosa. Transl Psychiatry 2023; 13:291. [PMID: 37658054 PMCID: PMC10474135 DOI: 10.1038/s41398-023-02585-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023] Open
Abstract
Anorexia nervosa (AN) is a heritable eating disorder (50-60%) with an array of commonly comorbid psychiatric disorders and related traits. Although significant genetic correlations between AN and psychiatric disorders and related traits have been reported, their shared genetic architecture is largely understudied. We investigated the shared genetic architecture of AN and schizophrenia (SCZ), bipolar disorder (BIP), major depression (MD), mood instability (Mood), neuroticism (NEUR), and intelligence (INT). We applied the conditional false discovery rate (FDR) method to identify novel risk loci for AN, and conjunctional FDR to identify loci shared between AN and related phenotypes, to summarize statistics from relevant genome-wide association studies (GWAS). Individual GWAS samples varied from 72,517 to 420,879 participants. Using conditional FDR we identified 58 novel AN loci. Furthermore, we identified 38 unique loci shared between AN and major psychiatric disorders (SCZ, BIP, and MD) and 45 between AN and psychological traits (Mood, NEUR, and INT). In line with genetic correlations, the majority of shared loci showed concordant effect directions. Functional analyses revealed that the shared loci are involved in 65 unique pathways, several of which overlapped across analyses, including the "signal by MST1" pathway involved in Hippo signaling. In conclusion, we demonstrated genetic overlap between AN and major psychiatric disorders and related traits, and identified novel risk loci for AN by leveraging this overlap. Our results indicate that some shared characteristics between AN and related disorders and traits may have genetic underpinnings.
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Affiliation(s)
- Lasse Bang
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Shahram Bahrami
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Guy Hindley
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olav B Smeland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Linn Rødevand
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Piotr P Jaholkowski
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Alexey Shadrin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kevin S O' Connell
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Aihua Lin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Zillur Rahman
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Weiqiu Cheng
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Nadine Parker
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Chun C Fan
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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18
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Schlapfer L, Gettis MA, Dutreuil V, Cherven B. Hospitalization patterns for adolescents with eating disorders during COVID-19. J Eat Disord 2023; 11:137. [PMID: 37587528 PMCID: PMC10433551 DOI: 10.1186/s40337-023-00867-z] [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: 06/09/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE The purpose of this study was to examine differences in clinical characteristics and hospital length of stay (LOS) for adolescents with eating disorders (EDs) requiring medical stabilization during the pre-COVID-19 and COVID-19 time periods. METHODS Medical record data were abstracted for patients with EDs hospitalized for medical stabilization between 1/1/2019-2/29/2020 (pre-COVID-19) and 3/1/2020-12/31/2021 (during COVID-19). Patient demographics, clinical characteristics and LOS were compared between COVID-19 eras. Patients were categorized as boarding if they remained hospitalized ≥ 1 day after medical stabilization. Multivariate negative binomial linear regression models were performed to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors related to increased LOS. RESULTS Of the 467 admissions during this study, 120 were pre-COVID-19 and 347 were during COVID-19. Monthly admissions for EDs were higher during COVID-19 versus pre-COVID-19 (15.8 vs. 8.6, p = 0.001). On multivariate analysis, factors associated with increased LOS included admission during COVID-19 (IRR 1.27, 95% CI 1.15-1.40), p = 0.001), boarding (IRR 1.77, 95% CI 1.63-1.93, p = 0.001), public insurance (IRR 1.12, 95% CI 1.01-1.23, p = 0.032), nasogastric tube usage (IRR 1.62, 95% CI 1.48-1.76, p = 0.001), heart rate < 40 beats per minute (IRR 1.21, 95% CI 1.11-1.33, p = 0.001) and abnormal electrocardiogram (IRR 1.25, 95% CI 1.14-1.37, p = 0.001). CONCLUSION In addition to clinical factors, we found that admission during COVID-19, boarding, and public insurance were associated with increased LOS among patients with EDs. There is a need for greater availability of ED treatment centers to care for patients with EDs after medical stabilization.
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Affiliation(s)
- Leslie Schlapfer
- Children’s Healthcare of Atlanta, 1001 Johnson Ferry Rd NE, Atlanta, GA USA
| | - Margaret A. Gettis
- Children’s Healthcare of Atlanta, 1001 Johnson Ferry Rd NE, Atlanta, GA USA
| | - Valerie Dutreuil
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA USA
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19
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Catenacci V, Couturier J. Experiences of a virtual day program for adolescents with eating disorders: a qualitative analysis of benefits and barriers. J Eat Disord 2023; 11:133. [PMID: 37563716 PMCID: PMC10413601 DOI: 10.1186/s40337-023-00859-z] [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: 05/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, there was a detrimental impact to the symptoms and treatment of eating disorders, causing an increase in medical admissions and visits. Day treatment programs (DTPs), often used to bridge the gap between inpatient and outpatient treatment, were converted to online formats. This study aims to explore the impact of the transition to virtual DTPs on eating disorder treatment from the perspective of adolescents, their caregivers, and program staff. METHODS Twelve participants (3 adolescents, 4 caregivers, 5 healthcare providers) in a virtual day treatment program were interviewed using a semi-structured interview guide. Interviews were transcribed and managed with qualitative software NVivo 11.0. Conventional analysis was used to inductively identify pertinent themes related to patient, caregiver, and healthcare staff perceptions and experiences of the virtual day treatment. Summative content analysis provided counts of the barriers and benefits of virtual day treatment as identified by participants. RESULTS The majority of participants (10/12) had exposure to both virtual and in person settings, most participants (11/12) felt in-person day programs would be superior to virtual programs. Common limitations of the virtual format were feelings of isolation, less support from healthcare providers, parental burnout, and increased disordered eating. Common benefits were increased accessibility, parental involvement, improved communication with healthcare staff, and the ability for participants to be in their home environment and eat home food. Suggestions for improvement included designing a hybrid model of day treatment, increased family involvement, extending the day program to include dinners with family, and screening for patient appropriateness for the virtual setting. CONCLUSION This qualitative study suggests that there are many barriers to effective implementation of virtual day programs. However, the virtual DTP program offers increased accessibility to patients during a period of a health pandemic and to patients in rural/remote areas with limited treatment options. Suggestions provided by participants in this study, such as increased family involvement, frequency of in person check-ins and increased number of meals supported by the program, may help to improve outcomes in virtual day treatment programs.
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Affiliation(s)
- Vanessa Catenacci
- DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON Canada
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20
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Anderson KE, Han SC, Kavlich SG, Brown S, Ho J, Everhart SA. Adaptation of family-based treatment within an inpatient medical stabilization program for children with eating disorders. Int J Eat Disord 2023; 56:1511-1519. [PMID: 37129459 DOI: 10.1002/eat.23979] [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] [Received: 12/28/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family-based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting. METHOD The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting. RESULTS The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed. DISCUSSION Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings. PUBLIC SIGNIFICANCE This article describes how a children's hospital has adopted family-based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.
