The impact of Covid-19 on people affected by eating disorders is not unique to Ireland. Here are some examples of what’s been happening internationally.

Haripersad, Kannegiesser-Bailey, Morton et al 2020

• Data from Perth’s Children Hospital, Western Australia, points to increased hospital admissions for children requiring treatment for anorexia nervosa – in particular, nutritional rehabilitation and medical stabilisation. Potential explanations for this include increased social isolation, an intensification of eating disorder cognitions and being disconnected from protective factors such as routines and peer relationships.

Jones, Gentin, Clarke, Arakkakunnel 2020

• Data from Gold Coast University Hospital (GCUH), Australia, also highlights increased admissions for eating disorders, with a doubling of cases of children who required for in-patient care, whilst ‘average length of stay’ (ALOS) also increased. Potential reasons cited included stress and anxiety in the broader community and temporary closures of mental health services.

Gillespie 2021

• The Butterfly Foundation reported a 150% increase in calls during the first school term of 2021, compared to the same period in 2019

New Zealand

Strongman 2021

• At Auckland’s Starship Children’s Hospital, admissions of 10 to 15-year-olds doubled (from 33 in 2019 to 66 in 2020), along with admissions of under 20-year-olds at Auckland City Hospital. A similar increase was seen across all ages at Waikato Hospital, while hospitals in Wellington saw a rise of 31%.

Canada

McCullough 2021

• McMaster Children’s Hospital, Hamilton, Ontario, reported that from September-December 2020 there were 117 new referrals, compared to 67 in 2019, to its eating disorders service. For the same four month period there was a 30% increase in inpatient admissions.

Couturier 2021

• Eating disorder programmes in Ontario have seen three times the typical number of referrals for outpatient care, along with unprecedented increases in children requiring inpatient hospitalisation

Sole-Smith 2021

In the United States, the National Eating Disorders Association (NEDA) reported a 41% increase in messages to its telephone and online help lines in January 2021 compared with January 2020.

Marsh 2020; Bradley 2021; Jayanetti 2021; Beat 2021; Scottish Government 2021; Keedy 2021; Chapman 2021

• In England, the number of children and young people seeking emergency support for anorexia nervosa and bulimia nervosa in the community reached an all time high of 625.
• There were 19,562 new referrals of under-18s with eating disorders to NHS-funded secondary mental health services in 2020, a rise of 46% from the 13,421 new referrals in 2019.
• Beat’s helpline reported an increase of 173% in calls between February 2020 and January 2021
• Calls to Beat’s helpline from people in Northern Ireland increased by 120% in 2020, compared to 2019.
• A report by the Scottish government described an ‘unprecedented increase’ in eating disorders amongst children and young people, with increased severity also causing concern.
• In London, between January and March 2021 there was a 40% increase in children receiving treatment, compared to January-March 2020.
• From April 2020-February 2021, there was a 36% increase in hospital admissions for children across England.

Gainsford 2021

• In France, the Fédération Française Anorexie Boulimie (FFAB), reported a 30% increase in calls to its helpline in 2020.

Israeli pilot study with adult outpatients (Lewis 2021)

• Some people with eating disorders felt the transition to online treatment negatively impacted the effectiveness and quality of treatment
• Others did not feel this was the case, disagreed or had a neutral view or positive outlook
• Two thirds of participants felt that they would opt not to continue with online therapy if given the choice and over half would not recommend online treatment to friends and family members
• Those with different eating disorder diagnoses did not differ in their satisfaction of online treatment or in their perception towards transitioning. Severity of eating disorder symptoms, depression or general anxiety were not associated with perceptions towards the transition.
• Participants who felt more positive towards the transition to online treatment had a stronger therapeutic alliance, more Covid-19 anxiety and a longer duration of treatment pre-lockdown.

Israel – Adolescent perspective (Yaffa 2021)

Researchers spoke with 4 adolescent women with anorexia nervosa to understand their experience of telehealth. At the time of quarantine, they were medically deteriorating and compromised. Findings suggest that telehealth was flexible, easily arranged in times of crisis, allowed for treatment times/slots that suited both the providers and patients. Patients did not have to leave school and other family members could join, if required. Three out of four of the adolescents experienced an improvement in their condition, with multidisciplinary support via telehealth, combined with living with well-organised families, and the motivation and ability to adjust to new circumstances. Team meetings for clinicians were moved online and easy to plan and carry out.

Davis 2020

In Singapore, multidisciplinary meetings were significantly reduced, whilst communication with patients’ primary caregivers increased and routine psychological support for inpatient services were reduced. Group meal supervision became individual meal supervision. Only one parent or caregiver could visit a patient, following a screening for Covid-19. Outpatient medicine and psychology sessions were reduced by approximately 50%, appointments for family-based treatment (FBT) were maintained. Psychologists provided increased support to patients and families by phone.

