The impact of the COVID-19 pandemic and associated public health response on people with eating disorder symptomatology: an Australian study

Jane Miskovic-Wheatley,Eyza Koreshe,Rachel Simeone,Marcellinus Kim,Sarah Maguire

doi:10.1186/s40337-021-00527-0

Jane Miskovic-Wheatley, Eyza Koreshe + Show 3 more

Open Access

https://doi.org/10.1186/s40337-021-00527-0

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Abstract

ObjectivePeople with lived experience of eating disorders (ED) may be particularly vulnerable to the COVID-19 pandemic and associated public health response due to exasperating situations such as social isolation, presence of other mental and physical health conditions, disruptions to treatment, etc. This study investigates the association of the pandemic with ED symptomatology to consider impact and identify risk factors for clinical consideration.MethodsParticipants with self-reported ED diagnosis and/or symptomatology over 16 years were invited to complete an online survey during the first months of the pandemic in Australia. Questions included history of ED, occurrence of co-occurring mental health conditions, change in ED symptoms since the start of the pandemic, and validated measures of ED illness, state mental health and loneliness.ResultsOf 1723 participants (mode age 24.9 years, 91.6% identifying as female, EDE-Q Global Score x = 4.08, SD = 1.18, 79.0% reporting co-occurring mental health condition, predominantly obsessive–compulsive disorder and/or anxiety), 88.0% reported an increase in body image concerns, 74.1% in food restriction, 66.2% binge eating and 46.8% driven exercise during the pandemic. Increased ED symptomatology was associated with poorer state mental health (i.e., depression, anxiety, and stress) and loneliness across the ED symptom profile. Most participants were negatively impacted by various aspects of the public health response, more so for those with more acute ED illness as measured by the Eating Disorder Examination Questionnaire (EDE-Q).ConclusionsAssociated with the COVID-19 pandemic is a mental health crisis, particularly for those with a lived experience of an eating disorder. With 40.5% of participants not having sought formal diagnostic assessment and less than half in treatment, this study provides evidence for the detrimental impact of the pandemic on people with a lived experience of an eating disorder, especially for those not yet supported by the health care system.

Highlights

The coronavirus disease 2019 (COVID-19) was declared a global pandemic in March 2020 by the World Health Organization and as of March 2021 had infected over 117 million people and caused over 2.6 million deaths worldwide [1]
This study investigates the impact of the COVID-19 pandemic and associated public health response on people with a self-reported lived experience of eating disorders across Australia
As less than half of the participants were in treatment at assessment and over 40% had never sought formal diagnosis or treatment, this study highlights the prevalence of unidentified and unsupported people in the com‐ munity experiencing increase eating disorder symptoms during this pandemic and the need for clinical awareness in general medical and mental health practice

Summary

Introduction

The coronavirus disease 2019 (COVID-19) was declared a global pandemic in March 2020 by the World Health Organization and as of March 2021 had infected over 117 million people and caused over 2.6 million deaths worldwide [1]. Research on the impact of acute respiratory epidemics on vulnerable populations have shown neuropsychiatric linkage between outbreaks and mental disorders [4]. The COVID-19 pandemic has similarities with past outbreaks in terms of global fear due to the virus itself, financial insecurity, and modern quarantine strategies such as mandatory lockdowns and ‘social distancing’ to curtail viral spread. Isolation significantly impacts mental health causing feelings of anxiety, depression, anger, and loneliness, with increased duration in quarantine directly associated with increased symptoms of Post-Traumatic Stress Disorder [5]. Following early warnings from the United Nations about a pandemic-associated mental health crisis [6], population-wide mental health concerns have been reported including a twofold increase in anxiety disorders, a threefold increase in major depressive disorders and suicide risk, and significant increases in binge drinking [7]. While all communities have been impacted socially, financially and psychologically, the pandemic may have significant impact on those most vulnerable, such as people with pre-existing mental health illnesses [8], especially people with lived experience of eating disorders [9]

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