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Affiliation(s)
| | - Sohyun C Han
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Sarah G Kavlich
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Shonda Brown
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Jennifer Ho
- Children's Hospital of Orange County, Mission Viejo, California, USA
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21
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Morgan K, Cutmore C, Matthews-Rensch K. Adding mini meals to a nasogastric refeeding protocol for patients with eating disorders can be achieved on general hospital wards. J Hum Nutr Diet 2023; 36:1207-1213. [PMID: 36945998 DOI: 10.1111/jhn.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Treatment of medically compromised patients with eating disorders is difficult in general hospital wards. There is currently no consensus on the best feeding method; however, previous research has demonstrated the safety of using enteral feeding. Because an oral diet has benefits on psychological and behavioural pathways, concurrent feeding requires further investigation. The present study aimed to examine acceptability and safety of implementing mini meals to a previously nil-by-mouth 7-day enteral feeding protocol. METHODS This was mixed methods research including a retrospective observational study and participant survey. Patients admitted to a tertiary hospital in Brisbane, Australia, between July 2020 and March 2021 were eligible. Eligible participants were provided mini meals from day 5. Type and quantity of meals consumed alongside clinical incident data were collected. The survey examined acceptability of mini meals. Descriptive statistics were used to interpret findings. Content analyses were conducted on survey responses. RESULTS Sixty-four participants (95%, n = 57/60 female, 25.2 ± 8.9 years; 75%, n = 45/60 diagnosed with anorexia nervosa) were included. At least half of the participants consumed some or all of the mini meals at each meal period. No clinical incidents were reported. Twenty-six (50%, n = 26/52) surveys were returned. Half (54%, n = 14/26) agreed-strongly agreed that mini meals improved their experience. Eleven participants desired more choice in menu items. CONCLUSIONS The present study found that introducing mini meals into an enteral feeding protocol is acceptable and safe for patients with eating disorders. Participants reported benefits in returning to eating; however, some items on the menu require reconsideration to enable increased consumption.
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Affiliation(s)
- Kate Morgan
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Clare Cutmore
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Kylie Matthews-Rensch
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Eating disorders and Nutrition Research Group 'ENRG', Western Sydney University, Sydney, Australia
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22
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Wong JWS, Skeldon S, Gill E, Taylor E, Billingham W, Stevenson PG, Shipton N, Ferguson G, Collins R, Newton R, Newell A, Martin AC. The increase in medical admissions with anorexia nervosa during the COVID-19 pandemic in Western Australia. Int J Eat Disord 2023; 56:1661-1666. [PMID: 37134198 DOI: 10.1002/eat.23977] [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] [Received: 09/13/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE A comparative study to describe the increase in medical admissions of children and adolescents with anorexia nervosa (AN) in Western Australia in 2019 (pre-pandemic) and 2020 (peri-pandemic). METHOD Patient demographics, physiological parameters, length of stay, time to assessment by the Eating Disorder Service (EDS), and commencement of specialist eating disorder (ED) outpatient treatment was collected for adolescents admitted with AN between 1st January 2019 and 31st December 2020. RESULTS The number of admissions doubled from 126 in 2019 to 268 in 2020. The number of children admitted increased by 52%. The median length of hospital stay was shorter in 2020 (12 vs. 17 days; p < .001), but the 28-day readmission rate was greater (39.9% vs. 22.2%; p < .001). At the time of hospital discharge in 2020, only 60% of patients were able to step-down into specialist ED outpatient treatment, compared to 93% in 2019. The mean number of admissions per child before completing EDS assessment increased significantly in 2020 (2.75 vs. 0, p < .001). DISCUSSION Shorter inpatient stays and delays in the commencement of specialist ED outpatient treatment may have contributed to the increased readmission rate seen in 2020. PUBLIC SIGNIFICANCE This research is important as it explores the reasons for increased medical presentations and admissions of youth with AN during the COVID-19 pandemic in Western Australia. We hope that our lessons learned may be helpful to others trying to balance similar clinical workloads.
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Affiliation(s)
- Jessica W S Wong
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sarah Skeldon
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Emma Gill
- Eating Disorder Service, Child and Adolescent Mental Health Service, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ellen Taylor
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul Geoffrey Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicolene Shipton
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Grant Ferguson
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel Collins
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel Newton
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Amanda Newell
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew C Martin
- Department of Adolescent Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
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23
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Novack K, Dufour R, Picard L, Taddeo D, Nadeau PO, Katzman DK, Booij L, Chadi N. Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians' perspectives. Ann Gen Psychiatry 2023; 22:16. [PMID: 37101241 PMCID: PMC10132795 DOI: 10.1186/s12991-023-00443-4] [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: 02/26/2023] [Accepted: 03/26/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND As a result of the public health measures put in place during the COVID-19 pandemic in Canada, many health services, including those for the treatment of eating disorders, were provided at a distance. This study aims to describe the adaptations made in specialized pediatric eating disorder programs in Canada and the impact of these adaptations on health professionals' experience of providing care. METHODS A mixed-methods design was used to survey healthcare professionals working in specialized pediatric eating disorder programs about adaptations to treatment made during the pandemic and the impact of these adaptations on their experience of providing care. Data were collected between October 2021 and March 2022 using a cross-sectional survey comprising 25 questions and via semi-structured interviews. Quantitative data were summarized using descriptive statistics and qualitative data were interpreted using qualitative content analysis. RESULTS Eighteen healthcare professionals in Canada completed the online survey, of whom six also participated in the semi-structured interviews. The cross-sectional survey confirmed that, unlike in pre-pandemic times, the majority of participants provided medical care (15/18) and mental health care (17/18) at a distance during the pandemic, with most participants using telephone (17/18) and videoconferencing (17/18). Most (16/18) health professionals indicated that virtual care would continue to be used as a tool in pediatric ED treatment after the pandemic. Participants used a combination of virtual and in-person care, with most reporting weighing patients both in clinic (16/18) and virtually (15/18). Qualitative content analysis generated five themes: (1) responding to increased demand with insufficient resources; (2) adapting to changes in care due to the COVID-19 pandemic; (3) dealing with uncertainty and apprehension; (4) virtual care as an acceptable and useful clinical tool, and (5) optimal conditions and future expectations. Most interview participants (5/6) had globally positive views of virtual care. CONCLUSIONS Providing virtual multidisciplinary treatment for children and adolescents with eating disorders seemed feasible and acceptable to professionals during the pandemic. Moving forward, focusing on health professionals' perspectives and providing appropriate training in virtual interventions is essential given their central role in successful implementation and continued use of virtual and hybrid care models.
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Affiliation(s)
- Kaylee Novack
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Rachel Dufour
- Department of Psychology, Concordia University, Montreal, Canada
| | - Louis Picard
- Department of Psychology, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Université de Montréal, 3175 Chemin de la Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | | | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Linda Booij
- CHU Sainte-Justine Hospital Research Centre, Montreal, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Université de Montréal, 3175 Chemin de la Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
- CHU Sainte-Justine Hospital Research Centre, Montreal, Canada.
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Wilksch SM. Toward a more comprehensive understanding and support of parents with a child experiencing an eating disorder. Int J Eat Disord 2023. [PMID: 36942822 DOI: 10.1002/eat.23938] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The majority of eating disorder (ED) carer research has been conducted with parents of adult patients, using qualitative methodologies, focusing on carer burden and distress during treatment. This article aimed to use results from a large, national, quantitative survey of parents of child or adolescent patients as a springboard for encouraging a more comprehensive investigation of parent experiences. METHODS The online survey assessed treatment experiences and parent distress (DASS-21) but also less commonly investigated topics including symptom detection, experiences with primary care providers, and impacts on parent physical and psychological health, romantic relationship, finances, and employment. RESULTS Key findings included parents (N = 439; 91.6% female): were the first person to notice the ED symptoms in 81.8% of cases; had only a 14.7% chance of a helpful experience with both the first general practitioner and first therapist they saw; needed to see M = 3.55 therapists before finding one that could help; reported worse than normal psychological health (96.0%), physical health (70.5%), and romantic relationship (92.7%); required M = 70.06 days leave from work to care for their child (per household); and 91.8% accessed treatment in the private sector with median out-of-pocket expenses of AUD 10,0001-AUD 20,000. DISCUSSION Recommendations to address research and practice gaps include: increased focus on supporting initial symptom detection; improving primary care and treatment experiences; and, increasing the number of ED treatment providers. Urgently needed are solutions to the overwhelming demand for services and clearly, more support for parents. Such strategies are vital for reducing the overall burden of EDs. PUBLIC SIGNIFICANCE Most eating disorder (ED) caregiver research has focused on experiences of supporting adult patients during treatment. This article used a large national survey to explore parent experiences of their child or adolescent's ED in less commonly investigated areas, such as detection, primary care, impact on parent physical and psychological health, romantic relationship, employment and finances. Findings suggested mixed experiences with health care providers and a very significant toll of the illness on the domains measured. Recommendations were provided for how these important areas can be addressed.
