COVID-19 Pandemic and Eating Disorders among University Students

Stress, physical activity, and mindfulness practices among youth amidst COVID-19

Introduction

The COVID-19 pandemic has exacerbated stress and anxiety among young people, particularly university students, impacting their mental well-being and daily life. Given the rise in social isolation and economic uncertainty, the adoption of mindfulness practices such as sophrology, meditation, and yoga becomes essential for improving their mental health. This study aims to evaluate the impact of these practices on stress levels and their effect on engagement in physical activities among youths.

Method

This study employed a mixed methods design to assess the impact of different wellness and mindfulness practices on stress levels and physical activity (PA) engagement among university students. Quantitative data were gathered electronically from 218 students at the University of Rouen and the university of Paris-Cité through validated questionnaires, including custom tools on sports and mindfulness practices and the Perceived Stress Scale (PSS). The sample consisted mainly of young adults aged 18 to 35, with a majority of 170 female and 48 male participants. Qualitative insights were gathered through semi-structured interviews with three directors of the university's sports and physical activities department (SUAPS), as well as four wellness program instructors. Data analysis involved statistical techniques using Statistical Analysis System (SAS) software for quantitative data, while qualitative data were analyzed thematically using Sphinx software, a tool for textual analysis. Ethical approval for the study was obtained, and confidentiality of all participants was maintained throughout the research.

Results and conclusion

The COVID-19 pandemic had significant effects on French university students' PA, mental health, and stress levels. Lockdowns led to a decline in sports practices for many, while others adapted by increasing their engagement in fitness and wellness practices. The majority of participants (64.68%) reported moderate levels of stress. A significant correlation was found between motivations for mental health support and stress management, and higher levels of stress (p = 0.0000 and p = 0.0024, respectively). Regular participation in wellness activities was associated with lower stress (p = 0.0193). The findings reinforce the idea that incorporating wellness practices into educational environments can strengthen students' mental resilience and overall well-being, equipping them with essential tools to effectively cope with future stressors.

The collateral effects of the COVID-19 pandemic: A gender-specific systematic review of disordered eating behaviour in the general population

OBJECTIVE

The COVID-19 pandemic initiated public health measures, impacting mental health and exacerbating disordered eating behaviours (DEB). This study aims to fill gaps in understanding DEB in the general population during the pandemic, emphasising gender dynamics and the experiences of gender and/or sexual minority (SGM) individuals.

METHOD

A systematic literature review followed PRISMA guidelines to investigate DEB during the pandemic, focusing on gender-sensitive analyses and SGM populations. Outcomes from the included studies were synthesised to identify patterns and associations related to DEB, particularly considering gender dynamics and SGM experiences.

RESULTS

Significant gender associations with DEB were observed, with women consistently exhibiting higher scores. SGM populations also showed elevated DEB symptoms. Longitudinal studies indicated changes in DEB over time, with some decreases observed among men.

CONCLUSIONS

The review underscores significant gender differences in DEB during the pandemic, with women exhibiting higher symptom levels. Lockdown measures had nuanced impacts on DEB, varying across studies. Various factors including pandemic-related stressors influenced DEB. Consideration of these factors can inform tailored interventions for DEB in the general population. Overall, the review enhances our understanding of how gender intersects with the pandemic's impact on DEB, emphasising the need for diverse approaches to address these behaviours.

Does so-called "healthy" content on instagram display balanced recipes? A pilot study in relation to the risk of unhealthy eating patterns in social network users

OBJECTIVE

social networks (SN) including Instagram have increased in popularity. However, SN-mediated content may influence eating behaviors in a negative way. This study analyzed whether Instagram content claimed as "healthy" complies with nutritional guidelines.

METHODS

recipes posted in French on Instagram with the caption #healthy or similar ones were analyzed, once from February to May 2023 and again in April 2024. Health authorities' guidelines and food pyramid inclusion criteria were used for the quantitative and qualitative analysis, respectively. Recipes were then classified as balanced, partially unbalanced or unbalanced, with the two subgroups "restrictive" and "excessive", and according to the main protein source.

RESULTS

we coded a total of 114 courses (2 datasets of 57 courses each). Among these, 3 were classified as balanced main courses, 45 as partially unbalanced main courses and 66 as unbalanced main courses (21 were deemed as restrictive, 21 as excessive and 24 were otherwise inadequate), with a majority of hypocaloric courses. Approximately half of the recipes were vegetarian or vegan.

