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In a recent study published in The Lancet Child & Adolescent Health Journal, researchers examined the incidence rates of eating disorders and self-harm two years after the coronavirus disease 2019 (COVID-19) pandemic.

Study: Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. Image Credit: AhmetMisirligul/Shutterstock.com

Background

Self-harm and eating disorders are commonly used as coping mechanisms that can signal the presence of deeper psychological distress.

Reports indicate that individuals in socially disadvantaged environments are most likely to experience the adverse effects of the pandemic on mental health. However, whether the pandemic has worsened pre-existing socioeconomic disparities affecting self-harm and eating disorder rates is unclear. 

About the study

The study collected data from the Clinical Practice Research Datalink (CPRD), a UK database of anonymous primary care electronic health records.

The team focused on an observation period of 10 years before and two years after the pandemic, covering a period between 1 January 2010 and 31 March 2022. The study included individuals aged between 10 and 24 years with one year of continuous registration and data contribution.

The study counted person-time at risk for each participant based on the start of the study, their tenth birthday, one year of continuous registration to a general practice, or one year of data recorded in a general rule.

Follow-up for each person was concluded at the earliest of the following events: outcome of interest, 25th birthday, cessation of registration with the practice, last data collection from the practice by the CPRD, or death.

The study’s main focus was determining the incidence rates of eating disorders and self-harm. The identification of self-harm and eating disorders was conducted using Read, SNOMED, or EMIS codes in CPRD Aurum and Read or SNOMED codes in CPRD GOLD.

The incidence rates were based on the initial record of the analyzed outcome for each eligible participant. People who had a history of eating disorders were considered vulnerable to self-harm. In contrast, those who had a history of self-harm were deemed at risk of developing eating disorders. All instances of self-harm were considered outcome counts.

Results

From January 2010 to March 2022, the team noted that 7,672,027 individuals aged between 10 and 24 years from 1,475 general practices were recruited. The monthly incidence rate of eating disorders and self-harm among girls increased since July 2020.

Between 1 March 2020 and 31 March 2022, there was a 33.1% higher incidence of eating disorders among girls. The incidence of first self-harm events was also higher, with an increase of 18.6% compared to the expected rate.

The incidence rates of various outcomes for boys rose after April 2020. Still, they remained consistently lower than or similar to the estimated rates noted two years after the pandemic began. The incidence of eating disorders reported among boys was 22.8% lower than expected, while the incidence of first self-harm episodes was 11.5% lower.

The pandemic led to a rise in eating disorders among females, particularly girls between 13 and 16 years old. The observed incidence was higher than expected, with a smaller elevation among girls aged between 17 and 19.

The incidence of eating disorders among girls aged between 13 and 16 years was 42.4% more than estimated, while for girls aged between 17 and 19 years, it was 32.0% more than expected. Notably, the incidence of eating disorders among girls aged between 10 and 12 years and between 20 and 24 years was similar to the expected incidence.

During the first two years of the pandemic, there was a higher prevalence of self-harm among girls, particularly those aged between 13 and 16 years, with an estimated incidence of 38.4% higher than expected. No increase in self-harm incidence was observed among girls in other age cohorts.

Furthermore, self-harm incidence was lower than anticipated among boys aged between 17 and 19 and 20 and 24.

Before the pandemic, girls from the least deprived quintile had a higher monthly eating disorder prevalence rate than those from the most deprived quintile. This difference further increased during the pandemic.

During the period between 1 March 2020 and 31 March 2022, there was a significant rise in eating disorder diagnoses, especially among girls from the least deprived quintile. The incidence observed in this group was 52.4% higher than estimated, while in the more deprived quintile, it was 22.2% higher.

Conclusion

Over the last two years, the COVID-19 pandemic has significantly increased primary care-reported eating disorder diagnoses and self-harm events among teenage girls.

Early detection and timely treatment access are crucial in preventing exacerbations of existing mental health conditions in young people. It is important to provide adequate access and treatment from general practitioners and mental health services to address the mental health needs of young people.

Journal reference:

  • Trafford, A.M., Carr, M.J., Ashcroft, D.M., Chew-Graham, C.A., Cockcroft, E., Cybulski, L., Garavini, E., Garg, S., Kabir, T., Kapur, N., Temple, R.K., Webb, R.T. & Mok, P.L.H. (2023) Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. The Lancet Child & Adolescent Health. doi: 10.1016/S2352-4642(23)00126-8. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(23)00126-8/fulltext

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