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Affiliation(s)
- Simon M Wilksch
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
- Advanced Psychology Services, Adelaide, South Australia, Australia
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25
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Vyver E, Han AX, Dimitropoulos G, Patten SB, Devoe DJ, Marcoux-Louie G, Katzman DK. The COVID-19 Pandemic and Canadian Pediatric Tertiary Care Hospitalizations for Anorexia Nervosa. J Adolesc Health 2023; 72:344-351. [PMID: 36202680 PMCID: PMC9529357 DOI: 10.1016/j.jadohealth.2022.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/16/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Global studies show an increase in hospitalizations for pediatric eating disorders (EDs). No published Canadian studies have confirmed these findings in pediatric ED programs for one-year post onset of the COVID-19 pandemic. The primary objective was to examine health administrative data from two pediatric tertiary care ED programs: Alberta Children's Hospital (ACH) and Hospital for Sick Children (SickKids) to determine the number of pediatric hospitalizations with the most responsible discharge diagnosis of anorexia nervosa (AN). METHODS This hospital-based design explored monthly pediatric hospitalizations in seven-year-olds to 18-year-olds between March 11, 2014 and March 11, 2021 using the Discharge Abstract databases. The analysis used negative binomial regression with robust standard errors to compare hospitalization counts in the months preceding and following the World Health Organization pandemic declaration (March 11, 2020). RESULTS Hospitalizations due to pediatric AN increased by 63% and 132% at SickKids (p < .001) and ACH (p < .001), respectively, in the first year of the pandemic compared to the previous six years. The total number of non-ED hospitalizations decreased by 29.3% and 2.4% at SickKids and ACH, respectively. DISCUSSION This is the first Canadian study to show a rise in pediatric hospitalizations over one year due to AN in two tertiary care hospitals following the onset of the pandemic, confirming the impact that the pandemic has had on children and adolescents with AN in Canada.
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Affiliation(s)
- Ellie Vyver
- Department of Pediatrics, Section of Adolescent Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Eating Disorder Program, Alberta Health Services, Calgary, Alberta, Canada.
| | - Angela X. Han
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Calgary Eating Disorder Program, Alberta Health Services, Calgary, Alberta, Canada,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Scott B. Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J. Devoe
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
| | - Gisele Marcoux-Louie
- Calgary Eating Disorder Program, Alberta Health Services, Calgary, Alberta, Canada,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Debra K. Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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Couturier J, Norris M. The Shadow Pandemic: Eating Disorders, Youth, and COVID-19. J Adolesc Health 2023; 72:321-322. [PMID: 36803848 PMCID: PMC9935426 DOI: 10.1016/j.jadohealth.2022.12.008] [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: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 02/19/2023]
Affiliation(s)
| | - Mark Norris
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Muscle dysmorphia symptomatology among a national sample of Canadian adolescents and young adults. Body Image 2023; 44:178-186. [PMID: 36642014 DOI: 10.1016/j.bodyim.2023.01.001] [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: 08/05/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
The aim of this study was to describe muscle dysmorphia (MD) symptomatology among a large, diverse, and national sample of adolescents and young adults in Canada. Data from the Canadian Study of Adolescent Health Behaviors (N = 2256) were analyzed. MD symptomatology was assessed using the Muscle Dysmorphic Disorder Inventory (MDDI). Men (mean [M] = 33.9, standard deviation [SD] = 8.6) reported significantly greater overall MD symptomatology compared to women (M = 30.1, SD = 7.3) and transgender/gender non-conforming (TGNC; M = 31.5, SD = 7.6) participants. Similarly, the prevalence of clinical MD risk was also highest among men (25.7 %). In regression analyses, participants who identified as South Asian (B 1.97, 95 % confidence interval [CI] 0.41, 3.52) or Middle Eastern (B 2.92, 95 % CI 0.50,5.35), compared to White participants, or identified as gay or lesbian (B 2.65, 95 % CI 1.19, 4.10), compared to heterosexual participants, had greater MD symptomatology. Findings are the first to describe the MD symptomatology among Canadian adolescents and young adults. Health care and public health professionals should be aware of the overall high occurrence of MD symptomatology in this sample, and future research is needed to continue to describe MD among Canadian young people.
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Couturier J, Pellegrini D, Grennan L, Nicula M, Miller C, Agar P, Webb C, Anderson K, Barwick M, Dimitropoulos G, Findlay S, Kimber M, McVey G, Lock J. Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent anorexia nervosa during the COVID-19 pandemic. Transl Behav Med 2023; 13:85-97. [PMID: 36327378 PMCID: PMC9972350 DOI: 10.1093/tbm/ibac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Family-Based Treatment (FBT)-the most widely supported treatment for pediatric eating disorders-transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists' readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.
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Affiliation(s)
- Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Danielle Pellegrini
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Laura Grennan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Maria Nicula
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Catherine Miller
- Eating Disorder Program, Canadian Mental Health Association, Waterloo Wellington, Kitchener, ON, Canada
| | - Paul Agar
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
| | | | - Melanie Barwick
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Sheri Findlay
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gail McVey
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, ON, Canada
- Ontario Community Outreach Program for Eating Disorders, University Health Network, Toronto, ON, Canada
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Güzel Â, Mutlu NL, Molendijk M. COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses. Eat Weight Disord 2023; 28:19. [PMID: 36805344 PMCID: PMC9941242 DOI: 10.1007/s40519-023-01547-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has been a leading cause of stress and feelings of loss of control, both of which have been related to eating disorder (ED) pathology onset and deterioration. We aim to estimate the magnitude of changes in the prevalence rates of, and indicators for, ED psychopathology in the face of the COVID-19 pandemic. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Searches for eligible studies were performed in PubMed, Web of Science and pre-print servers until January 15 2023. RESULTS Our searches yielded 46 eligible studies reporting on a total of 4,688,559 subjects. These data provide strong evidence indicating increased rates of diagnosed and self-reported ED's and a concordant increased need for care in the face of the pandemic. ED symptom severity scores in patients were not elevated during the pandemic, except for those related to anorexia nervosa. On average, people in the general population report relatively high levels of emotional and binge eating during the pandemic, although the evidential strength for these associations is only anecdotal to moderate. Moderators of between-study heterogeneity were not detected. CONCLUSIONS Altogether, our results suggest that the COVID-19 pandemic is associated with a wide spread negative effect on ED pathology in patient samples and the general population. The development of online prevention and intervention programs for EDs during stressful times like a pandemic is encouraged. A limitation is that the results reported here may be prone to biases, amongst others, self-report bias. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis. PREREGISTRATION Prospero [ https://www.crd.york.ac.uk/prospero ] ID: CRD42022316105.
