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. 2025 Sep 29;30(1):77.
doi: 10.1007/s40519-025-01788-3.

Mental health of children and young people with pre-existing eating problems during the COVID-19 pandemic

Johanna Lee  1 , Natalia K Rojas  2 , Snehal M Pinto Pereria  2 , Terence Stephenson  1 , Jennifer McGowan  3 , Trudie Chalder  4 , Emma Dalrymple  1 , Tamsin Ford  5 , Isobel Heyman  1 , Shamez Ladhani  6 , Kelsey McOwat  6 , Ruth Simmons  6 , Olivia Swann  7 ; CLoCk Consortium; Roz Shafran  8
Affiliations

Mental health of children and young people with pre-existing eating problems during the COVID-19 pandemic

Johanna Lee et al. Eat Weight Disord. .

Abstract

Objective: The study sought to explore mental health trajectories of children and young people (CYP) who retrospectively reported eating problems prior to the pandemic, over a 2-year period (2021-23). Given the rapid increase in eating disorder presentations during the pandemic, these CYP may be particularly susceptible to pandemic-related challenges, including social and functional restrictions.

Methods: Data on 2023 CYP from the Children and Young People with Long COVID (CLoCk) study recruited Jan-March 2021 who completed questionnaires at 3-, 6-, 12-, and 24-months post SARS-CoV-2 PCR-testing were analysed. Associations between baseline eating problems (N = 241) and emotional and behavioural symptoms (measured by the Strengths and Difficulties Questionnaire (SDQ) total difficulties and impact scores) at each time-point were examined by regression models. Multi-level models were used to determine whether SDQ total and impact trajectories of those with/without prior self-reported eating problems differed.

Results: Compared to CYP who did not report pre-existing eating problems, those that did had more mental health difficulties at all time points: reflected in significantly higher SDQ total difficulties and impact scores. However, mental health scores of CYP reporting pre-pandemic eating problems were stable over time. Whereas, CYP without eating problems had a slight increase in mental health difficulties over time. Differences between groups diminished but remained significant when controlling for potential confounding variables including prior mental health difficulties.

Discussion: Young people with eating problems had more emotional and behavioural symptoms during 2021-23, compared with those that did not have eating problems. However, mental health did not worsen over time amongst CYP with pre-existing eating problems, providing evidence of some relative resilience to the effects of the pandemic in this population.

Public significance: Eating disorders are a major public health concern and presentations have remained high since the Covid-19 pandemic. Understanding how eating difficulties relate to mental health symptomology over time has implications for service planning.

Level of evidence: Level III: Evidence obtained from well-designed cohort study.

Keywords: COVID-19; Children and young people; Eating problems; Mental health; Pandemic.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was provided by the Health Research Authority Yorkshire and the Humber—South Yorkshire Research Ethics Committee (REC Ref.: 21/YH/0060; IRAS project ID: 293495) and the study is registered with the ISRCTN registry (ISRCTN 34804192). Conflict of interest: Declaration of interests Terence Stephenson is Chair of the Health Research Authority and therefore recused himself from the Research Ethics Application. Trudie Chalder is a member of the National Institute for Health and Care Excellence committee for long COVID. She has written self-help books on chronic fatigue and has done workshops on chronic fatigue and post-infectious syndromes. Terence Stephenson and Roz Shafran are part of Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, where their research is made possible by the National Institute of Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre.

Figures

Fig. 1
Fig. 1
A flowchart of participants from enrolment into the CLoCk study to analytical sample under consideration
Fig. 2
Fig. 2
Mean SDQ total difficulties over time and 95% confidence intervals, by pre-existing eating problems status, adjusted for potential confounders. Note Time points reflect the mean questionnaire return time in months within each data collection sweep. Mean return time at 3 months = 9th May 2021; 6 months = 31st July 2021; 12 months = 3rd Feb 2022; 24 months = 21st Jan 2023. For the Eating Problems group, the first 3-month questionnaire was returned on 19th May 2021, and the last 24-month questionnaire was returned on 6th Jan 2023. For the No Eating Problems group, the first 3-month questionnaire was returned on 17th Apr 2021; and the last 24-month questionnaire was returned on 15th Mar 2023. The trajectory was modelled with an interaction between pre-existing eating problems status and time, p < 0.001. Scores were adjusted for initial SARS-CoV-2 result, age group, sex, IMD-5, ethnicity, prior physical and mental health, EHCP, and prior psychological therapies. CI = Confidence Interval, IMD = Index of Multiple Deprivation, EHCP = Education Health and Care Plan. Higher scores indicate more emotional and behavioural difficulties, with scores above 18 indicating scores in the top 10% of the population and guiding clinical caseness for mental health disorders
Fig. 3
Fig. 3
Mean SDQ impact scores over time and 95% confidence intervals, by pre-existing eating problems status, adjusted for potential confounders. Note Time points reflect the mean questionnaire return time in months within each data collection sweep. Mean return time at 3 months = 9th May 2021; 6 months = 31st July 2021; 12 months = 3rd Feb 2022; 24 months = 21st Jan 2023. For the Eating Problems group, the first 3-month questionnaire was returned on 19th May 2021, and the last 24-month questionnaire was returned on 6th Jan 2023. For the No Eating Problems group, the first 3-month questionnaire was returned on 17th Apr 2021; and the last 24-month questionnaire was returned on 15th Mar 2023. Trajectory was modelled with an interaction between pre-existing eating problems status and time, p < 0.001. Scores were adjusted for SARS-CoV-2 result, age group, sex, IMD-5, ethnicity, prior physical and mental health, EHCP, and prior psychological therapies. CI = Confidence Interval, IMD = Index of Multiple Deprivation, EHCP = Education Health and Care Plan. Higher scores indicate more impact of their emotional and behavioural difficulties with scores above 3 indicating impact in the top 10% of the population
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