DISCUSSION

these results suggest that food recipes published on Instagram as #healthy may, at times, be far from nutritional guidelines and could rather promote unbalanced eating patterns. This suggest that food-related content on SN might be insufficiently moderated and that recipes referenced as #healthy should perhaps be accompanied by warnings and preventive measures. This observation, in addition to other detrimental behaviors displayed on SN (e.g. extreme physical activity or body image pressure) may contribute to the increased incidence of eating disorders (ED) associated with problematic SN use. Alerts on this risk and accessible tools for the prevention and early detection of ED risk in SN users are urgently needed.

Navigating the challenges: exploring the association between COVID-19 lockdowns and eating behavior in university students: a systematic review and investigation of factors impacting ed levels

INTRODUCTION

The COVID-19 pandemic has significantly impacted the mental and physical well-being of individuals globally, with university students being particularly susceptible to mental health issues. Factors such as the transition to adulthood, economic hardships, and academic responsibilities, compounded by pandemic-related disruptions like lockdowns and remote learning, have elevated stress levels and altered daily routines. The pandemic has given rise to post-traumatic stress symptoms in certain individuals, including university students which may contribute to the emergence of emotional eating or adopting unhealthy eating patterns as a coping mechanism, leading to excessive consumption or unhealthy dietary choices. This review aims to investigate the influence of COVID-19 restrictions on eating disorders among university students and identifying the contributing factors.

CONTENT

Out of 59 identified articles, 10 met the inclusion criteria, involving 23,542 participants (70.2 % women, 29.35 % men, 0.42 % gender fluid/undisclosed). The lockdown led to increased prevalence and severity of eating disorders among university students, particularly in women.

SUMMARY

The review highlights a notable increase in eating disorders among university students during the COVID-19 pandemic. Mental health issues, reduced physical activity, and economic stress were significant contributors to this trend, with women being disproportionately affected.

OUTLOOK

To mitigate the impact of future pandemics or similar disruptions, universities should implement early screening, provide mental health counseling, virtual support groups, nutritional guidance, and opportunities for physical activity. Encouraging students to seek professional help is crucial for managing mental health and eating habits in such scenarios.

Lifestyles and academic stress among health sciences students at the National University of Chimborazo, Ecuador: a longitudinal study

Background

The significant changes experienced by university students in their training are inherent to educational processes. Social isolation caused by the COVID-19 pandemic, online education and the reopening of higher-education institutions produced substantial variations in the lifestyle of university students in health sciences and generated academic stress and perceived stress. This study was conducted at the National University of Chimborazo (UNACH), a public institution located in Riobamba, central Ecuador, the diverse student's population provided an ideal setting for examining the interplay between academic and perceived stress, lifestyle factors, and learning modalities. The research focused on health sciences students across six academic programs. The university's geographical position and demographic characteristics offered a representative sample for investigating these factors within the context changing.

Aim

To compare academic and perceived stress and university students' lifestyles at two different periods: (1) during the mandatory social confinement caused by the COVID-19 pandemic with an online learning modality (T1); (2) in the post-pandemic period with a return to face-to-face activities (T2).

Design

An observational, analytical, quantitative, and longitudinal study.

Participants

Students from six programs (Nursing, Physiotherapy, Clinical Laboratory, Medicine, Dentistry, and Clinical Psychology) from the Faculty of Health of the National University of Chimborazo-Ecuador (n = 2,237) participated voluntarily, the students had one mean age of M = 21.31 (SD = 2.36) at T1 and M = 22.94 (SD = 2.40) at T2. Non-probability convenience sampling was employed due to the accessibility of the student population and the importance of including the maximum number of relevant individuals within the study population.

Methods

The following instruments were used: Nola Pender's Lifestyle Profile Questionnaire, Cognitive Systemic Inventory for the study of academic stress, and Cohen's Perceived Stress Scale.

Results

In T1 and T2, students reported high levels of stress, and increased unhealthy lifestyle increased with the return to classrooms. Additionally, upon returning to face-to-face activities (T2), the mean score applied to the responses of Nola Pender's Lifestyle Profile Questionnaire decreased from M = 113.34 (SD = 23.02) to M = 107.2 (SD = 29.70; p < 0.001). There was significant difference (p < 0.001) in academic stress in T1 [M = 66.25 (SD = 15.66)] and T2 [M = 64.00 (SD = 17.91)].

