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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-317132

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.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-307401

ABSTRACT

Background: Only one in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Early intervention has been associated with better prognosis, with those seeking specialised intervention in the early stages of their illness more than twice as likely to achieve remission. Current screening measures typically require expert administration and are rarely validated across a spectrum of DSM-5 eating disorder presentations or for online use. In light of COVID-19 and increasing reliance on telehealth technologies in the intervention and delivery of mental health services, online assessments suitable for self-referral are likely to be the first step to seeking care. InsideOut Institute has developed a 6-item online screening tool for the purposes of identifying eating disorder risk and symptomatology, aimed specifically at increasing help-seeking behaviour in subsyndromal and early presentations. Methods: : This study investigates the reliability and validity of the InsideOut Institute Screener (IOI-S), using a cross-sectional survey research design. Participants aged 14 and over will complete an extensive baseline survey battery for evaluation. 50% of participants will be randomly selected for one follow-up re-test of the IOI-S only, two weeks post initial testing. The IOI-S will be analysed for statistical reliability on two parameters: internal consistency and test re-test reliability, and for statistical validity on four parameters: concurrent validity, sensitivity and specificity, convergent and discriminant validity. Discussion: The rapid and ongoing shift to digital intervention has highlighted gaps and opportunities in our pathways to care. Adequate screening for eating disorders is a major gap. This study aims to validate an online screening tool for use in telehealth early intervention, designed for users seeking information for a suspected eating disorder. The screener meets those at risk ‘where they are’ (i.e. online) and may improve timely referrals to relevant services. This is of particular salience as face-to-face healthcare and traditional frontline interventions are disrupted, and we are challenged to re-design our practices to deliver diagnostic and treatment services in highly adaptive digital contexts.

4.
J Eat Disord ; 10(1): 9, 2022 Jan 17.
Article in English | MEDLINE | ID: covidwho-1635513

ABSTRACT

OBJECTIVE: People with lived experience of eating disorders (ED) may be particularly vulnerable to the COVID-19 pandemic and associated public health response due to exasperating situations such as social isolation, presence of other mental and physical health conditions, disruptions to treatment, etc. This study investigates the association of the pandemic with ED symptomatology to consider impact and identify risk factors for clinical consideration. METHODS: Participants with self-reported ED diagnosis and/or symptomatology over 16 years were invited to complete an online survey during the first months of the pandemic in Australia. Questions included history of ED, occurrence of co-occurring mental health conditions, change in ED symptoms since the start of the pandemic, and validated measures of ED illness, state mental health and loneliness. RESULTS: Of 1723 participants (mode age 24.9 years, 91.6% identifying as female, EDE-Q Global Score x = 4.08, SD = 1.18, 79.0% reporting co-occurring mental health condition, predominantly obsessive-compulsive disorder and/or anxiety), 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 (i.e., depression, anxiety, and stress) 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 ED illness as measured by the Eating Disorder Examination Questionnaire (EDE-Q). CONCLUSIONS: Associated with the COVID-19 pandemic is a mental health crisis, particularly for those with a lived experience of an eating disorder. 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 study investigates the impact of the COVID-19 pandemic and associated public health response on people with a self-reported lived experience of eating disorders across Australia. A nation-wide online survey of 1723 participants aged 16­80 years indicated eating disorders symptoms increased globally including body image concern (for 88% of participants), food restriction (74%) and binge eating (66%), especially for those reporting more acute eating disorder illness, poorer mental health (including depression, anxiety, and stress) and experience of loneliness. Albeit necessary, several pandemic experiences were identified as being particularly associated with more acute eating disorder illness such as changes in daily routine, social media reactions, restricted access to support people, and changes to treatment. As less than half of the participants were in treatment at assessment and over 40% had never sought formal diagnosis or treatment, this study highlights the prevalence of unidentified and unsupported people in the community experiencing increase eating disorder symptoms during this pandemic and the need for clinical awareness in general medical and mental health practice.

