Impact of the COVID-19 pandemic on persons experiencing an eating disorder in the Republic of Ireland

The World Health Organization declared the coronavirus disease 2019 (COVID -19) a global pandemic on the 11th of March 2020. The first coronavirus case in Ireland was detected on the 29th of February 2020 and the Irish government imposed its first lockdown on the 27th of March 2020 with restrictions to slow the spread of the disease. These measures had adverse impacts on people’s mental and psychological well-being (Nisticò et al., 2021). Schlegl et al. (2020) conducted a survey of one hundred and fifty-nine patients who were diagnosed with anorexia nervosa and recently discharged from the inpatient unit, and approximately 70% of patients reported that during the pandemic, their desire to engage in physical exercise increased and their concerns about food, shape, and weight were worsened. A recent systematic review of fifty-three studies (n = 53) that included 36,485 individuals with different types of eating disorder (ED) found that nineteen studies (n = 19) which is 36% of total studies reported an increase in the eating disorder symptoms during the pandemic (Devoe, 2023). In this systematic review, eight studies reported an increase in depression and nine studies reported an increase in anxiety symptoms; however, patterns of change appeared to be diagnostic and timing-specific (e.g. lockdowns). Rodger et al. (2020) studied potential pathways that could exacerbate eating disorder risk and symptoms during the COVID-19 pandemic for example, the disruption of daily routines and constraints on outdoor activities may increase weight and shape concerns and increase ED risk and symptoms (Rodgers et al., 2020). We expect the pandemic to have a similar impact on people with eating disorders in Ireland.

In this cross-sectional survey, all adult patients attending the eating disorder service in St Patrick’s Mental Health Services (SPMHS) Dublin for one year before the COVID-19 pandemic, that is, all patients in the inpatient unit, outpatient, and day hospital service from March 2019 to March 2020, were invited to participate in the study. They were previously diagnosed with an eating disorder as per DSM-5 diagnostic criteria in clinical assessment. This survey was approved by the local ethical research committee in April 2021 and was conducted for six weeks from June 2021 to August 2021.

The participants completed an online questionnaire that assessed the impact of the COVID-19 pandemic on eating disorder symptoms and different aspects of their lives, such as social, occupational, and mental health. The online questionnaire was a modified version of one used in a previous study and included Likert-scale responses (Schlegl et al., 2020). The Perceived Stress Scale (PSS) is the most widely applied measure of perceived stress, that is, the degree to which an individual perceives situations within their life as stressful (Cohen et al., 1983). The shortened 4-item version used in our study has been shown to have good validity and reliability (F. Karam et al., 2012). The ENRICHD Social Support Instrument is a 7-item measure of social support, i.e., the existence or availability of people on whom an individual can rely. Scores range between 8 to 34, with higher scores indicating greater social support circumstances (Berkman et al., 2000). We used non-probability convenience sampling from the population (n = 88) who attended the SPMHS Eating Disorders Services one year before the COVID-19 pandemic began. Thirty-three (37.5%) participants participated in the study but only twenty-four (27.3%) completed the survey. All participants were female (n = 24); the majority were Caucasian (n = 23), and one was of Asian descent. Most participants (n = 22) were between the ages of 18 and 30.

Most of the participants, 83.3% (n = 20) reported that the pandemic worsened overall symptoms of the eating disorders, and 70% (n = 17) reported that the pandemic worsened their quality of life. This study found that the COVID-19 pandemic adversely affected most of the symptoms of anorexia nervosa, e.g., Two thirds of the participants, 75% (n = 18) reported that their drive for thinness worsened during the pandemic, 83.3% (n = 20) reported fear of gaining weight was worsened. Almost half of the participants 47.3% (n = 4) with bulimia nervosa reported no change in the purging behaviour and 50 percent reported no change in binge eating patterns. In summary, the findings of perceived stress scale-4 (PSS-4), it clearly illustrated that most participants, 91.7% (n = 22) said they often felt they do not have control of important things in their lives, and 80% (n = 19) were not confident of their ability to control problems. Almost half of the participants (n = 11) stated that they had someone to confide in when they felt overwhelmed, while one quarter (n = 6) reported always having someone available, indicating the presence of social support.

The results suggested a negative impact on most eating disorder symptoms, and participants reported higher levels of stress in their lives. Although a range of plausible explanations have been proposed, the mechanisms underlying these observations remain to be determined; for example, increased stress experienced during the pandemic may have contributed to an increased drive for physical activity, as one of the functions exercising serves in patients with AN is affect regulation (Meyer et al., 2011). High stress levels were reported by the participants, mirrored by the findings on the PSS-4 scale. This might be due to the closure of leisure activities during the lockdown and people leaving their houses, mainly for exercise. This is mirrored by the findings of a recent study reporting worsening anxiety, depression, and social isolation during the pandemic (Vitagliano et al., 2021).

Parsons et al. (2021) reported a significant surge in hospital admissions for eating disorders in children, adolescents, and adults. Various medical facilities, including Crumlin Hospital Dublin, reported a three-to four-fold increase in the presentation of eating disorders in 2020 compared to 2019. Adult services also experienced a surge, particularly in the 18–24 age group (Parsons et al., 2021). The Health Service Executive (HSE) National Clinical Programme for Eating Disorders published figures for 2020 revealing a 60% increase in referrals and a 43% increase in assessments compared to 2019 during Eating Disorders Awareness Week in March 2021 (Driscoll et al., 2023).

Our survey is limited by small sample size, but the findings are similar to other studies assessing impact of the pandemic on people with an eating disorder. Future research can assess the long-term impact of the pandemic on this vulnerable patient group.