Conclusions

Upon returning to university classrooms (T2), the number of students who reported an "unhealthy" lifestyle increased. Academic stress was high in T1 and T2 and was reported higher in online activities during social isolation.

Risk Factors for Eating Disorders in University Students: The RUNEAT Study

The purpose of the study is to assess the risk of developing general eating disorders (ED), anorexia nervosa (AN), and bulimia nervosa (BN), as well as to examine the effects of gender, academic year, place of residence, faculty, and diet quality on that risk. Over two academic years, 129 first- and fourth-year Uneatlántico students were included in an observational descriptive study. The self-administered tests SCOFF, EAT-26, and BITE were used to determine the participants' risk of developing ED. The degree of adherence to the Mediterranean diet (MD) was used to evaluate the quality of the diet. Data were collected at the beginning (T1) and at the end (T2) of the academic year. The main results were that at T1, 34.9% of participants were at risk of developing general ED, AN 3.9%, and BN 16.3%. At T2, these percentages were 37.2%, 14.7%, and 8.5%, respectively. At T2, the frequency of general ED in the female group was 2.5 times higher (OR: 2.55, 95% CI: 1.22-5.32, p = 0.012). The low-moderate adherence to the MD students' group was 0.92 times less frequent than general ED at T2 (OR: 0.921, 95%CI: 0.385-2.20, p < 0.001). The most significant risk factor for developing ED is being a female in the first year of university. Moreover, it appears that the likelihood of developing ED generally increases during the academic year.

The use and misuse of the SCOFF screening measure over two decades: a systematic literature review

PURPOSE

The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested.

METHODS

The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors.

RESULTS

180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use.

CONCLUSION

This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested.

LEVEL OF EVIDENCE

Level I.

Access and efficacy of university mental health services during the COVID-19 pandemic

Objective

This study sought to understand the mental health issues, mental health support and efficacy of that support among university students.

Participants

All students enrolled in a College of Arts and Sciences at one mid-size university received an email that contained a link to an anonymous, online questionnaire developed and disseminated through PsychData. 162 students completed the questionnaire.

Methods

Mixed methods: Data was summarized using descriptive analysis, testing for significance, testing for differences, and content analysis.

Results

Participants reported high levels of anxiety (76%) and depression (65%). Results indicated that participant demographics were associated with types of mental access, and support. Unexpected results included lack of knowledge or information on cost, and how to access mental health services hindered access for participants, and although telehealth was the most widely used support, in contrast to other studies, participants indicated a preference for face-to-face mental health services.

Conclusion

Results highlight the need for improving communication about and access to mental health services in higher education Recommendations and implications for policy and support services are provided.

Depression, anxiety, and stress in medical students in Peru: a cross-sectional study

Objective

To determine the prevalence and factors associated with depressive, anxious, and stress symptoms in medical students in Peru, during the second pandemic wave of COVID-19.

Methods

We conducted an analytical cross-sectional study in 405 medical students from a university in northern Peru. The DASS-21 instrument was used to evaluate mental health outcomes (depression, anxiety, and stress), and to investigate their association with socio-educational characteristics.

Results

We found a prevalence of depressive, anxious, and stress symptoms of 71.6% (95% CI: 66.94-75.95), 71.9% (95% CI: 67.2-76.2), and 62.7% (95% CI: 57.8-67.4); respectively. Students with eating behavior disorders had a higher prevalence of depressive symptoms (PR: 1.35), anxious symptoms (PR: 1.27), and stress symptoms (PR: 1.31). The prevalence of depressive symptoms (PR: 1.57), anxious symptoms (PR: 1.27), and stress symptoms (PR: 1.24) increased in students who did not report regular physical activity. In addition, having almost always academic exhaustion increased the prevalence of depressive symptoms (PR: 1.46), stress symptoms (PR: 1.72). On the contrary, the prevalence of depressive symptoms (PR: 0.79), anxious symptoms (PR: 0.73) and stress symptoms (PR: 0.82) decreased in male students. Students who reported sleeping 8 or more hours daily had a lower prevalence of stress symptoms (PR: 0.82).

Conclusion

Symptoms of depression and anxiety occurred in 7 out of 10 students, and stress in 6 out of 10. Among the factors associated with the presence of anxiety, depression, and stress were eating behavior disorder and not regularly exercising. Periodic evaluations of mental symptomatology are required and counseling should be promoted in medical schools.

