Mental Health After COVID-19 Death-Related Loss in Individuals With Eating Disorders: A Multi-Country Nested Matched Case-Control Study

Kayla Costello; Andreas Birgegård; Stina Borg; Laura M Thornton; Katherine A Thompson; Elin Hedlund; Christine M Peat; Rachel W Goode; Jet D Termorshuizen; Emma Forsén Mantilla; Eric F van Furth; Cynthia M Bulik; Hunna J Watson

doi:10.1002/eat.24347

Mental Health After COVID-19 Death-Related Loss in Individuals With Eating Disorders: A Multi-Country Nested Matched Case-Control Study

Int J Eat Disord. 2024 Dec 6. doi: 10.1002/eat.24347. Online ahead of print.

Authors

Kayla Costello^{1

2}, Andreas Birgegård³, Stina Borg³, Laura M Thornton¹, Katherine A Thompson^{4

5}, Elin Hedlund³, Christine M Peat¹, Rachel W Goode^{1

6}, Jet D Termorshuizen^{3

7}, Emma Forsén Mantilla^{3

8}, Eric F van Furth^{7

9}, Cynthia M Bulik^{1

3

10}, Hunna J Watson^{1

11

12}

Affiliations

¹ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
² Department of Psychology, State University of New York, University at Albany, Albany, New York, USA.
³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁴ Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
⁵ The Metis Foundation, San Antonio, Texas, USA.
⁶ School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁷ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.
⁸ Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
⁹ Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia.
¹² Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.

PMID: 39641428
DOI: 10.1002/eat.24347

Abstract

Objective: 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.

Method: 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.

Results: 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.

Discussion: 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.

Keywords: COVID‐19; anxiety; bereavement; coronavirus; death; eating disorders; grief; longitudinal; loss; pandemic.

Abstract

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