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Affiliation(s)
- Âmine Güzel
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Naz Lâl Mutlu
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Marc Molendijk
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands.
- Leiden Institute of Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands.
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30
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İnce B, Phillips M, Schmidt U. Intensive community and home-based treatments for eating disorders: a scoping review study protocol. BMJ Open 2023; 13:e064243. [PMID: 36792335 PMCID: PMC9933757 DOI: 10.1136/bmjopen-2022-064243] [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] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Institutionally based intensive treatment modalities (inpatient, day patient and residential treatments) for eating disorders (EDs) are associated with high treatment costs and significant challenges for patients and carers, including access difficulties and disruption to daily routines. Intensive community and home-based treatments have been suggested as alternatives to institutionally based intensive treatments for other severe mental illnesses, with promising clinical, social and health economic outcomes. The possible advantages of these treatments have been proposed for EDs, but this emerging area of research has not yet been systematically investigated. This scoping review aims to map the available literature on intensive community and home treatments for EDs, focusing on their conceptualisation, implementation and clinical outcomes. METHODS This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. This review will include any peer-reviewed study concerning intensive community and home-based treatments for any EDs, with no restrictions on geographical context or study design. Grey literature will also be considered. The literature search will be conducted in four databases: PubMed, PsycInfo, MEDLINE and Web of Science. Two researchers will independently screen the titles, abstracts and text of the returned articles for eligibility. Data charting and analysis will consist of a narrative description of the included studies, quantitative and qualitative findings relative to the aims of this scoping review. Gaps in the literature will be highlighted to inform future research, clinical practice, and policy. ETHICS AND DISSEMINATION Ethical approval is not required as all data are available from public sources. The results of this scoping review will be disseminated through peer-reviewed publication, conference presentation, and social media.
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Affiliation(s)
- Başak İnce
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Phillips
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
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de Oliveira C, Tanner B, Colton P, Kurdyak P. Understanding the scope of preventable acute care spending among patients with eating disorders. Int J Eat Disord 2023. [PMID: 36757092 DOI: 10.1002/eat.23910] [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: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The economic burden of eating disorders is substantial. One potential way to reduce costs, without sacrificing care, may be to target preventable (i.e., potentially unnecessary) acute care. This study sought to determine the amount and proportion of preventable and non-preventable acute care spending among individuals with eating disorders. METHOD We undertook a population-based, cross-sectional study of all individuals over the age of 17 with eating disorders (diagnosed through hospitalization) in Ontario, Canada, to determine potentially preventable and non-preventable acute care spending. Preventable acute care (i.e., preventable emergency department visits and hospitalizations) was defined using previously validated algorithms. We undertook analyses for the full sample, by sex and by eating disorder diagnosis (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, multiple). RESULTS Among 7547 individuals with eating disorders, 15% of all acute care spending (i.e., $1.33 million) was considered preventable; this figure was higher for females (14%) and those with bulimia nervosa (21%). Among emergency department visits, 25% of visits were considered preventable; the largest proportions were for non-emergent (11%) and primary care treatable (10%) conditions. Among hospitalizations, 9% were considered preventable; the highest proportions of preventable care spending were for short-term diabetes complications (1.8%) and urinary tract infections (1.8%). DISCUSSION Although the economic burden of eating disorders is substantial, there is some scope to decrease acute care spending among this patient population. Care coordination and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some acute care episodes. PUBLIC SIGNIFICANCE Many jurisdictions have implemented strategies to reduce costs and improve the quality of care among patients with high health care needs, such as those with eating disorders; however, it is unclear whether any costs can be reduced and, if so, which costs. Cost-savings resulting from the reduction of unnecessary care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Patricia Colton
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Ford CA, Boyer CB, Halpern CT, Katzman DK, Ross DA. The Distinguished Dozen: 2022 Journal of Adolescent Health Articles Making Distinguished Contributions to Adolescent and Young Adult Health. J Adolesc Health 2023; 72:161-164. [PMID: 36604007 DOI: 10.1016/j.jadohealth.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
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Pilar M, Purtle J, Powell BJ, Mazzucca S, Eyler AA, Brownson RC. An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses. Community Ment Health J 2023; 59:122-131. [PMID: 35689717 PMCID: PMC9188272 DOI: 10.1007/s10597-022-00991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/24/2022] [Indexed: 01/09/2023]
Abstract
Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses- major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA.
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Amy A Eyler
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
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Schreyer CC, Vanzhula IA, Guarda AS. Evaluating the impact of COVID-19 on severity at admission and response to inpatient treatment for adult and adolescent patients with eating disorders. Int J Eat Disord 2023; 56:182-191. [PMID: 36394170 DOI: 10.1002/eat.23855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has been associated with increased hospitalization rates and worsened symptom severity in patients with eating disorders (ED), but most studies focused exclusively on adolescents. Further, research evaluating the impact of COVID-19 on response to inpatient treatment for ED is limited. This study aimed to compare demographic characteristics, symptom severity at admission, and discharge outcomes for adult and adolescent inpatients with EDs admitted before and after onset of the COVID-19 pandemic. We expected the post-COVID cohort would report elevated symptomatology and poorer response to treatment compared to the pre-COVID cohort and that this effect would be amplified for adolescents. METHOD Patients were consecutively hospitalized adults and adolescents treated in a specialized behavioral integrated inpatient-partial hospitalization program for eating disorders between March 2018 and March 2022 (N = 261). RESULTS The effect of COVID-19 on symptomatology was moderated by age group such that adolescents in the post-COVID cohort, but not adults, reported higher levels of eating disorder and depressive symptoms compared to the pre-COVID cohort. No group differences were observed for discharge outcomes (rate of weight gain, length of stay, or percent target weight). DISCUSSION Findings with respect to elevated symptomatology in adolescents but not adults may reflect the particularly negative impact of social isolation on adolescents. Future research is needed to assess the impact of COVID-19 on long-term treatment outcomes including relapse at 1-year, as well as the potential impact of COVID-19 on treatment availability for chronically ill adults or those with public insurance. PUBLIC SIGNIFICANCE Patients with eating disorders (ED) admitted to a specialty inpatient program after the start of the COVID-19 pandemic were younger and more likely to be male than those admitted pre-pandemic. Adolescents admitted post-COVID, but not adults, reported elevated ED and depressive symptoms compared to the pre-COVID cohort. Group differences were not observed for treatment response. Future research should evaluate the impact of COVID-19 on relapse risk in EDs.
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Affiliation(s)
| | - Irina A Vanzhula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angela S Guarda
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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35
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Couturier J, Sami S, Nicula M, Pellegrini D, Webb C, Johnson N, Lock J. Examining the feasibility of a parental self-help intervention for families awaiting pediatric eating disorder services. Int J Eat Disord 2023; 56:276-281. [PMID: 36285643 DOI: 10.1002/eat.23837] [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: 07/08/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Waitlists for eating disorder (ED) services grew immensely during the COVID-19 pandemic. To address this, we studied the feasibility of a novel parental self-help waitlist intervention. METHOD Parents of a child/adolescent (7-17 years) awaiting pediatric ED services were provided with our intervention, adapted from the family-based treatment model, and consisting of videos and reading material with no therapist involvement. Parent-reported child/adolescent weight was collected weekly 6 weeks pre-intervention, 2 weeks during the intervention, and 6-week post-intervention. Recruitment and retention rates were calculated. Regression-based interrupted time series analyses were completed to measure changes in the rate of weight gain. RESULTS Ninety-seven parents were approached, and 30 agreed to participate (31% recruitment rate). All but one completed end-of-study measures (97% retention rate). The average rate of weight gain was 0.24 lbs/week pre-intervention, which increased significantly to 0.78 lbs/week post-intervention (p < .034). DISCUSSION Our findings provide preliminary evidence that this intervention is feasible. Future research is needed to confirm the efficacy of this intervention on a larger scale. PUBLIC SIGNIFICANCE The COVID-19 pandemic has resulted in several challenges in providing care for children and adolescents with eating disorders, including long waiting lists and delays in treatment. This study suggests that providing parents on a waitlist with educational videos and reading material is acceptable to parents, and may even help in improving the child's symptoms of an eating disorder.
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Affiliation(s)
- Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Eating Disorder Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sadaf Sami
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria Nicula
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Danielle Pellegrini
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Eating Disorder Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Natasha Johnson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Eating Disorder Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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36
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Cozzi G, Grillone A, Zuliani E, Giangreco M, Zanchi C, Abbracciavento G, Barbi E, Amaddeo A. Suicide attempts and eating disorders in adolescents, the mental health wave of the second year of the COVID-19 pandemic: A paediatric emergency department perspective. Front Pediatr 2023; 11:1078274. [PMID: 36762280 PMCID: PMC9905671 DOI: 10.3389/fped.2023.1078274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
AIM We compared adolescents' visits to a tertiary-level paediatric emergency department (PED) in Italy during the pre-pandemic year and the first and second years of the COVID-19 pandemic, focusing on mental health presentations. METHODS This was a retrospective study. We collected the number of visits, the demographical features, triage codes, discharge diagnoses, and outcomes of adolescents 13-17 years old who accessed the PED from 1 March 2019 to 28 February 2022. RESULTS During the study period, 13,410 adolescents accessed the PED. The number of visits related to mental health problems was 304 (6.4%) in the second year of the pandemic and 306 (5.6%) in the pre-pandemic year, p = 0.07. In the same periods, females' prevalence was higher, 220 (72.4%) vs. 197 (64.4%), p = 0.03. The absolute number of subjects needing admission increased, 44 vs. 34, p = 0.21, and more urgent psychiatric consultations were needed, 161 vs. 114, p < 0.0001. The number of suicide attempts was 23 vs. 8, +188%, p = 0.01. The number of adolescents with eating disorders was 21 vs. 5, +320%, p = 0.001. CONCLUSION PED visits for suicide attempts and eating disorders in adolescents sharply increased in the second year of the pandemic.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Chiara Zanchi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,University of Trieste, Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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37
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Milliren CE, Richmond TK, Hudgins JD. Emergency Department Visits and Hospitalizations for Eating Disorders During the COVID-19 Pandemic. Pediatrics 2023; 151:190339. [PMID: 36541052 DOI: 10.1542/peds.2022-058198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies have reported increasing eating disorder incidence and severity following the coronavirus disease 2019 (COVID-19) pandemic. In a diverse cohort of pediatric hospitals, we examined trends in the volume of emergency visits and inpatient admissions for eating disorders before and during the pandemic. METHODS We examined monthly trends in volume of patients with eating disorders (identified by principal International Classification of Diseases, 10th Revision, diagnosis codes) across 38 hospitals in the Pediatric Health Information System pre- (January 2018-March 2020) and post-COVID-19 onset (April 2020-June 2022). Using interrupted time series analysis, we examined the pre- and post monthly trends in eating disorder emergency and inpatient volume. RESULTS Before the pandemic, eating disorder emergency visit volume was increasing by 1.50 visits per month (P = .006), whereas in the first year postonset, visits increased by 12.9 per month (P < .001), followed by a 6.3 per month decrease in the second year postonset (P < .001). Pre-COVID-19, eating disorder inpatient volume was increasing by 1.70 admissions per month (P = .01). In the first year postonset, inpatient volume increased by 11.9 per month (P < .001), followed by a 7.6 per month decrease in the second year postonset (P < .001). CONCLUSIONS The volume of patients seeking emergency and inpatient eating disorder care at pediatric hospitals has increased dramatically since the pandemic onset and has not returned to prepandemic levels despite a decline in the second year postonset, with important implications for hospital capacity.
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Affiliation(s)
| | - Tracy K Richmond
- Divisions of Adolescent and Young Adult Medicine.,Departments of Pediatrics
| | - Joel D Hudgins
- Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.,Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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38
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Chaphekar AV, Vance SR, Garber AK, Buckelew S, Ganson KT, Downey A, Nagata JM. Transgender and other gender diverse adolescents with eating disorders requiring medical stabilization. J Eat Disord 2022; 10:199. [PMID: 36564815 PMCID: PMC9789657 DOI: 10.1186/s40337-022-00722-7] [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: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the high prevalence of eating disorders in gender diverse adolescents, little is known about the characteristics of gender diverse youth with eating disorders who require inpatient medical stabilization. The primary objective of this study was to describe the medical, anthropometric, and psychiatric characteristics of gender diverse adolescents hospitalized for eating disorders and compare these characteristics to cisgender peers hospitalized for eating disorders. The secondary objective was to evaluate percent median body mass index as one marker of malnutrition and treatment goal body mass index as a recovery metric between patients' birth-assigned sex and affirmed gender using standardized clinical growth charts. METHODS A retrospective chart review was conducted of 463 patients admitted to an inpatient eating disorders medical unit between 2012 and 2020. To compare medical, anthropometric, and psychiatric data between gender diverse and cisgender patients, chi-square/Fisher's exact and t-tests were used. Clinical growth charts matching the patients' birth-assigned sex and affirmed gender identity were used to assess percent of median body mass index and treatment goal body mass index. RESULTS Ten patients (2.2%) identified as gender diverse and were younger than cisgender patients [13.6 (1.5) years vs. 15.6 (2.7) years, p = 0.017]. Gender diverse patients were hospitalized with a higher percent median body mass index compared to cisgender peers [97.1% (14.8) vs. 87.9% (13.7), p = 0.037], yet demonstrated equally severe vital sign instability such as bradycardia [44 (8.8) beats per minute vs. 46 (10.6) beats per minute, p = 0.501], systolic hypotension [84 (7.1) mmHg vs. 84 (9.7) mmHg, p = 0.995], and diastolic hypotension [46 (5.8) mmHg vs. 45 (7.3) mmHg, p = 0.884]. Gender diverse patients had a higher prevalence of reported anxiety symptoms compared to cisgender patients (60% vs. 28%, p = 0.037). CONCLUSIONS Gender diverse patients demonstrated complications of malnutrition including vital sign instability despite presenting with a higher weight. This is consistent with a greater proportion of gender diverse patients diagnosed with atypical anorexia nervosa compared to cisgender peers. Additionally, psychiatric comorbidities were present among both groups, with a larger percentage of gender diverse patients endorsing anxiety compared to cisgender patients.
