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The COVID-19 pandemic has profoundly impacted the mental health of adolescents/young adults (AYA) globally. Patients with eating disorders (EDs) are no exception, with studies noting worsening ED-related symptomatology (e.g., calorie restriction, binging, purging, excessive exercise) during the pandemic. Though anecdotally, ED programs have felt an increase in demand for ED-related care, there is little empiric evidence to date. We aimed to compare ED-related care pre- and post-onset of the pandemic among AYA in inpatient and outpatient settings using a sample of geographically diverse adolescent medicine programs.
This study examined data from 11 academic adolescent medicine programs throughout the United States as well as data from one private ED program, which was analyzed separately. Data were obtained as part of the National Eating Disorder Quality Improvement Collaborative, a 25+ site collaborative of adolescent medicine programs. We defined “pre-pandemic” as January 2018-March 2020 and “post-onset of the pandemic” as April 2020-December 2020. We used segmented regression models to examine the trend in monthly volume of patients seeking care for EDs in the inpatient and outpatient settings separately. We compared changes pre- versus post-onset of the pandemic allowing for different slopes in the pre- and post- periods (interaction) and testing for an immediate shift at the time of pandemic related restrictions (intercept). We analyzed data separately for each site and then pooled data from all sites to examine overall trends across sites. For the pooled analysis, we utilized log-transformations to allow for easier comparison of programs of different sizes (i.e., examining relative rather than absolute changes in patient volume).
There was some variability in trends by site. Results from our pooled analysis examining changes in the number of patients requiring medical hospitalization pre- and post-onset of COVID-19 showed a slight increase pre-pandemic of about 1% each month (95% CI: 0.3 to 2% per month; p=0.02). There was an immediate significant decrease of 50% in patients requiring medical hospitalization following onset of the pandemic (95% CI: -67% to -23%; p=0.003). Following this shift, there was a significant average increase in slope of hospitalized patients with EDs of 17% per month (95% CI: 10 to 25% per month; p<0.001). Our pooled analysis examining the number of patients requesting outpatient assessments showed no change pre-pandemic but a significant decline of 71% immediately following onset of the pandemic (95% CI: -88 to -31%; p=0.007), and subsequently an increase of 24% per month on average (95% CI: 11 to 40% per month; p=0.002). In the private ED program, post-onset of the pandemic there was an average of 6 additional inquiries per month (slope=6.3; p<0.001).
We found a significant pandemic-related national increase in both inpatient and outpatient ED patient volume. Given the limitations in ED-related care that existed pre-pandemic, these findings raise concern that existing systems will not be able to meet the current needs. Our results highlight the need to address workforce issues related to ED care as well as improve ED prevention strategies.