The Impact of the COVID-19 Pandemic and Associated Public Health Response on People with Eating Disorder Symptomatology: A National Australian Study

Abstract Background Associated with the COVID-19 pandemic is a mental health crisis. People with lived experience of eating disorders (ED) may be particularly vulnerable due to exasperating factors including social isolation, co-occurring conditions, etc. This study investigates the association of the pandemic with ED symptomatology to consider impact and identify risk factors for clinical consideration. Methods Australian participants over 16 years self-reported ED diagnosis and/or symptomatology. An online survey was conducted due to reach, cost-effectiveness, safety and suitability. Participants recorded ED status, co-occurring mental health conditions, completed validated measures of ED illness, state mental health and loneliness, and changes in ED symptoms during the pandemic. Results Of 1723 participants (mode age 24.9 years, 91.6% identifying as female, EDE Global Score x = 4.08, SD = 1.18), 88.0% reported an increase in body image concerns, 74.1% in food restriction, 66.2% binge eating and 46.8% driven exercise during the pandemic. Increased ED symptomatology was associated with poorer state mental health and loneliness across the ED symptom profile. Most participants were negatively impacted by various aspects of the public health response, more so for those with more acute illness. Conclusions With 40.5% of participants not having sought formal diagnostic assessment and less than half in treatment, this study provides evidence for the detrimental impact of the pandemic on people with a lived experience of an eating disorder, especially for those not yet supported by the health care system. This presents baseline data - investigation is ongoing to 6 month follow up to assess longer-term impact.