How Did the COVID-19 Pandemic Affect Eating Disorder Treatment Access?

For adolescents and young adults with eating disorders, eating disorder treatment costs can be substantial and patients often face a wide variety of medical and non-medical barriers to efficient and effective treatment access. These health care issues were exacerbated by the COVID-19 pandemic, as the isolation and anxiety associated with COVID-19 exacerbated many patients’ eating disorder symptoms. These findings were published in the Journal of Eating Disorders.

A wealth of evidence has demonstrated that the COVID-19 pandemic has substantially affected the mental health of children, adolescents, and young adults across the globe. In particular, the number of new cases and severity of pre-existing cases of eating disorders increased during the pandemic – largely attributed to the societal stressors associated with COVID-19. However, relatively little is known about how the pandemic affected primary caregivers of patients with eating disorders and health care professionals in this field. To this aim, the current study sought to evaluate 1) the costs associated with eating disorder treatment, 2) whether the pandemic affected these costs, and 3) the implications of how these costs may pose a barrier to treatment access.

Investigators recruited adolescents and young adults (aged 16 to 25 years) with lived/living eating disorder experience, primary caregivers, clinicians, and decision-makers across Canada to participate in a survey between December 2022 and March 2023. The survey assessed the potential changes in eating disorder treatment costs and/or service delivery based on pandemic-related disruptions. Additionally, respondents completed a survey of demographic information (ie, age, location, gender identity, sexual orientation, ethnicity, race, and disability status). A total of 117

Of the 117 survey respondents, 24.7% were adolescents and young adults with lived/living eating disorder experience, 24.7% were caregivers of patients with eating disorders, 44.4% were clinicians, 3.4% were decision-makers, and 2.6% of participants did not indicate their group affiliation. Due to low response among decision-makers, their data was combined with clinicians.

Among adolescents and young adults accessing eating disorder treatment, the top direct, medical were therapist/psychiatrist services (58.6%), medication (44.8%), and dietitian services (37.9%). The most frequently reported non-medical costs associated with eating disorder treatment were transportation (78.4%), virtual care (44.8%), and supporting family members (31%). Additionally, barriers to treatment were largely long waitlists (58.6%) and a lack of eating disorder-specific treatment options (58.6%). However, 10.3% of adolescents and young adults indicated that virtual care was beneficial for reducing medical costs.

The investigators observed similar responses from caregivers, who cited the top direct medical costs as special food and nutritional supplements (82.8%) and medication (62.1%), along with transportation (82.8%) and supporting themselves as primary caregivers (58.6%) as top non-medical costs. Caregivers also found that long waitlists (72.4%) and limited access to qualified mental health professionals (69%) were major barriers to care.

For health care workers, the most frequently reported barriers to service delivery were increased work demands (64.3%) and fear of COVID-19 exposure (58.9%). Among health care professionals, 70% providing virtual care during the pandemic and 34.5% considered leaving their positions within 1 to 2 years due to pandemic-related impacts.

Qualitative analyses based on interviews and discussions with the subset of respondents revealed 4 main themes regarding costs associated with ED treatment during the pandemic: financial burdens, exacerbated stressors, resource challenges, and systemic impacts. Additionally, the pandemic worsened personal, family, and work-related stressors, leading to isolation, strained relationships, and burnout among caregivers and clinicians.

The investigators indicated that providing enhanced support for patients and caregivers seeking eating disorder treatment is necessary during both crisis and non-crisis periods. Additionally, health care systems must address resource management to retain proper staffing.

The investigators concluded, “This data can help inform hospital administrators and policymakers to make decisions regarding future crises and the long-term impact of the pandemic on [eating disorders].”

The generalizability of these findings may be limited, as respondents were primarily women, White, and were largely from Ontario and Alberta.

This article originally appeared on Psychiatry Advisor