Nutritional Behavior in European Countries during COVID-19 Pandemic-A Review

COVID-19 is highly linked with hyperinflammation and dysfunction of the immune cells. Studies have shown that adequate nutrition, a modifiable factor affecting immunity and limiting systemic inflammation, may play an adjunct role in combating the negative consequences of SARS-CoV-2 infection. Due to the global lockdown conditions, the COVID-19 pandemic has contributed, among others, to restrictions on fresh food availability and changes in lifestyle and eating behaviors. The aim of this paper was to review the data regarding eating habits in European countries within the general population of adults and some specific subpopulations, including obese, diabetic, and psychiatric patients, during the COVID-19 pandemic. The PubMed database and the official websites of medical organizations and associations were searched for the phrases "COVID" and "eating habits". Papers regarding the pediatric population, non-European countries, presenting aggregated data from different countries worldwide, and reviews were excluded. During the COVID-19 pandemic, unhealthy lifestyles and eating behaviors were commonly reported. These included increased snacking, intake of caloric foods, such as sweets, pastries, and beverages, and a decline in physical activity. Data suggest that poor eating habits that create a positive energy balance have persisted over time as an additional post-COVID negative consequence.

Alexithymia and Interoceptive Confusion in Covid-19 Pandemic Distress

Objective

Alexithymic traits are associated with the difficulty of perceiving 'non-affective interoceptive signals', and are related to a problematic management of stressful life events (SLEs). The main purpose of this study was to quantify the psychological response of the general population to COVID-19 pandemic stress and to evaluate potential correlations with the presence of 'alexithymic traits' and 'interoceptive confusion' (study protocol # 0077794/2022).

Method

175 subjects from general population were assessed with the Toronto-Alexithymia Scale (TAS-20), the Event-Revised Impact Scale (IES-R), the Interoceptive Accuracy Scale (IAS), and the Interoceptive Confusion Questionnaire (ICQ).

Results

a significant relationship emerged between alexithymic traits (assessed with the TAS-20), the ICQ 'interoceptive confusion', and the domain of 'hyper-arousal' as assessed with IES-R. Logistic regression model showed that ICQ-Total Score and IES-R 'hyper-arousal' domain were significantly correlated with TAS-20 total score, with DR value (R2 corrected) explaining the 36.8% of the variability (standard error: 10.7).

Conclusions

This study, albeit with the limitations of a cross-sectional experimental design with self-evaluation tools in a general population sample, showed a vulnerability to COVID-19 pandemic stress due to high levels of hyper-arousal in subjects with alexithymic traits and interoceptive confusion.

Anorexia nervosa and the COVID-19 pandemic among young people: a scoping review

BACKGROUND

The extent to which the recent global COVID-19 Pandemic has impacted young people with restrictive eating disorders [i.e., anorexia nervosa (AN) and atypical anorexia nervosa (AAN)] is unclear. We conducted a scoping review of the literature to identify how the pandemic has impacted this population and to identify gaps in the current literature to inform future research efforts.

MAIN BODY

We searched PubMed, EMBASE, the Web of Science, The Cochrane Library, PsycInfo, ProQuest Dissertations and Theses Global, LitCovid, Google Scholar, and relevant agency websites from 2019 to 2022. We included studies that focused on young people with AN/AAN globally. Of the 916 unduplicated articles screened, 17 articles met the inclusion criteria, reporting on 17 unique studies including 4,379 individuals. Three key findings were identified. First, an increase in hospitalizations related to eating disorders was found during COVID-19 among young people with AN and AAN. Multiple studies cited increased medical instability, even though the overall duration of disease was shorter compared to pre-pandemic levels. Second, changes in eating disorder-related symptomology during the pandemic were reported in this population, as well as poorer overall behavioral and mental health. Suggested reasons behind changes included boredom or minimal distraction from pathological thoughts, increased social isolation, increased social media and online use (e.g., reading blogs or watching YouTube), gym and school closures, changes in routines due to lockdowns and quarantines, and worries over gaining the "Quarantine 15". Third, there was an increase in the use of telemedicine as a treatment modality for the treatment of AN. Challenges were reported by both clinicians and patients regardless of past experience using telemedicine. When compared to no treatment, telemedicine was recognized as the best option during COVID-19 lockdowns; however some individuals expressed the preference for in-person treatment and planned to return to it once it became available.