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Affiliation(s)
- Anita V Chaphekar
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA.
| | - Stanley R Vance
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Sara Buckelew
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, Canada
| | - Amanda Downey
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
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Santoso M, Milliren CE, Woods ER, Forman SF, Richmond TK. COVID-19 related familial economic disruptions and eating disorder patients' mental health concerns and motivation to recover. J Eat Disord 2022; 10:197. [PMID: 36539850 PMCID: PMC9764300 DOI: 10.1186/s40337-022-00709-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Family support has been shown to be important for adolescents and young adults (AYA) in eating disorder (ED) treatment. Many families were impacted by the pandemic, potentially altering their ability to support individuals in ED treatment. This study examined the association of COVID-19 related familial economic change with self-reported mental health (MH) and ED concerns in AYA seeking treatment for ED. METHODS AYA patients with EDs aged 10-27 years enrolled in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) completed an additional COVID-19-specific survey (n = 89) that assessed their perception of the effects of the pandemic on their lives and their ED. Participants self-reported on familial economic disruptions, measured through a composite score of four markers: (1) family member's work hours cut, (2) family member was required to stop working, (3) family member lost job permanently, and (4) family lost health insurance/benefits. In bivariate analyses, we examined the association between self-reporting any familial economic disruption and self-reported changes in intrusive ED thoughts, feelings of anxiety, feelings of depression, feelings of isolation, and motivation to recover from their ED. Logistic regression models were used to examine the association between familial economic disruptions on self-reported changes in ED/MH affect and motivation to recover adjusting for age and ED diagnosis. RESULTS Forty-six percent of participants self-reported that the pandemic had resulted in at least one economic familial disruption. Of patients reporting any familial economic disruption, 29% reported decreased motivation for ED recovery, and over 75% reported worsening feelings of depression, anxiety, isolation, and/or intrusive eating disorder thoughts. Reporting any COVID-19 familial economic disruption was marginally associated with feelings of isolation (p = 0.05). Though the findings were only marginally significant, the odds of reporting worsening feelings of depression, anxiety, intrusive ED thoughts or motivation to recover were nearly twice in those who reported a COVID-19-related familial economic disruption compared to those who did not report such a disruption. CONCLUSIONS Family-related economic disruptions are associated with ED/MH-related concerns and motivation to recover from an ED during the COVID-19 pandemic in AYA patients.
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Affiliation(s)
- Monique Santoso
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA.
| | - Carly E Milliren
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, USA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Tracy K Richmond
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
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40
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How COVID-19 Phases Have Impacted Psychiatric Risk: A Retrospective Study in an Emergency Care Unit for Adolescents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121921. [PMID: 36553364 PMCID: PMC9776965 DOI: 10.3390/children9121921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Dramatic events during the COVID-19 pandemic have acutely impacted the psychosocial environment worldwide, with negative implications for mental health, particularly for more vulnerable children and adolescents with severe psychiatric illnesses. Some data suggest that the pandemic waves may have produced different psychopathological consequences, further worsening in the second phase of the pandemic, compared to those in the first lockdown, soon after March 2020. To test the hypothesis of a further worsening of psychiatric consequences of COVID-19 in the second lockdown compared to the first lockdown, we focused our analysis on a consecutive sample of youth referred to a psychiatric emergency unit for acute mental disorders in the time period between March 2019-March 2021. The sample, consisting of 241 subjects (123 males and 118 females, ranging in age from 11 to 17 years), was divided into three groups: Pre-Lockdown Group (PLG, 115 patients); First Lockdown Group (FLG, 65 patients); and Second Lockdown Group (SLG, 61 patients). Patients in the SLG presented more frequently with non-suicidal self-injuries (NSSIs), suicidal ideation, and suicidal behavior, while no significant differences in self-harm were found between PLG and FLG. Eating disorders were more frequent in both the FLG and SLG, compared to the PLG, while sleep problems were higher only in the SLG. Furthermore, patients in the SLG presented with more frequent psychological maltreatments and neglect, as well as with psychiatric disorders in the parents. Adverse traumatic experiences and internalizing disorders were significantly associated with an increased risk of suicidality. Intellectual disability was less represented from the PLG to SLG, and similarly, the rate of ADHD was lower in the SLG. No differences were found for the other psychiatric diagnoses. This information may be helpful for a better understanding and management of adolescents with severe emotional and behavioral disorders after the exposure to long-lasting collective traumas.
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41
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Meier K, van Hoeken D, Hoek HW. Review of the unprecedented impact of the COVID-19 pandemic on the occurrence of eating disorders. Curr Opin Psychiatry 2022; 35:353-361. [PMID: 35903873 PMCID: PMC9594124 DOI: 10.1097/yco.0000000000000815] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the recent literature on the impact of the coronavirus disease-2019 (COVID-19) pandemic on incidence and severity of symptoms of eating disorders (EDs). RECENT FINDINGS A worrying increase of EDs in- and outpatients has been reported since the COVID-19 pandemic began in 2019/2020. Restrictions implemented during the pandemic to protect populations against COVID-19 increased the risk for onset and for worsening of EDs by disrupting eating and exercise routines, social isolation, lack of support, and limited access to healthcare. Substantial increases since the start of the pandemic have been reported for overall incidence (15%), hospital admissions (48%) and emergency department visits (11%) for EDs, with even higher increases among women and children or adolescents with an ED. During the pandemic, ED patients reported increased severity of ED-specific symptoms and increased anxiety, depression and suicidal ideations and -attempts. Treatments shifted largely toward online methods for continuity of care, despite concerns about the quality of care provided and difficulties in self-monitoring. Our review provides preliminary evidence for a similar effectiveness of online treatment to prepandemic face-to-face treatment. In-person assessment remains essential for detecting EDs and for those requiring medical admission. SUMMARY Although the ongoing COVID-2019 pandemic affected mental health globally, research shows that it particularly affected individuals with an ED diagnosis or at risk for an ED, especially women, children and adolescents, and those with anorexia nervosa.
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Affiliation(s)
- Karien Meier
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | | | - Hans W. Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, New York, USA
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42
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Giacomini G, Elhadidy HSMA, Paladini G, Onorati R, Sciurpa E, Gianino MM, Borraccino A. Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192012988. [PMID: 36293569 PMCID: PMC9602016 DOI: 10.3390/ijerph192012988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 05/08/2023]
Abstract
Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual's well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people's mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs' hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ to 22.2‱). Significant hospitalization rate increases were observed both in 15-19 and in 10-14 females' age groups in 2021. Non-significant increases were observed in all males' age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.
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Affiliation(s)
- Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | | | - Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Piedmont Region, 10195 Grugliasco, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
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Couturier J, Gayowsky A, Findlay S, Webb C, Sami S, Chan AKC, Chanchlani R, Kurdyak P. A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence. Int J Eat Disord 2022; 55:1316-1330. [PMID: 35920409 DOI: 10.1002/eat.23789] [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: 04/19/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined a 2-year period following an eating disorder (ED) diagnosis in order to determine patterns of health care utilization. METHOD We conducted a retrospective cohort study of children (n = 1560) diagnosed with an ED between 2000 and 2017. The ED diagnosis was made at a tertiary level hospital for children and adolescents presenting for outpatient assessment by specialist adolescent medicine physicians and recorded in a program database over this period of time. We then created three sex- and age-matched comparison cohorts using provincial health administrative databases including: a general population cohort, a diabetes cohort (to compare nonmental health care utilization) and a mood disorder cohort (to compare mental health care utilization). Outcomes included hospitalizations, emergency department visits, as well as general practitioner, psychiatrist, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcomes) were calculated. RESULTS Compared to the general population cohort, the ED cohort had higher odds and rates of all types of health care utilization. Compared to the diabetes cohort, the ED cohort had higher odds of nonmental health-related admissions (OR 1.45, 95% CI 1.09-1.95) and higher rates of nonmental health-related emergency department visits (RR 1.59, 95% CI 1.18-2.13). Compared to the mood disorder cohort, the ED cohort had higher rates of pediatrician visits, which were mental health-related (RR 14.88, 95% CI 10.64-20.82), however most other types of mental health service utilization were lower. DISCUSSION These patterns indicate that the service needs of young people diagnosed with EDs are higher than those with diabetes with respect to nonmental health admissions and emergency department visits, while in terms of mental health service utilization, there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits. These findings must be interpreted in the context of under-detection and under-treatment of EDs. PUBLIC SIGNIFICANCE STATEMENT Our study found that the health service needs of young people with EDs are higher than those with diabetes with respect to admissions and emergency department visits, while there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits.
