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. 2023 Oct 3;195(38):E1291-E1299.
doi: 10.1503/cmaj.221318.

Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada

Alene Toulany  1 , Natasha R Saunders  2 , Paul Kurdyak  2 , Rachel Strauss  2 , Longdi Fu  2 , Nicolette Joh-Carnella  2 , Simon Chen  2 , Astrid Guttmann  2 , Therese A Stukel  2
Affiliations

Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada

Alene Toulany et al. CMAJ. .

Abstract

Background: Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic.

Methods: We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10-105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age.

Results: Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10-17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17-2.26), young adults aged 18-26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10-1.16) and older adults aged 41-105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07-1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54-1.54) but decreased for all adult age groups, especially older adults aged 41-105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64-0.80).

Interpretation: Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.

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Conflict of interest statement

Competing interests: Natasha Saunders reports receiving personal fees from The BMJ Group’s Archives of Diseases in Childhood and grants from the Canadian Institutes of Health Research (CIHR), the Ontario Ministry of Health, the Centre for Addiction and Mental Health and The Hospital for Sick Children. Astrid Guttmann reports funding from CIHR. No other competing interests were reported.

Figures

Figure 1:
Figure 1:
Observed and expected rates (per 100 000 people) of eating disorder–related emergency department visits in Ontario by age group (10–17 yr, 18–26 yr, 27–40 yr, 41–105 yr), from January 2017 to August 2022.
Figure 2:
Figure 2:
Adjusted monthly incidence rate ratios of observed versus expected eating disorder–related emergency department visits following the onset of the COVID-19 pandemic, modelled using prepandemic trends in Ontario, by age group. Sex, age group, year and seasonality (months) were used to predict expected rates.
Figure 3:
Figure 3:
Observed and expected rates (per 100 000 people) of eating disorder–related hospital admissions over time in Ontario by age group (10–17 yr, 18–26 yr, 27–40 yr, 41–105 yr), from January 2017 to August 2022.
Figure 4:
Figure 4:
Adjusted monthly incidence rate ratios of observed versus expected eating disorder–related hospital admissions following the onset of the COVID-19 pandemic, modelled using prepandemic trends in Ontario, by age group. Sex, age group, year and seasonality (months) were used to predict expected rates.
See this image and copyright information in PMC

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