CONCLUSION

The pandemic significantly impacted young people with restrictive eating disorders as seen by increased hospitalizations and requests for outpatient care. A primary driver of the changes in eating disorder symptomatology may be lockdowns and quarantines. Further research investigating how the series of lockdowns and re-openings impacted individuals with AN/AAN is warranted.

Mediating Roles of Psychological Distress, Insomnia, and Body Image Concerns in the Association Between Exercise Addiction and Eating Disorders

Purpose

Exercising can promote good health. However, excessive exercising may have downsides. This study examined the association between exercise addiction and eating disorders and whether the identified association was mediated by psychological distress, insomnia (including sleep quality), and body image concern.

Methods

A total of 2088 adolescents (mean age of 15.3 years) participated in this cross-sectional study by questions assessing exercise addiction, eating disorders, psychological distress, insomnia, sleep quality, and body image concern.

Results

There were significantly positive relationships between the variables (r=0.12-0.54, p<0.01) with effect sizes from small to large. The four potential mediators (ie, insomnia, sleep quality, psychological distress, and body image concern), individually and in total, significantly mediated the association between exercise addiction and eating disorders.

Conclusion

The findings suggest that exercise addiction in adolescents may influence eating disorders through multiple pathways, such as insomnia, psychological distress, and body image concerns. Future research should examine these relationships longitudinally and use gathered information to inform intervention development. Clinicians and healthcare workers are encouraged to assess exercise addiction when treating individuals with eating disorders.

Low Cooking Skills Are Associated with Overweight and Obesity in Undergraduates

Culinary skills are defined as the confidence, attitude, and the application of one's individual knowledge in performing culinary tasks, and their development may be associated with better diet quality and better health status. This study aimed to analyze the association between cooking skills, overweight, and obesity in undergraduates. This is a descriptive, observational, and cross-sectional study, with data collected between October 2020 and March 2021, with undergraduate students (n = 823) at the Federal University of Rio Grande do Norte. Participants answered the online Brazilian Cooking Skills and Healthy Eating Questionnaire Evaluation, BCSQ, which included socioeconomic information. Logistic regressions were used to assess the associations of cooking skills with overweight and obesity. From the total of the students, 70.8% were female, with a median age of 23 (21-30) years; 43.6% were with overweight or obesity; 48.8% were eutrophic; and 7.7% underweight. Overweight and obesity were significantly associated with low levels of culinary self-efficacy and self-efficacy in the use of fruits, vegetables, and seasonings in the bivariate analysis. The logistic regressions showed that living with other people and eating out were associated with higher chances of overweight and obesity. Sharing the responsibility for preparing meals and a high self-efficacy in the use of fruits, vegetables, and seasonings were associated with lower chances for overweight/obesity. Overall, our study showed that overweight and obesity were associated with lower cooking skills in the studied undergraduates. Therefore, the study demonstrates that culinary skills can be explored in educational programs that aim to reduce overweight/obesity in students.

COVID-19 Vaccine Hesitancy and Its Associated Factors Among Adolescents

Background

Currently, COVID-19 disease is a major public health issue that affects a large number of people worldwide. The COVID-19 vaccine is one of the best preventative measures. Adolescents between the ages of 12 and 17 are eligible to get the COVID-19 vaccine. The COVID-19 pandemic cannot be stopped if people are reluctant to use this vaccine. However, the extent of COVID-19 vaccine hesitancy and related variables among adolescents are not well understood.

Objectives

To assess the magnitude of COVID-19 vaccine hesitancy and its associated factors among adolescents in Seka Chekorsa town, Jimma, Ethiopia.

Methods

Institutional-based cross-sectional study employing both qualitative and quantitative methods were used. The study participants were selected using a simple random sampling technique. Data were collected using interviewer-administered questions. Data collected was checked for completeness and entered into EPI data version 3.1. Finally, data were exported to SPSS version 25 for further analysis. The bivariate analysis was used to identify variables eligible for multivariate logistic regressions. In a multivariable analysis to identify factors that have statistically significant association, a p value less than 0.05 and a 95% confidence interval were used. The qualitative data were triangulated with quantitative data.

