When the Covid-19 pandemic started, its impact on mental health became a pressing concern, especially for vulnerable groups like Children and Young People (CYP). But what about the CYP battling disordered eating – a group of people who particularly struggle with mental and physical health issues alongside social difficulties?
Background
Approximately 13% of CYP aged 11 to 16 years exhibited signs of possible eating problems. These behaviours, falling under the umbrella of disordered eating, range from eating too little to eating in an uncontrolled manner, and are often tied to body weight, shape, or image concerns. People with disordered eating may experience a clinical eating disorder, such as anorexia nervosa, an eating disorder characterised by behaviours to keep the individual’s body weight as low as possible. Others may experience behaviours that are typically less severe or frequent than those seen in clinical eating disorders. Nevertheless, research indicates that these behaviours during adolescence are associated with a heightened risk of mental and physical health problems, as well as social functioning difficulties.
Understanding the mental health of CYP struggling with disordered eating is crucial. The Covid-19 pandemic likely heightened the risk of eating disorders and exacerbated mental health difficulties. Young people with eating disorders particularly struggle during times of uncertainty. They perceive uncertainty negatively and often feel anxious and stressed, experiencing a loss of control. They resort to disordered eating behaviours to help regain control. The pandemic undoubtedly brought about uncertainty with concerns over the spread of the virus, lockdown measures, school closures and reopenings, and restrictions on socialising.
They may have also been especially vulnerable due to social restrictions which limited their social support networks and peer interactions, an aspect which they often report as vital for their recovery. However, research has predominantly focused on the mental health of adults with eating disorders, with less attention paid to CYP, and when addressed, the focus tends to be on their eating disorder symptoms.
In our study, we aimed to explore the long-term impact of the pandemic on the mental health of CYP with disordered eating prior to the pandemic and compare them to those without disordered eating.
What did we do?
We used data from the Children and Young People with Long Covid (CLoCk) study, which documented changes in the mental and physical health of over 30,000 CYP across England, aged 11-17 years, following PCR testing. They were contacted to complete an online CLoCk questionnaire, which included questions about their mental and physical health.
In our study, we analysed data from 2,023 CYP who completed their PCR test between January and March of 2021, and completed the CLoCk questionnaire at 3, 6, 12, and 24 months post-testing. We compared CYP who self-reported disordered eating prior to the pandemic with those who did not. Specifically, we examined their change in mental health difficulties over time, and to do this, we looked at their scores on the Strengths and Difficulties Questionnaire (SDQ), a globally recognised and validated mental health measure. Higher SDQ scores indicate greater mental health difficulties.
What did we find?
We conducted cross-sectional analyses to initially compare the mental health of those with and without disordered eating at each time-point, finding that CYP with disordered eating had higher scores on the SDQ at all time-points.
We conducted longitudinal analyses, comparing the mental health trajectories of those with and without disordered eating, finding that:
- CYP with disordered eating experienced no change in mental health over time,
- CYP without disordered eating had increasing mental health difficulties over time.
What do our results mean?
Surprisingly, CYP exhibited stable mental health trajectories contrary to our expectations, unveiling a silver lining amidst the pandemic storm. This hints that the pandemic had a nuanced impact.
- CYP with disordered eating often face social functioning difficulties that surpass those of their peers without such disordered eating. The social restrictions imposed during the pandemic may have had little impact on them.
- Social distancing measures also reduced triggers like face-to-face body-based social comparisons, known to impact body dissatisfaction and disordered eating behaviours.
- Increased familial support when peer interactions were disrupted may have served as a protective factor for maintaining stable mental health.
Digging deeper into our findings, a troubling truth emerges. Despite the absence of significant changes in their mental health, CYP with disordered eating consistently exhibited elevated mental health difficulties. This unwavering mental health struggle underscores the need for mental health support.
How can we improve our study?
Our analysis drew from a substantial sample of 2,023 CYP. However, we encountered issues with demographic diversity. Predominantly, the participants were older girls, of White ethnicity, from the least deprived areas. This imbalance echoes an issue often seen in eating disorder research, perpetuating the stereotype of those primarily affected as SWAG (skinny, White, affluent girls). Yet, research underscores that eating disorders transcend age, ethnicity, gender, socioeconomic status, and sexual orientation. Our study falls short in representing those affected by disordered eating, however they were less inclined to participate in the study. This raises the issue: how can we foster greater diversity in eating disorder research?
Conclusions
Unravelling the nuances of our findings reveals a paradox: while CYP with disordered eating showed resilience in their mental health, their underlying mental health struggles remained profound. Therefore, we should not overlook the mental health support they require, highlighting the need to understand their unique needs.
Conversely, the trend of deteriorating mental health among CYP without disordered eating beckons further investigation. Qualitative avenues could shed light on the underlying mechanisms for this change.
Moreover, our study’s demographic limitations serve as a reminder of the need for inclusivity in eating disorder research. The road ahead demands a concerted effort to represent all individuals affected by eating disorders.
References
- Cooper, M., Reilly, E. E., Siegel, J. A., Coniglio, K., Sadeh-Sharvit, S., Pisetsky, E. M., & Anderson, L. M. (2022). Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. Eating disorders, 30(1), 54-76.
- Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2002). Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Archives of general psychiatry, 59(6), 545-552.
- Konstantellou, A., Hale, L., Sternheim, L., Simic, M., & Eisler, I. (2019). The experience of intolerance of uncertainty for young people with a restrictive eating disorder: a pilot study. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 24, 533-540.
- Lindstedt, K., Neander, K., Kjellin, L., & Gustafsson, S. A. (2018). A life put on hold: adolescents’ experiences of having an eating disorder in relation to social contexts outside the family. Journal of multidisciplinary healthcare, 425-437.
- Murphy, R., Calugi, S., Cooper, Z., & Dalle Grave, R. (2020). Challenges and opportunities for enhanced cognitive behaviour therapy (CBT-E) in light of COVID-19. The Cognitive Behaviour Therapist, 13, e14.
- Patel, K., Tchanturia, K., & Harrison, A. (2016). An exploration of social functioning in young people with eating disorders: a qualitative study. PloS one, 11(7), e0159910.
- Stephenson, T., Shafran, R., De Stavola, B., Rojas, N., Aiano, F., Amin-Chowdhury, Z., … & CLoCk Consortium. (2021). Long COVID and the mental and physical health of children and young people: national matched cohort study protocol (the CLoCk study). BMJ open, 11(8), e052838.
Word Count: 950 words (5-minute read)
Credit: Cover picture attributed to StorySet (https://storyset.com/illustration/sulkiness/cuate)