O2037: The Impact of the COVID-19 Pandemic on Adolescent/young Adult Eating Disorder Patient Volume: Data from the National Eating Disorder Quality Improvement Collaborative

Purpose/Objectives: The COVID-19 pandemic has impacted the mental health of adolescents/young adults (AYA) globally. Patients with eating disorders (EDs) are no exception, with studies noting worsening ED-related symptomatology (e.g., calorie restriction, binging, purging, excessive exercise) during the pandemic. We aimed to compare ED-related care pre- and post-onset of the pandemic among AYA in inpatient and outpatient settings using a sample of geographically diverse adolescent medicine programs.

Design/Methods: This study examined data from 13 academic adolescent medicine programs throughout the United States as well as data from one non-hospital based ED program, which was analyzed separately. Data were obtained as part of the National Eating Disorder Quality Improvement Collaborative, a 25+ site collaborative of adolescent medicine programs. We defined “pre-pandemic” as January 2018-March 2020 and “post-onset of the pandemic” as April 2020-December 2020. We used segmented regression models to examine trends in monthly volumes of patients seeking care for EDs in inpatient and outpatient settings separately. We compared changes pre- versus post-onset of the pandemic allowing for different slopes in the pre- and post- periods (interaction) and testing for an immediate shift at the time of pandemic related restrictions (intercept). We analyzed data separately for each site and then performed pooled and aggregate analyses of the data to examine overall trends across sites.

Results: There was some variability in trends by site. Results from our aggregate analysis showed that prior to onset of the pandemic, admissions were increasing only slightly by 0.6 per month (p=0.21). There was an immediate significant decline of 54 ED admissions following onset of the pandemic in April 2020 (p=0.001). Following this shift, there was a significant increase over time of 14.6 admissions per month on average (p < 0.001). Our aggregate analysis of new outpatient ED evaluations showed a slight increase pre-pandemic of 1.3 per month (p=0.003) but a significant decline of 103.7 assessments immediately following onset of the pandemic (p < 0.001). Subsequently there was an increase of 19.9 new ED evaluations per month on average (p < 0.001). In the non-hospital based ED program, post-onset of the pandemic there was an average of 6 additional inquiries per month (slope=6.3; p< 0.001).

Conclusion/Discussion: We found a significant pandemic-associated national increase in both inpatient and outpatient ED patient volume. Given the limitations in ED-related care that existed pre-pandemic, these findings raise concern that existing systems will not be able to meet current needs. Our results highlight the need to address workforce issues related to ED care as well as improve ED prevention strategies.