Pandemic Stringency Measures and Hospital Admissions for Eating Disorders.

Importance: Hospitalizations for eating disorders rose dramatically during the COVID-19 pandemic. Public health restrictions, or stringency, are believed to have played a role in exacerbating eating disorders. Few studies of eating disorders during the pandemic have extended to the period when public health stringency restrictions were lifted. Objective: To assess the association between hospitalization rates for eating disorders and public health stringency during the COVID-19 pandemic and after the easing of public health restrictions. Design, Setting, and Participants: This Canadian population-based cross-sectional study was performed from April 1, 2016, to March 31, 2023, and was divided into pre-COVID-19 and COVID-19-prevalent periods. Data were provided by the Canadian Institute for Health Information and the Institut National d'Excellence en Santé et Services Sociaux for all Canadian provinces and territories. Participants included all children and adolescents aged 6 to 20 years. Exposure: The exposure was public health stringency, as measured by the Bank of Canada stringency index. Main Outcomes and Measures: The primary outcome was hospitalizations for a primary diagnosis of eating disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F50), stratified by region, age group, and sex. Interrupted time series analyses based on Poisson regression were used to estimate the association between the stringency index and the rate of hospitalizations for eating disorders. Results: During the study period, there were 11 289 hospitalizations for eating disorders across Canada, of which 8726 hospitalizations (77%) were for females aged 12 to 17 years. Due to low case counts in other age-sex strata, the time series analysis was limited to females within the 12- to 17-year age range. Among females aged 12 to 17 years, a 10% increase in stringency was associated with a significant increase in hospitalization rates in Quebec (adjusted rate ratio [ARR], 1.05; 95% CI, 1.01-1.07), Ontario (ARR, 1.05; 95% CI, 1.03-1.07), the Prairies (ARR, 1.08; 95% CI, 1.03-1.13), and British Columbia (ARR, 1.11; 95% CI, 1.05-1.16). The excess COVID-19-prevalent period hospitalizations were highest at the 1-year mark, with increases in all regions: Quebec (RR, 2.17), Ontario (RR, 2.44), the Prairies (RR, 2.39), and British Columbia (RR, 2.02). Conclusion and Relevance: In this cross-sectional study of hospitalizations for eating disorders across Canada, hospitalization rates for eating disorders in females aged 12 to 17 years were associated with public health measure stringency. The findings suggest that future pandemic preparedness should consider implications for youths at risk for eating disorders and their resource and support needs.

Mental Health Hospitalizations in Canadian Children, Adolescents, and Young Adults Over the COVID-19 Pandemic.