Results

In this study, 379 adolescents were participated, yielding a response rate of 95.2%. The magnitude of COVID-19 vaccine hesitancy among adolescents was 29% (95% CI: 24.3-33.5%). Being female (AOR = 1.89, 95%, 1.81-3.56), primary education (AOR = 2.99, 95% CI: 1.26-3.56), source information from social media (AOR = 2.42, 95% CI: 1.06-5.57), poor knowledge about COVID-19 disease (AOR = 3.18, 95% CI: 1.66-6.12), unfavorable attitude (AOR = 5.2, 95% CI: 2.76-9.79) and poor knowledge towards COVID-19 vaccine (AOR = 5.66, 95% CI, 2.91-11.0) were associated with COVID-19 vaccine hesitancy among adolescents.

Conclusion

This study shows that COVID-19 vaccine hesitancy among adolescents is very high. Being female, poor knowledge towards COVID-19 disease and the vaccine, an unfavorable attitude and social media were factors significantly associated with COVID-19 vaccine hesitancy.

Eating disorders during lockdown: the transcultural influence on eating and mood disturbances in Ibero-Brazilian population

BACKGROUND

COVID-19 pandemic has implied exceptional restrictive measures to contain its widespread, with adverse consequences on mental health, especially for those people with a background of mental illness, such as eating disorders (EDs). In this population, the influence of socio-cultural aspects on mental health has been still underexplored. Then, the main aim of this study was to assess changes in eating and general psychopathology in people with EDs during lockdown regarding the ED subtype, age, and provenance, and considering socio-cultural aspects (e.g., socioeconomical factors such as work and financial losses, social support, restrictive measures, or health accessibility, among others).

METHODS

The clinical sample was composed of 264 female participants with EDs (74 anorexia nervosa (AN), 44 bulimia nervosa (BN), 81 binge eating disorder (BED), and 65 other specified feeding and eating disorder (OSFED)), with a mean age of 33.49 years old (SD = 12.54), from specialized ED units in Brazil, Portugal, and Spain. The participants were evaluated using the COVID-19 Isolation Eating Scale (CIES).

RESULTS

A global impairment in mood symptoms and emotion regulation was reported in all the ED subtypes, groups of age, and countries. Spanish and Portuguese individuals seemed more resilient than Brazilian ones (p < .05), who reported a more adverse socio-cultural context (i.e., physical health, socio-familial, occupational, and economic status) (p < .001). A global trend to eating symptoms worsening during lockdown was observed, regardless of the ED subtype, group of age, and country, but without reaching statistical significance. However, the AN and BED groups described the highest worsening of the eating habits during lockdown. Moreover, individuals with BED significantly increased their weight and body mass index, similarly to BN, and in contrast to the AN and OSFED groups. Finally, we failed to find significant differences between groups of age although the younger group described a significant worsening of the eating symptoms during lockdown.

CONCLUSIONS

This study reports a psychopathological impairment in patients with EDs during lockdown, being socio-cultural aspects potential modulatory factors. Individualized approaches to detect special vulnerable groups and long-term follow-ups are still needed.

[Behavioral (non-chemical) addictions and COVID-19]

The review examines the impact of the COVID-19 pandemic on the prevalence, manifestation, as well as the possibility of preventing and treating behavioral (non-chemical) addictions. Particular attention is paid to various manifestations of Internet addiction (IA): gaming, gambling, cybersexual and food addiction (FA). During the pandemic, Internet use increased significantly, leading to an increase in IA, mainly due to gaming, which correlated with the level of psychosocial problems. The increase in gambling occurred mainly in individuals with addiction or risk groups, while in the population the frequency of gambling decreased or did not change. Immediately after the start of the COVID-19 pandemic, the number of requests to porn sites increased dramatically, suggesting an increase in cybersex addiction. However, longitudinal studies in adolescents show a slight decrease in the interest in pornography in boys, and an increase from an initially low level in girls. The proportion of eating disorders and FA significantly increased. An increase in FA was associated with depression, anxiety, and also in obese individuals. In the era of COVID-19 prevention practices and general remedial activity should take into account the needs of the general population, emphasizing the importance of self-regulating and balanced lifestyles with moderate and sensible Internet use during the pandemic.

Trends in eating disorder risk among U.S. college students, 2013-2021

Despite concerns about rising rates of mental health problems among college students in recent years, little is known about trends in eating disorder (ED). This study examined data from the 2013-2020/2021 Healthy Minds Study (HMS), a large study of US college students (N = 267,599). Students completed the SCOFF scale, a validated measure of ED symptoms. From 2013 to 2020/2021 the prevalence of ED risk increased significantly from 15% to 28% (13% increase, 95% CI, 12.2-13.9) with young, female, and Hispanic students experiencing the largest increases. ED risk increased significantly by 3 percentage points (95% CI, 1.7-4.2) during the COVID-19 pandemic.

