Eating disorders and COVID-19 - different or just more?

Cathal Rafferty; Angela O'Donnell; Sally Campbell; Bohan Sun; Jenny King; Zeinab Ali; Diarmuid Lynch; Elizabeth Barrett; Sarah Richardson; Michelle Clifford; Fiona McNicholas

doi:10.1007/s11845-024-03649-x

Eating disorders and COVID-19 - different or just more?

Ir J Med Sci. 2024 Mar 16. doi: 10.1007/s11845-024-03649-x. Online ahead of print.

Authors

Cathal Rafferty¹, Angela O'Donnell², Sally Campbell², Bohan Sun², Jenny King³, Zeinab Ali³, Diarmuid Lynch³, Elizabeth Barrett^{2

4}, Sarah Richardson³, Michelle Clifford⁵, Fiona McNicholas^{2

3

5}

Affiliations

¹ School of Medicine, University College Dublin, Dublin, Ireland. cathal.rafferty@ucdconnect.ie.
² School of Medicine, University College Dublin, Dublin, Ireland.
³ Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Crumlin Dublin 12, Dublin, Ireland.
⁴ Department of Paediatric Liaison Psychiatry, Children's Hospital Ireland, Temple St. Dublin 2, Dublin, Ireland.
⁵ Lucena CAMHS, SJOG, Rathgar Dublin 6, Dublin, Ireland.

PMID: 38492150
DOI: 10.1007/s11845-024-03649-x

Abstract

Background: COVID-19 saw an increase in child mental health presentations internationally. Clinicians analogised the exponential increase in anorexia nervosa to a 'tsunami' or 'outbreak', raising parallel concerns regarding medical and psychological risks (Marsh in The Guardian, 2021; Leask in NZ Herald, 2021; Monteleone et al. in Eat Weight Disord 26(8):2443-2452, 2021) . It is unclear whether Ireland emulated this picture of increased referrals with increased medical compromise.

Aims: This paper examines both rates and clinical profiles of child eating disorder presentations in the Republic of Ireland (ROI), across different clinical settings.

Methods: Following ethical approval, retrospective chart reviews were conducted in a community eating disorder service and in two paediatric hospital settings. The time frame of the different studies ranged from January 2016 to December 2022.

Results: Community eating disorder services saw significantly higher referral rates post COVID-19 (3.78/month vs. 2.31/month, p = 0.02), with a shorter duration of illness (4.8 months vs. 7.4 months, p = 0.001), but no significant difference in ideal body weight % (IBW%) at referral (85.32% vs. 83.7%, p = 0.1). Both paediatric hospitals witnessed significantly increased referrals post-COVID-19 (hospital 1; 4.38/month vs. 1.93/month, p = 0.0001; hospital 2; 2.8/month vs. 0.92/month, p < 0.0001), but no significant difference in IBW% at assessment (hospital 1; 82.7% vs. 81.39%, p = 0.673; hospital 2; 81.5% vs. 83%, p = 0.563). There was no significant difference in clinical profile, management, or duration of hospital stay.

Conclusions: This study supports the growing consensus of a pandemic specific increase in eating disorder referrals to both medical and psychiatry services. However, there was little to indicate a change in clinical profile or severity. Ongoing monitoring of referrals is necessary to ensure adequate service availability and expertise.

Keywords: CAMHS; COVID-19; Eating disorders; Hospital admission; Referral rates.