Importance: The COVID-19 pandemic resulted in multiple socially restrictive public health measures and reported negative mental health impacts in youths. Few studies have evaluated incidence rates by sex, region, and social determinants across an entire population. Objective: To estimate the incidence of hospitalizations for mental health conditions, stratified by sex, region, and social determinants, in children and adolescents (hereinafter referred to as youths) and young adults comparing the prepandemic and pandemic-prevalent periods. Design, Setting, and Participants: This Canadian population-based repeated ecological cross-sectional study used health administrative data, extending from April 1, 2016, to March 31, 2023. All youths and young adults from 6 to 20 years of age in each of the Canadian provinces and territories were included. Data were provided by the Canadian Institute for Health Information for all provinces except Quebec; the Institut National d'Excellence en Santé et en Services Sociaux provided aggregate data for Quebec. Exposures: The COVID-19-prevalent period, defined as April 1, 2020, to March 31, 2023. Main Outcomes and Measures: The main outcome measures were the prepandemic and COVID-19-prevalent incidence rates of hospitalizations for anxiety, mood disorders, eating disorders, schizophrenia or psychosis, personality disorders, substance-related disorders, and self-harm. Secondary measures included hospitalization differences by sex, age group, and deprivation as well as emergency department visits for the same mental health conditions. Results: Among Canadian youths and young adults during the study period, there were 218 101 hospitalizations for mental health conditions (ages 6 to 11 years: 5.8%, 12 to 17 years: 66.9%, and 18 to 20 years: 27.3%; 66.0% female). The rate of mental health hospitalizations decreased from 51.6 to 47.9 per 10 000 person-years between the prepandemic and COVID-19-prevalent years. However, the pandemic was associated with a rise in hospitalizations for anxiety (incidence rate ratio [IRR], 1.11; 95% CI, 1.08-1.14), personality disorders (IRR, 1.21; 95% CI, 1.16-1.25), suicide and self-harm (IRR, 1.10; 95% CI, 1.07-1.13), and eating disorders (IRR, 1.66; 95% CI, 1.60-1.73) in females and for eating disorders (IRR, 1.47; 95% CI, 1.31-1.67) in males. In both sexes, there was a decrease in hospitalizations for mood disorders (IRR, 0.84; 95% CI, 0.83-0.86), substance-related disorders (IRR, 0.83; 95% CI, 0.81-0.86), and other mental health disorders (IRR, 0.78; 95% CI, 0.76-0.79). Conclusions and Relevance: This cross-sectional study of Canadian youths and young adults found a rise in anxiety, personality disorders, and suicidality in females and a rise in eating disorders in both sexes in the COVID-19-prevalent period. These results suggest that in future pandemics, policymakers should support youths and young adults who are particularly vulnerable to deterioration in mental health conditions during public health restrictions, including eating disorders, anxiety, and suicidality.

[Social Cognition and the Sense of Agency in Autism: From Action to Interaction]. / Cognition sociale et sens de l'agentivité en autisme : de l'action à l'interaction.

The sense of agency (SoA) refers to the ability for one to detect that she is the cause of an action (Gallagher, 2000). The SoA is linked to motor control but also to self-awareness and could play an important role in social interactions. Autism spectrum disorder (ASD) is characterized by an alteration of social interactions and communication (DSM-5; APA, 2013) and is often seen as a primary deficit of functions specific to social cognition. However, motor control is also altered in ASD. We hypothesize that motor symptoms and social impairments could both arise from the same alteration of SoA. We first introduce theoretical models of implicit and explicit SoA (Synofzik et al., 2008) and present their neurofunctional basis. Then, we assess the clinical expressions of a disrupted SoA in different neuropsychiatric disorders such as schizophrenia. In ASD, the atypical formation of internal models of action during motor acquisition (Haswell et al., 2009) could be at the source of an altered implicit SoA. A lack of fidelity of sensorimotor agency cues (Zalla et al., 2015) could also entail an alteration of explicit SoA. We discuss the main clinical expressions of ASD that may ensue from a disrupted SoA (difficulties in theory of mind and imitation, deficits in motor coordination and praxis, etc.).

Is the Theory of Mind deficit observed in visual paradigms in schizophrenia explained by an impaired attention toward gaze orientation?

Schizophrenia is associated with poor Theory of Mind (ToM), particularly in goal and belief attribution to others. It is also associated with abnormal gaze behaviors toward others: individuals with schizophrenia usually look less to others' face and gaze, which are crucial epistemic cues that contribute to correct mental states inferences. This study tests the hypothesis that impaired ToM in schizophrenia might be related to a deficit in visual attention toward gaze orientation. We adapted a previous non-verbal ToM paradigm consisting of animated cartoons allowing the assessment of goal and belief attribution. In the true and false belief conditions, an object was displaced while an agent was either looking at it or away, respectively. Eye movements were recorded to quantify visual attention to gaze orientation (proportion of time participants spent looking at the head of the agent while the target object changed locations). 29 patients with schizophrenia and 29 matched controls were tested. Compared to controls, patients looked significantly less at the agent's head and had lower performance in belief and goal attribution. Performance in belief and goal attribution significantly increased with the head looking percentage. When the head looking percentage was entered as a covariate, the group effect on belief and goal attribution performance was not significant anymore. Patients' deficit on this visual ToM paradigm is thus entirely explained by a decreased visual attention toward gaze.