The impact of the COVID-19 pandemic on eating disorder symptoms and COVID-19-related stress

Introduction
The coronavirus (COVID-19) has led to a worldwide pandemic with various consequences, such as heightened stress and an increase in the risk of developing psychological problems. The pandemic posed specific challenges for patients with eating disorders (ED), with worsening of ED symptoms as a possible consequence. This longitudinal prospective study investigated the associations between COVID-19-related stress and ED symptoms during periods of lockdown compared to reopening periods during the COVID-19 pandemic.

Methods
Over a two-year period, starting in August 2020, patients (N = 108) in specialized treatment for an ED completed monthly measurements of the Eating Disorder Examination Questionnaire (EDE-Q) and the COVID-19 Peritraumatic Distress Index (CPDI). Using mixed linear models, we investigated whether (1) ED symptoms were higher during lockdown periods compared to reopening periods, (2) COVID-19-related stress was higher during lockdown period when compared to reopening periods, (3) COVID-19-related stress was associated with higher levels of ED symptoms, and whether (4) COVID-19-related stress mediated the
association between period (lockdown versus reopening) and ED
symptoms.

Results
Results showed a significant negative total effect between period and ED symptoms, with ED symptoms being lower during the reopening periods compared to the lockdown periods. Secondly, during lockdown periods, patients experienced more COVID-19-related stress than during the reopening periods. Thirdly, there was a significant positive association between COVID-19-related stress and ED symptoms. Finally, results showed a significant negative direct effect of period on ED symptoms, where, controlling for COVID-19-related stress, patients experienced fewer ED symptoms during the reopening periods compared to the lockdown periods (partial mediation).

Conclusion
Both COVID-19-related stress and ED symptoms were higher during lockdown than reopening periods, and greater COVID-19-related stress was associated with more severe ED symptoms. The mediation analysis showed that ED symptoms were higher during lockdown than during reopening periods, partly due to more COVID-19-related stress during lockdown periods.