Costello Kayla, Birgegård Andreas, Borg Stina, Thornton Laura M, Thompson Katherine A, Hedlund Elin, Peat Christine M, Goode Rachel W, Termorshuizen Jet D, Mantilla Emma Forsén, van Furth Eric F, Bulik Cynthia M, Watson Hunna J
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Psychology, State University of New York, University at Albany, Albany, New York, USA.
Int J Eat Disord. 2025 Feb;58(2):427-439. doi: 10.1002/eat.24347. Epub 2024 Dec 6.
The COVID-19 pandemic caused millions of deaths worldwide and significantly impacted people with eating disorders, exacerbating symptoms and limiting access to care. This study examined the association between COVID-19 death-related loss-defined as the death of a family member, friend, or acquaintance due to COVID-19-and mental health among people with preexisting eating disorders in the United States (US), the Netherlands, and Sweden.
Participants with a history of eating disorders completed a baseline survey early in the pandemic (US: N = 511; Netherlands: N = 510; Sweden: N = 982) and monthly (US, the Netherlands) or biannual (Sweden) follow-ups from April 2020 to May 2021. The surveys assessed pandemic impact on eating disorder-related behaviors and concerns, anxiety, depression, sleep disturbances, and COVID-19-related deaths. A matched nested case-control design was used to compare individuals experiencing a death-related loss with matched controls.
A substantial proportion experienced a COVID-19 death-related loss (US: 33%; Netherlands: 39%; Sweden: 17%). No significant differences were found between cases and controls on eating disorder, anxiety, depression, or sleep outcomes.
Despite the expected influence of COVID-19 death-related loss on mental health, our study found no significant association. Reactions to pandemics may be highly individual, and practitioners may want to consider broader losses-such as bereavement, missed educational experiences, relationship disruptions, financial instability, and employment challenges-when addressing patients' needs. Future research should continue to explore how death-related loss impacts eating disorder risk and progression.
新冠疫情在全球造成数百万死亡，并对饮食失调患者产生了重大影响，加剧了症状并限制了获得护理的机会。本研究调查了在美国、荷兰和瑞典，新冠死亡相关损失（定义为因新冠疫情导致家庭成员、朋友或熟人死亡）与已有饮食失调症患者心理健康之间的关联。
有饮食失调病史的参与者在疫情早期完成了一项基线调查（美国：N = 511；荷兰：N = 510；瑞典：N = 982），并在2020年4月至2021年5月期间每月（美国、荷兰）或每半年（瑞典）进行一次随访。调查评估了疫情对饮食失调相关行为和担忧、焦虑、抑郁、睡眠障碍以及新冠相关死亡的影响。采用匹配嵌套病例对照设计，将经历与死亡相关损失的个体与匹配的对照组进行比较。
很大一部分人经历了与新冠死亡相关的损失（美国：33%；荷兰：39%；瑞典：17%）。在饮食失调、焦虑、抑郁或睡眠结果方面，病例组和对照组之间未发现显著差异。
尽管预期与新冠死亡相关的损失会对心理健康产生影响，但我们的研究未发现显著关联。对疫情的反应可能高度个体化，从业者在满足患者需求时，可能需要考虑更广泛的损失，如丧亲之痛、错过的教育经历、人际关系破裂、经济不稳定和就业挑战。未来的研究应继续探索与死亡相关的损失如何影响饮食失调的风险和进展。
