Eating Disorders in Teen Girls Doubled During the Pandemic

Trends in prevalence of mental health diagnoses among youths differed by age and sex during the COVID-19 pandemic, with female adolescents representing “the most vulnerable population,” a cross-sectional study showed.

Among teenage girls, the prevalence of anxiety disorders, attention deficit-hyperactivity disorder (ADHD), depression, and eating disorders all increased, with the prevalence of diagnosed eating disorders more than doubling, from 0.26% in March 2020 to 0.36% in October 2020 and 0.56% in March 2022, reported Loreen Straub, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues.

“Female youth, especially female adolescents, represented the most vulnerable population with regard to marked increases in the prevalence of MH [mental health] diagnoses during the pandemic, the most pronounced being the prevalence of eating disorders,” the authors wrote in a research letter published in JAMA Network Open.

“While people might have speculated that teenage girls might be a particularly vulnerable population, we thought we would further look into this, given the data that we have,” Straub told MedPage Today. “Seeing this evidence of that strong increase in mental health diagnoses, particularly among teenage girls, ever since the pandemic started was really, really concerning for us.”

Despite a “considerably lower” prevalence of eating disorders in males ages 13 to 18, trends were similar when compared with teen girls: 0.03% in March 2020 to 0.06% in March 2022, the authors said. Changes in other mental health diagnoses were not observed for teen boys.

Among kids ages 6 to 12, the prevalence of diagnosed mental health conditions — with the exception of ADHD — was lower than among adolescents.

However, the trend in prevalence of eating disorders among younger kids was similar to adolescents. Prior to the pandemic versus during the pandemic, diagnoses increased from 0.03% to 0.05% among girls, and from 0.01% to 0.03% among boys.

Additionally, among 6- to 12-year-old girls, similar but “far less pronounced” changes in the prevalence of other mental health diagnoses were observed, Straub and colleagues noted, while no trends for other diagnoses were seen among 6- to 12-year-old boys.

Although studies conducted shortly after the pandemic began showed an overall uptick in mental health problems among kids, there has not been a nationwide study that examined these trends stratified by age and sex, the authors said.

Asked what could be behind the rise in mental health diagnoses, Straub said she and her colleagues could only speculate. The pandemic disrupted nearly everyone’s daily routines, increased social isolation and financial strain on families, and reduced healthcare access. Among younger people in particular, it led to a “general lack of structure” that may also have been a contributor, she added.

The reduced ability to be active and to exercise may have led to a degree of psychological distress about body weight, which could then manifest in eating disorders. In addition, young people may have been exposed to “certain triggering messages through social media,” Straub said.

Another possible explanation is that parents and caregivers were spending more time with their children, which may lead to parents more readily spotting mental health problems, including eating disorders, she noted.

“Again, this is a hypothesis,” she stressed, and would need to be further studied.

“It’s really important to first try to identify what’s really going on here … [and] try to identify the underlying causes of the increase that we see … before we can talk more about targeted strategies that can be developed to reverse the alarming trends that we see,” Straub said.

For this study, the researchers used the Optum deidentified Clinformatics Data Mart Database, a geographically diverse commercial healthcare claims database, to assess the monthly proportion of youths, stratified by age and sex, who were given a mental health diagnosis from January 2018 to March 2022.

In all, about 1.7 million youths contributed data to each calendar month; 440,722 were girls ages 6 to 12, 410,373 were girls ages 13 to 18, 461,331 were boys ages 6 to 12, and 426,358 were boys ages 13 to 18.

One limitation to the study was that it included only commercially insured youths; therefore, “patterns might look different” for publicly or uninsured populations, Straub said.

In addition, the study may not be entirely representative of all commercially insured youths across the country, because certain regions may have been more heavily sampled than others. Furthermore, the study looked only at mental health diagnoses recorded by providers, so the results may underestimate their true prevalence.