5.
J Eat Disord ; 9(1): 109, 2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1430482

ABSTRACT

BACKGROUND: Eating disorders are amongst the deadliest of all mental disorders, however detection and early intervention rates remain extremely low. Current standardised screening questionnaires can be arduous or confronting and are ill-validated for online use, despite a universal shift to digital healthcare. The present study describes the development and pilot validation of a novel digital screening tool (the InsideOut Institute-Screener) for high risk and early stage eating disorders to drive early intervention and reduced morbidity. METHODS: We utilised a mixed cross-sectional and repeated measures longitudinal survey research design to assess symptom severity and recognised parameters of statistical validity. Participants were recruited through social media and traditional advertising, and through MTurk. An Eating Disorders Examination Questionnaire (EDE-Q) global score of 2.3 and assessment of eating disorder behaviours was used to determine probable ED. 1346 participants aged 14-74 (mean [SE] age 26.60 [11.14] years; 73.8% female, 22.6% male) completed the survey battery. 19% were randomised to two-week follow-up for reliability analysis. RESULTS: Strong positive correlations between the IOI-S and both the EDE-Q global (rs = .88) and SCOFF (rs = .75) total score were found, providing support for the concurrent validity of the scale. Inter-item correlations were moderate to strong (rs = .46-.73). Correlations between the IOI-S and two measures of social desirability diverged, providing support for the discriminant validity of the scale. The IOI-S demonstrated high internal consistency (α = .908, ω = .910) and excellent two-week test-retest reliability (.968, 95% CI 0.959-0.975; p ≤ 0.1). The IOI-S accurately distinguished probable eating disorders (sensitivity = 82.8%, specificity = 89.7% [AUC = .944], LR+ = 8.04, LR- = 0.19) and two stepped levels of risk. CONCLUSIONS AND RELEVANCE: The present study provides excellent initial support for the psychometric validity of the InsideOut Institute digital screening tool, which has the potential to streamline early intervention in the hopes of reducing current high morbidity and mortality. Further validation should be undertaken in known clinical populations. Eating disorders are amongst the deadliest of all mental disorders, however detection and early intervention rates remain extremely low. The present study describes the initial psychometric validation of a novel digital screening tool (the InsideOut Institute Screener) for high risk and early stage eating disorders, for self-referral and/or use in primary care. 1346 participants aged 14-74 of all genders completed a survey battery designed to assess common parameters of statistical validity. Strong support was found for the screener's ability to accurately measure eating disorder risk and symptomatology. The screener was highly positively correlated with a well known and extensively validated long form self-report questionnaire for eating disorder symptomatology. This study is a pilot validation and the genesis of a project that aims ultimately to drive early intervention leading to reduced morbidity and mortality rates in this illness group.

6.
J Crit Care ; 66: 33-43, 2021 12.
Article in English | MEDLINE | ID: covidwho-1370571

ABSTRACT

PURPOSE: This scoping review sought to identify objective factors to assist clinicians and policy-makers in making consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable. MATERIALS AND METHODS: Review of guidelines and tools used in ICUs, hospital wards and emergency departments on how to best allocate intensive care beds and ventilators either during routine care or developed during previous epidemics, and association with patient outcomes during and after hospitalisation. RESULTS: Eighty publications from 20 countries reporting accuracy or validity of prognostic tools/algorithms, or significant correlation between prognostic variables and clinical outcomes met our eligibility criteria: twelve pandemic guidelines/triage protocols/consensus statements, twenty-two pandemic algorithms, and 46 prognostic tools/variables from non-crisis situations. Prognostic indicators presented here can be combined to create locally-relevant triage algorithms for clinicians and policy makers deciding about allocation of ICU beds and ventilators during a pandemic. No consensus was found on the ethical issues to incorporate in the decision to admit or triage out of intensive care. CONCLUSIONS: This review provides a unique reference intended as a discussion starter for clinicians and policy makers to consider formalising an objective a locally-relevant triage consensus document that enhances confidence in decision-making during healthcare rationing of critical care and ventilator resources.


Subject(s)
COVID-19 , Pandemics , Critical Care , Health Care Rationing , Humans , Triage , Ventilators, Mechanical
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