Effect of the COVID-19 Pandemic on Healthy Components of Diet and Factors Associated with Unfavorable Changes among University Students in France

Introduction: The COVID-19 pandemic and the lockdowns have affected many aspects of university students’ daily lives, including their dietary habits. This study aimed to evaluate the change of diet quality of university students before and during the COVID-19 period, and the factors associated with unfavorable changes in diet quality. Methods: An online cross-sectional study was performed in May 2021 among Rouen (France) university students. Socio-demographic characteristics, body mass index, depression, academic stress, risk of eating disorders and food security were collected. The French “Programme National Nutrition Santé-Guidelines Score 2” (PNNS-GS2) was used to access diet quality. Results: A total of 3508 students were included, 74.4% were female, the mean age was 20.7 (SD = 2.3), and 7.0% were in a situation of food insecurity. The PNNS-GS2 score decreased between the pre- and the COVID-19 pandemic period for 33.1% of university students. The associated factors with the decrease in the PNNS-GS2 score were food insecurity, financial insecurity, not living with parents, depression, academic stress, eating disorders, being in the two first years of study and having been infected by COVID-19. Conclusions: Diets with healthy components decreased for one-third of university students since the COVID-19 pandemic, and this was shown to be associated with food insecurity, poor mental health and eating disorder. This study provides important information to help public health authorities and universities give better support to student health feeding programs during pandemics and lockdowns.

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

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.

Validation of the Arabic version of the ORTO-R among a sample of Lebanese young adults

BACKGROUND

Within the literature, there is a variety of different measurement methods for orthorexic behaviours. The ORTO-15 is the one that attracted most research attention. Many scholars criticized the ORTO-15 for its unstable factor structure and over-estimation of the prevalence of orthorexia nervosa. For this purpose, Rogoza and Donini (Eat Weight Disord 26:887-895, 2020) re-assessed the original data and created a new tool, ORTO-R. The development of the ORTO-R theoretically solved many ambiguities associated with its parent measure. However, to date, no study, including the original one, tested the validity of the ORTO-R, leaving its utility somewhat speculative.

METHODS

We gathered data from 363 Lebanese individuals, who answered the ORTO-R questions and a set of measures used to determine the validity of the scale (eating attitudes, perfectionism, body dissatisfaction, self-esteem, anxiety, and depression). Within this study, we analysed the internal consistency of the scale and different aspects of its validity (factorial, convergent, and divergent).

RESULTS

Results supported all expectations; we successfully confirmed a one-factor measurement model of the ORTO-R, which appeared to be internally consistent. The ORTO-R score correlated positively to other orthorexic behaviours as well as to disordered eating attitudes, perfectionism, anxiety, and depression. It was also negatively related to self-esteem, but was unrelated to body dissatisfaction.

CONCLUSION

The ORTO-R may be deemed as a valid instrument for the assessment of orthorexic behaviours.

LEVEL OF EVIDENCE

V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Dietetics Students' Perceptions of Academic and Health Impacts of the COVID-19 Pandemic

This study examined dietetics students' perceptions of coronavirus disease-2019 (COVID-19) pandemic impacts on academics and mental and physical health. Data were collected via a cross-sectional online survey in February to March 2021 from undergraduate dietetics students across the United States. Among the 526 students who participated, during the fall 2020 semester, 87% experienced increased stress, 64% reported mental health concerns, and 32% reported disordered eating. Sixty-two percent agreed their program met educational needs; however, 62% also agreed COVID-19 negatively impacted the quality of education and 49% agreed to learning less than normal. Pandemic impacts are critical to consider as students enter dietetic internships and start careers.

Seizure and neuropsychiatric compromise as onset of SARS-CoV-2 associated encephalitis

Infectious SARS-CoV-2 meningitis is rare, especially as the first manifestation of a SARS-CoV-2 infection. Infectious SARS-CoV-2 meningitis can initially manifest with seizures and neuropsychiatric abnormalities, worsen to the point of coma, and occasionally lead to death. Patients with infectious SARS-CoV-2 meningitis require comprehensive evaluation and forced treatment in order to improve the often poor outcome.