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Affiliation(s)
- Jennifer Couturier
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sheri Findlay
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Webb
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sadaf Sami
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Datta N, Van Wye E, Citron K, Matheson B, Lock JD. The COVID-19 pandemic and youth with anorexia nervosa: A retrospective comparative cohort design. Int J Eat Disord 2022; 56:263-268. [PMID: 36125016 PMCID: PMC9538435 DOI: 10.1002/eat.23817] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE There is a growing body of literature suggesting the novel coronavirus pandemic (COVID-19) negatively impacts mental health in individuals self-reporting an eating disorder (ED); however, limited pediatric data is available about the impact COVID-19 has had on youth with EDs, specifically Anorexia Nervosa (AN). Our study uses a cross-sectional design to explore differences in ED symptoms between adolescents diagnosed with AN during the COVID-19 pandemic compared to a retrospective cohort of adolescents for whom these measures were previously collected, prior to the pandemic. METHOD We report cross-sectional data assessing differences between AN behaviors and cognitions during the COVID-19 pandemic compared to a retrospective cohort (n = 25 per cohort) assessed before the pandemic. RESULTS Results suggest that individuals with a first-time diagnosis of AN during the pandemic had lower percent expected body weight, and more compulsive exercise behaviors. CONCLUSIONS These data support existing pediatric findings in exercise and body weight differences in adolescents with AN before and during the pandemic. Findings may be helpful in informing considerations for providers treating ED patients amidst and after the pandemic. PUBLIC SIGNIFICANCE This manuscript compares a retrospective cohort of adolescents diagnosed with AN prior to the pandemic to a cohort of adolescents diagnosed with AN during the pandemic. Results report that adolescents diagnosed with AN during the pandemic have lower weights and increased compensatory exercise behavior compared to adolescents diagnosed with AN before the pandemic despite no difference in length of illness. Findings may be helpful in informing considerations for providers treating ED patients amidst and after the pandemic.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Eliza Van Wye
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Kyra Citron
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Brittany Matheson
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - James D. Lock
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
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45
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Chauvet-Gelinier JC, Roussot A, Vergès B, Petit JM, Jollant F, Quantin C. Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study. J Clin Med 2022; 11:jcm11164787. [PMID: 36013026 PMCID: PMC9409983 DOI: 10.3390/jcm11164787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has had a detrimental impact on mental health, including on food-related behaviors. However, little is known about the effect of the pandemic on anorexia nervosa (AN). We sought to assess an association between the COVID-19 pandemic and a potential increase in hospitalizations for AN in France. We compared the number of hospitalizations with a diagnosis of AN during the 21-month period following the onset of the pandemic with the 21-month period before the pandemic using Poisson regression models. We identified a significant increase in hospitalizations for girls aged 10 to 19 years (+45.9%, RR = 1.46[1.43−1.49]; p < 0.0001), and for young women aged 20 to 29 (+7.0%; RR = 1.07[1.04−1.11]; p < 0.0001). Regarding markers of severity, there was an increase in hospitalizations for AN associated with a self-harm diagnosis between the two periods. Multivariate analysis revealed that the risk of being admitted for self-harm with AN increased significantly during the pandemic period among patients aged 20−29 years (aOR = 1.39[1.06−1.81]; p < 0.05 vs. aOR = 1.15[0.87−1.53]; NS), whereas it remained high in patients aged 10 to 19 years (aOR = 2.40[1.89−3.05]; p < 0.0001 vs. aOR = 3.12[2.48−3.98]; p < 0.0001). Furthermore, our results suggest that the pandemic may have had a particular effect on the mental health of young women with AN, with both a sharp increase in hospitalizations and a high risk of self-harming behaviors.
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Affiliation(s)
- Jean-Christophe Chauvet-Gelinier
- Department of Psychiatry, Dijon University Hospital, 21000 Dijon, France
- INSERM, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, 21000 Dijon, France
| | - Bruno Vergès
- INSERM, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 21000 Dijon, France
| | - Jean-Michel Petit
- INSERM, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 21000 Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, 75014 Paris, France
- McGill Group for Suicide Studies, McGill University, Montreal, QC H3A 0G4, Canada
- Nîmes Academic Hospital (CHU), 30900 Nîmes, France
- Moods Team, INSERM, UMR-1178, CESP, 94276 Le Kremlin-Bicêtre, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, 21000 Dijon, France
- INSERM, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21000 Dijon, France
- INSERM, CESP, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
- Correspondence: ; Tel.: +33-38029-3629
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Couturier J, Pellegrini D, Grennan L, Nicula M, Miller C, Agar P, Webb C, Anderson K, Barwick M, Dimitropoulos G, Findlay S, Kimber M, McVey G, Paularinne R, Nelson A, DeGagne K, Bourret K, Restall S, Rosner J, Hewitt-McVicker K, Pereira J, McLeod M, Shipley C, Miller S, Boachie A, Engelberg M, Martin S, Holmes-Haronitis J, Lock J. A qualitative evaluation of team and family perceptions of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia Nervosa during the COVID-19 pandemic. J Eat Disord 2022; 10:111. [PMID: 35883167 PMCID: PMC9321306 DOI: 10.1186/s40337-022-00631-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, outpatient eating disorder care, including Family-Based Treatment (FBT), rapidly transitioned from in-person to virtual delivery in many programs. This paper reports on the experiences of teams and families with FBT delivered by videoconferencing (FBT-V) who were part of a larger implementation study. METHODS Four pediatric eating disorder programs in Ontario, Canada, including their therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5), participated in our study. We provided FBT-V training and delivered clinical consultation. Therapists recorded and submitted their first four FBT-V sessions. Focus groups were conducted with teams and families at each site after the first four FBT-V sessions. Focus group transcripts were transcribed verbatim and key concepts were identified through line-by-line reading and categorizing of the text. All transcripts were double-coded. Focus group data were analyzed using directed and summative qualitative content analysis. RESULTS Analysis of focus group data from teams and families revealed four overarching categories-pros of FBT-V, cons of FBT-V, FBT-V process, and suggestions for enhancing and improving FBT-V. Pros included being able to treat more patients and developing a better understanding of family dynamics by being virtually invited into the family's home (identified by teams), as well as convenience and comfort (identified by families). Both teams and families recognized technical difficulties as a potential con of FBT-V, yet teams also commented on distractions in family homes as a con, while families expressed difficulties in developing therapeutic rapport. Regarding FBT-V process, teams and families discussed the importance and challenge of patient weighing at home. In terms of suggestions for improvement, teams proposed assessing a family's suitability or motivation for FBT-V to ensure it would be appropriate, while families strongly suggested implementing hybrid models of FBT in the future which would include some in-person and some virtual sessions. CONCLUSION Team and family perceptions of FBT-V were generally positive, indicating acceptability and feasibility of this treatment. Suggestions for improved FBT-V practices were made by both groups, and require future investigation, such as examining hybrid models of FBT that involve in-person and virtual elements. Trial registration ClinicalTrials.gov NCT04678843 .
