Resident Physician - Adolescent Medicine McGill University Faculty of Medicine and Health Sciences Burlington, Ontario, Canada
Background: The COVID-19 pandemic saw a rise in the incidence and severity of anorexia nervosa (AN) among youth, accompanied by longer wait times for services and limited opportunities for in-person visits. How these changes affected outcomes for adolescents with AN remains largely unknown. Objective: We sought to assess clinical outcomes of adolescents with newly diagnosed AN or atypical AN (AAN) over a 1 year period treated during the pandemic compared to preceding years. Design/Methods: We performed a retrospective analysis of adolescents (aged 10-18 years) with AN/AAN at a tertiary pediatric hospital. Patients were analyzed in two cohorts: Pre-pandemic (diagnosed between July 2017 and December 2018) vs. Pandemic (diagnosed between July 2020 and December 2021). Clinical and demographic information was collected at assessment and at 1, 3, 6 and 12 month intervals. Results: In total, 253 patients were included. There was a significant increase in newly diagnosed AN/AAN during the pandemic (n=176 vs. n=77; p= < 0.0001). Cohorts were similar in age (pre=14.5; pandemic=14.9) and female sex (90.9% vs. 93.2%). During the pandemic, there was a significantly higher percentage of AN diagnoses compared to AAN (58% vs 38%; p=0.003) and an increased rate of weight loss (2.18 kg/month vs.1.49 kg/month; p=0.0037). At 12 months, the mean number of eating disorder (ED)-related emergency room visits was significantly higher among the pandemic cohort (0.35 vs. 0.13; p=0.0015), with a greater percentage occurring during the first month post diagnosis (60% vs. 30.0% p=0.08). The mean number of ED-related hospitalizations over 12 months was also increased (0.45 vs. 0.2; p=0.0025). During the pandemic, most (72%) hospitalizations occurred in the first month following diagnosis and antipsychotic prescriptions were more common (12% vs. 1.3% p=0.0057). Family-based treatment (FBT) was accepted by 48% of families pre-pandemic vs. 35% during the pandemic (p=0.055); of those in FBT, 59% of the pandemic cohort achieved weight restoration during therapy, however, overall mean weight restoration at 12 months did not differ between the two groups (99.6% vs. 98.6%; p=0.64).
Conclusion(s): Patients newly diagnosed with anorexia nervosa during the pandemic attained weight restoration at the same rate as those diagnosed in the pre-pandemic period. However, the pandemic cohort had significantly more ED-related emergency room visits, hospitalizations, and need for antipsychotic medication, suggesting a more complicated treatment course.
