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Abstract
Introduction/Background Anorexia Nervosa has the highest mortality rate of any psychiatric condition. During the COVID-19 pandemic, the prevalence of many psychiatric conditions was observed to increase worldwide. Eating Disorder charities reported unprecedented demand for their services. In addition, there has been a shortage of specialist Tier 4 Eating Disorder beds nationally with many units closing during the pandemic. For young people, the COVID-19 lockdowns led to social isolation, increased academic pressures and increased stress in their home environment – described by many as a ‘perfect storm’ for deterioration of mental health.
Aim This retrospective study aimed to analyse inpatient admissions with Anorexia Nervosa and their management under the Gastroenterology team at the Bristol Royal Hospital for Children (BRHC) pre and during the COVID – 19 pandemic over a 3-year period, from June 2018 to June 2021.
Subject and Methods All inpatients with anorexia nervosa under 18 years admitted to BRHC were identified using the Trust diagnostic code F50, F50.1. Patient electronic records were individually reviewed to include only those admitted directly for anorexia nervosa management, and collate admission details including length of stay, specific management and discharge destination.
Results 80 patients fulfilled the search criteria. 96% patients were female, with an average age of 13.7 years.
There was an increase in number of admissions and length of hospital stay (LOS) in 2020/2021 compared to 2019/2020 and 2018/2019 (figure 1). Admissions during the COVID-19 pandemic (June 2020 – May 2021) increased by 60% compared with 2019/2020, although only 27% higher than in 2018–19. Length of stay increased by 54% from the 2019/2020 and by 41% from 2018–2019.
The average daily number of inpatients between November 2020 to February 2021 was up to ten times higher than the same period in the previous two years (figure 2).
There was a three-fold increase (10.5%, 2020/2021 compared with 3.3%, 2018/2019) in proportion of patients requiring mental health section in order to provide lifesaving weight restoring treatment compared to 2018/2019. An increased number of patients required NG feeding and psychiatric medications. A higher nursing ratio of up to 6:1 was required for patients needing physical restraint for feeding and controlling excessive exercising. No patients required these measures in 2019–2020.
Percentage of patients admitted to specialist Tier 4 eating disorder (ED) units dropped in 2020/2021 compared to previous 2 years, despite an increase in complexity and severity of illness.
New inpatient admissions and average length of stay by quarters from June 2018 - May 2021
Average daily bed occupancy with anorexia nervosa patients per month from May 2018 - June 2021
Summary and Conclusion This study has demonstrated an increase in number of inpatient admissions for patients with Anorexia Nervosa at a single centre over the past year. A national shortage in specialised Tier 4 ED beds has also likely contributed to increase in patient volume, length of stay and requirement for more intensive management, placing a greater demand on hospital resources.
It is recognised that there is an increasing number of patients presenting with Anorexia Nervosa. The observed trend of patients with increased complexity and severity, delay in presentation and prolonged hospital stay is likely to have been influenced by COVID-19 pandemic.