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada. .,McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | | | | | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | - Paul Agar
- McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada.,McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada.,Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada.,McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | | | - Aylee Nelson
- St. Joseph's Care Group, Thunder Bay, ON, Canada
| | | | | | - Shelley Restall
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | | | - Kim Hewitt-McVicker
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | | | - Martha McLeod
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | - Sherri Miller
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Ahmed Boachie
- University of Toronto, Toronto, ON, Canada.,Southlake Regional Health Centre, Newmarket, ON, Canada
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47
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Ford CA. The Journal of Adolescent Health's Editor-in-Chief's Annual Reflection: A Year of Endurance and Looking Toward the Future. J Adolesc Health 2022; 71:1-3. [PMID: 35718386 PMCID: PMC9212740 DOI: 10.1016/j.jadohealth.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022]
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48
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Beaudry G, Drouin O, Gravel J, Smyrnova A, Bender A, Orri M, Geoffroy MC, Chadi N. A comparative analysis of pediatric mental health-related emergency department utilization in Montréal, Canada, before and during the COVID-19 pandemic. Ann Gen Psychiatry 2022; 21:17. [PMID: 35698227 PMCID: PMC9191527 DOI: 10.1186/s12991-022-00398-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/03/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Reports on longitudinal trends in mental health-related (MHR) emergency department (ED) utilization spanning the pre- and post-pandemic periods are lacking, along with evidence comparing healthcare services utilization by sociodemographic subgroups. The aim of this study was to evaluate COVID-19-associated changes in MHR ED utilization among youth overall and by age, sex, and socio-economic status (SES). METHODS This retrospective cross-sectional study analyzed MHR ED utilization before and during the COVID-19 pandemic at a large urban pediatric tertiary care hospital in Montréal, Canada. All ED visits for children (5-11 years) and adolescents (12-17 years) between April 1, 2016 and November 30, 2021 were included. The main outcome was the monthly count of MHR ED visits. Pre-pandemic and pandemic periods were compared using an interrupted time series design. The effect of seasonality (in months), age (in years), sex (male or female), and SES (low, average, high) were compared using a generalized additive model. RESULTS There were a total of 437,147 ED visits (204,215 unique patients) during the 5-year study period of which 9748 (5.8%) were MHR visits (7,686 unique patients). We observed an increase of 69% (95% CI, + 53% to + 85%; p = 0.001) in the mean monthly count of MHR ED visits during the pandemic period, which remained significant after adjusting for seasonality (44% increase, 95% CI, + 38% to + 51%; p = 0.001). The chance of presenting for a MHR ED visit increased non-linearly with age. There were increased odds of presenting for a MHR ED visit among girls between the pre-pandemic and pandemic periods (OR 1.42, 95% CI 1.29-1.56). No difference by SES group during and before the COVID-19 pandemic was found [OR 1.01, 95% CI 0.89-1.15 (low); OR 1.09, 95% CI 0.96-1.25 (high)]. CONCLUSIONS Our study shows important increases in MHR ED utilization among youth, and especially among girls, during the first 20 months of the COVID-19 pandemic, highlighting the need for sustained, targeted and scalable mental health resources to support youth mental health during the current and future crises.
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Affiliation(s)
| | - Olivier Drouin
- Sainte-Justine Hospital Research Center, Montréal, QC, Canada.,Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.,Division of General Pediatrics, Sainte-Justine University Hospital Centre, Montréal, QC, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Jocelyn Gravel
- Sainte-Justine Hospital Research Center, Montréal, QC, Canada.,Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.,Division of Pediatric Emergency Medicine, Sainte-Justine University Hospital Centre, Montréal, QC, Canada
| | - Anna Smyrnova
- Sainte-Justine Hospital Research Center, Montréal, QC, Canada
| | | | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Nicholas Chadi
- Sainte-Justine Hospital Research Center, Montréal, QC, Canada. .,Department of Pediatrics, Université de Montréal, Montréal, QC, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Ch de la Cote Ste-Catherine, Montréal, QC, H3T 1C5, Canada.
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49
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Patel BP, Sathiyamoorthy T, Giruparajah M, Toulany A, Hamilton JK. Weighing in on COVID-19: The impact of the pandemic on children and adolescents with obesity participating in a weight management program. Pediatr Obes 2022; 17:e12948. [PMID: 35686545 PMCID: PMC9347911 DOI: 10.1111/ijpo.12948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 mitigation measures, including closures of schools and recreational facilities and alterations in eating behaviours and physical activity, may impact weight. OBJECTIVE To examine changes in body weight and body mass index (BMI) in children and adolescents with obesity participating in an obesity treatment program before and during the COVID-19 pandemic in Ontario, Canada. METHODS Body weight and BMI at baseline and 6 months were recorded for the 'historic' cohort (females = 34, males = 21) before the pandemic (November 1, 2018, to March 18, 2020) and for the 'pandemic' cohort (females = 30, males = 30) during the pandemic (March 19, 2020 to July 31, 2021). Analyses were adjusted for baseline weight/BMI, age, and ON-Marg score, a measure of the social determinants of health. RESULTS In males, body weight (98.29 versus 89.28 kg, p < 0.001) and BMI (36.46 versus 34.85 kg/m2 , p = 0.027) were greater in the pandemic compared with historic cohort. In females, body weight (p = 0.769) and BMI (p = 0.548) were not different between the two cohorts. CONCLUSION The COVID-19 pandemic may have diminished the health impacts of a weight management program, particularly in males, leading to increased body weight and BMI.
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Affiliation(s)
- Barkha P. Patel
- Division of EndocrinologyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | | | - Mohana Giruparajah
- Division of EndocrinologyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Alene Toulany
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Division of Adolescent MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Jill K. Hamilton
- Division of EndocrinologyThe Hospital for Sick ChildrenTorontoOntarioCanada,Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada
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50
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Allgaier K, Schneider PS, Buck S, Reusch PA, Hagmann D, Barth GM, Renner TJ. [Child and Adolescent Psychiatric Emergencies During the Second Wave of the SARS-CoV2-19 Pandemic: Findings from the Tübingen University Hospital]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:275-285. [PMID: 35225657 DOI: 10.1024/1422-4917/a000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Child and Adolescent Psychiatric Emergencies During the Second Wave of the SARS-CoV2-19 Pandemic: Findings from the Tübingen University Hospital Abstract. Objective: Child and adolescent psychiatric emergencies during the SARS-CoV2-19 pandemic are part of a controversial discussion. This study investigates the volume of such emergencies, the age of the patients, and the diagnoses of eating disorders and obsessive-compulsive disorders (OCD) that occurred at the Child and Adolescent Psychiatric Center (CAP) Tübingen during the second wave of the pandemic compared to the year before. Methods: We evaluated data on all emergencies at CAP Tübingen (telephone calls, outpatients, patient admissions) from 10/2019-01/2020 (first time period) and 10/2020-01/2021 (second wave). Results: The volume of emergencies during the second wave (319 presentations) was 29.7 % higher than during the first time period, and the number of patients (172 presentations) increased by 10.3 %. Compared to the first time period, the number of inpatients was 27.9 % higher, and the emergency admissions increased by 27.8 %. Patients in the second wave were somewhat older, with an average age of 14.8 years (first period: 14.2 years). Eating disorders were more frequent during the second wave, whereas OCD were more frequent in the first time period. Conclusions: Almost 30 % more emergencies were recorded in the second wave of the pandemic, with especially eating disorders increasing. Systematic emergency records should be documented at all German CAPs to enable demand-oriented planning.
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Affiliation(s)
- Katharina Allgaier
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
| | - Priska S Schneider
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Simone Buck
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Pauline A Reusch
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Daniela Hagmann
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Gottfried M Barth
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Tobias J Renner
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
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