What you need to know
In the early months of the COVID-19 pandemic, hospitals reported an increase in children and adolescents seeking acute care for eating disorders. To determine if this was the case in Ontario, researchers compared the rates of emergency department (ED) visits and hospitalizations for pediatric eating disorders before and during the first 10 months of the pandemic. Looking at health administrative databases, they found an overall increase of 66 per cent increase in the risk of ED visits and 37% in the risk of hospitalization. More research is needed to understand the social and neurobiological mechanisms that may be at the root of these changes.
What is this research about?
In the first few months after the start of the COVID-19 pandemic, pediatric hospitals in high-income countries began to report substantial increases in acute presentations of eating disorders among children and adolescents. These findings were important because, before the pandemic, ED admissions or visits at pediatric hospitals and adolescent medicine departments had generally stagnated or decreased.
It is important to understand how eating disorders are presenting in Ontario to inform decisions about eating disorder resources and acute-care capacity during and after the pandemic.
What did the researchers do?
Researchers used the linked health administrative databases available at the Institute for Clinical Evaluative Sciences in Ontario. They conducted a population-based repeated cross-sectional study of acute care visits for eating disorders among children and adolescents aged three to 17 years from January 1, 2017, to December 26, 2020, in Ontario, Canada. This type of study follows participants at a single point in time.
What did the researchers find?
Acute care visits for eating disorders increased immediately after the pandemic started. Overall, the researchers saw a 66 per cent increase in ED visits and 37 per cent increase in the risk of hospital stays.
Among children and adolescents eligible for provincial health insurance in October 2020, ED visits reached a four-week peak rate of 35 ED visits and 43 hospitalizations per 100,000 people.
There were age-related differences. Among three to 13-year-olds, rates of ED visits were lower than would have been expected during the months of April and May, peaked in December 2020, then returned to expected rates. Among 14- to 17-year-olds, ED visits were higher than expected after the pandemic started, except in May 2020.
On the other hand, hospitalizations for eating disorders remained mostly higher than expected after the start of the pandemic.
Limitations of the research
The authors noted that their study had several limitations. Since they used health administrative data, there might have been potential coding errors, lags in the transfer of data and lack of clinical details. In addition, the study could only look at the effects of the COVID-19 pandemic within a 10-month timeframe due to the lag in data transfer. Also, the study did not include patients who saw other health professionals, such as social workers, psychologists and other therapists.
How can you use this research?
This research would be of interest to policy-makers and system planners as it has important implications for ongoing surveillance and allocation of resources for pediatric eating disorders.
About the researchers
Toulany, A.1,2,3,4,5, Kurdyak, P.3,5,6,7, Guttmann, A.1,2,3,4,5,8, Stukel, T.A.3,4, Fu, L. 3, Strauss, R. 3, Fiksenbaum, L.1,4, Saunders, N.R.1,2,3,4,5,8
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada