Impact of the COVID‐19 pandemic on care for anorexia and bulimia nervosa in US military‐connected adolescents and young adults

Abstract

AbstractObjectiveThis study examined the impact of the COVID‐19 pandemic on healthcare engagement for anorexia nervosa (AN) and bulimia nervosa (BN) in a large, geographically diverse population.MethodThis repeated monthly, cross‐sectional study queried Military Health System records of individuals aged 10–21 before and during the pandemic (February 2019–January 2022). ICD‐10 codes identified encounters for AN and BN. Monthly rates of care were modeled as the number of unique individuals with an ICD‐10‐identified eating disorder‐related encounter per month divided by the enrolled population. Poisson regression analysis evaluated rates of care stratified by eating disorder, clinical setting, and sex.ResultsIn a population of 1.76 million adolescents and young adults, 1629 individuals with AN or BN received care during the pre‐pandemic period; 3256 received care during the pandemic. The monthly rate of care for females with AN during the pandemic increased in inpatient settings (adjusted relative risk [aRR]: 1.31 [1.16–1.49]) and outpatient settings (aRR: 1.42 [1.37–1.47]); monthly care rates in males with AN increased in the outpatient setting (aRR: 1.46 [1.28–1.67]). Females with BN had increased engagement in outpatient settings (aRR: 1.09 [1.03–1.16]); BN care for males showed no significant monthly changes during the pandemic period in either healthcare setting.DiscussionWith increased rates of AN and BN disorder‐related care during the pandemic, screening for eating disorder symptomatology may allow for timely diagnosis and intervention in periods of heightened stress. Pandemic‐related increases in healthcare engagement may strain limited resources, emphasizing a need to expand accessibility of clinical expertise.Public SignificanceThis study indicates that monthly rates of healthcare engagement during the COVID‐19 pandemic for AN and BN varied based on clinical setting and sex in an adolescent and young adult population. The increased number of individuals seeking eating disorder‐related care, especially outpatient care, attributed to heightened stressors necessitates accessible professionals with eating disorder clinical expertise.