References

Haripersad, Y.V., Kannegiesser-Bailey, M., Morton. K. et al (2020) Outbreak of anorexia nervosa admissions during the COVID-19 pandemic. Archive of Disease in Childhood, https://adc.bmj.com/content/106/3/e15

Jones, P.D., Gentin, A., Clarke, J., Arakkakunnel, J. (2020) Eating disorders double and acute respiratory infections tumble in hospitalised children during the 2020 COVID shutdown on the Gold Coast. Journal of Paediatrics and Child Health, https://doi.org/10.1111/jpc.15248

Gillespie, E. (2021) Spike in eating disorders, body dissatisfaction among young Australians. SBS News. Retrieved from https://www.sbs.com.au/news/the-feed/spike-in-eating-disorders-body-dissatisfaction-among-young-australians

Strongman, S. (2021) Dying for help: Eating disorder treatment waiting lists months long. Retrieved from https://www.stuff.co.nz/national/health/300258689/dying-for-help-eating-disorder-treatment-waiting-lists-months-long

Gainsford, E. (2021) Eating disorders on the rise in France amid Covid-19 pandemic. France24. Retrieved from https://www.france24.com/en/tv-shows/focus/20210419-eating-disorders-on-the-rise-in-france-amid-covid-19-pandemic

McCullough, K. (2021) McMaster Children’s Hospital reports ‘unprecedented’ spike in eating disorders. The Hamilton Spectator. Retrieved from https://www.thespec.com/news/hamilton-region/2021/03/16/mcmaster-childrens-hospital-reports-unprecedented-spike-in-eating-disorders.html

Couturier, J., Pellegrini, D., Miller, C. et al. (2021) Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: a protocol for an implementation study in the COVID-19 context. Implement Science Communications, 2, 38. https://doi.org/10.1186/s43058-021-00143-8

Sole-Smith, V. (2021) Trapped in a house with an eating disorder. New York Times. Retrieved from https://www.nytimes.com/2021/03/31/well/mind/covid-eating-disorders.html

Marsh, S. (2020) Sharp rise in number of children in England seeking help for eating disorders. The Guardian. Retrieved from https://www.theguardian.com/society/2020/dec/16/shape-rise-in-number-of-children-in-england-seeking-help-for-eating-disorders

Bradley, J. (2021) ‘Unprecedented increase’ in eating disorders, Scottish Government report confirms. The Scotsman. Retrieved from https://www.scotsman.com/news/politics/unprecedented-increase-in-eating-disorders-scottish-government-report-confirms-3176834

Jayanetti, C. (2021) NHS sees surge in referrals for eating disorders among under-18s during Covid. The Guardian. Retrieved from https://www.theguardian.com/society/2021/feb/20/covid-eating-disorder-referrals-rise-under-18s

Beat (2021) Eating Disorders Awareness Week 2021: Key Policy Asks, Northern Ireland. Beat.

Scottish Government (2021) Eating disorder services review: Summary recommendations. Scottish Government. Retrieved from https://www.gov.scot/publications/scottish-eating-disorder-services-review-summary-recommendations/pages/3/

Lewis, Y.D., Elran-Barak, R., Grundman-Shem Tov, R., Zubery, E. (2021) The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients’ perspectives during the COVID-19 lockdown. Journal of Eating Disorders, 9, 31. https://dx.doi.org/10.1186%2Fs40337-021-00383-y

Yaffa, S., Adi, E.L., Itai, P., Marit, J.M., Doron, G., Stein, D. (2021) Treatment of eating disorders in adolescents during the COVID-19 pandemic: a case series. Journal of Eating Disorders, 9, 17. https://doi.org/10.1186/s40337-021-00374-z

Davis, C., Chong, K., Yin Oh, J. et al. (2020) Caring for children and adolescents with eating disorders in the current Coronavirus 19 pandemic: A Singapore perspective. Journal of Adolescent Health, 67(1), 131-134.

Keedy, C. (2021) Sharp rise in children waiting for treatment in London for eating disorders. ITV News. Retrieved from https://www.itv.com/news/london/2021-05-13/sharp-rise-in-children-waiting-for-treatment-in-london-for-eating-disorders

Chapman, T. [@tessa5news] (2021, May 12) New: the shocking rise in children being admitted to hospital with eating disorders. At @StGeorgesTrust in London they used to admit one patient every two weeks. Now they have up to ten at a time. Last year, 5 children had to be sectioned on the ward. Twitter. https://twitter.com/tessa5news/status/1392523949632802821