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      Risk and resilience factors for specific and general psychopathology worsening in people with Eating Disorders during COVID-19 pandemic: a retrospective Italian multicentre study

      research-article
      Author(s): 1 , , 2 , 2 , 3 , 4 , 5 , 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 3 , 13 , 11 , 14 , 15 , 7 , 16 , 6 , 10 , 8 , 17 , 17 , 18 , 13 , 19 , 12 , 2
      Publication date (Electronic):
      Journal: Eating and Weight Disorders
      Publisher: Springer International Publishing
      Keywords: Eating disorders, COVID-19, Risk factors, Vulnerability, Resilience, Psychopathology

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          Abstract

          Purpose

          The COVID-19 pandemic restrictions had negative impact on the psychopathology of people with Eating Disorders (EDs). Factors involved in the vulnerability to stressful events have been under-investigated in this population. We aimed to assess which factors contributed to COVID-19-induced worsening in both general and specific psychopathology.

          Methods

          Three-hundred and twelve people with a clinically defined diagnosis of an ED and undergoing a specialist ED treatment in different Italian ED services before the spreading of COVID-19 pandemic filled in an online survey. ED specific and general psychopathology changes after COVID-19 quarantine were retrospectively evaluated. Factors related to COVID-19 concerns (financial condition, fear of contagion, perceived social isolation/support, satisfaction in peer, family or sentimental relationships), illness duration and treatment-related variables (type of treatment provided, type of access to care, satisfaction with therapeutic relationships) were included as predicting factors in a structural equational model, which included latent variables consisting of general and ED psychopathology items as outcomes.

          Results

          A perceived low quality of therapeutic relationships, fear of contagion and increased isolation were positively associated with psychopathology worsening. Reduced satisfaction with family and with friends’ relationships and reduced perceived social support were associated with ED and general symptoms deterioration, respectively. No significant effect emerged for intimate relationships, illness duration, economic condition and type of treatment.

          Conclusions

          This study provides a comprehensive evaluation of clinical variables associated with psychopathological changes during the COVID-19 lockdown period highlighting potential risk and resilience factors and, possibly, informing treatment as well as prevention strategies for EDs.

          Level of evidence IV

          Evidence obtained from multiple time series analysis such as case studies

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          Most cited references55

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)
          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
          Article 0 comments Cited 7353 times – based on 0 reviews     Review now
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            The PHQ-9: validity of a brief depression severity measure.

            K Kroenke, R L Spitzer, J. Williams (2001)
            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              lavaan: AnRPackage for Structural Equation Modeling

              Yves Rosseel (2012)
              Article 0 comments Cited 4215 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Alessio Maria Monteleone:
                ORCID: http://orcid.org/0000-0002-6786-4458
                alessiomaria.monteleone@unicampania.it
                Journal
                Journal ID (nlm-ta): Eat Weight Disord
                Journal ID (iso-abbrev): Eat Weight Disord
                Title: Eating and Weight Disorders
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 1124-4909
                ISSN (Electronic): 1590-1262
                Publication date (Electronic): 10 January 2021
                Pages: 1-10
                Affiliations
                [1 ]GRID grid.9841.4, ISNI 0000 0001 2200 8888, Department of Psychiatry, , University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie, ; 80138 Napoli, Italy
                [2 ]GRID grid.11780.3f, ISNI 0000 0004 1937 0335, Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, Section of Neurosciences, , University of Salerno, ; Salerno, Italy
                [3 ]GRID grid.7605.4, ISNI 0000 0001 2336 6580, Eating Disorders Center for Treatment and Research, Department of Neuroscience, , University of Turin, ; Turin, Italy
                [4 ]Centro Unico Disturbi Comportamento Alimentare, ASUFC, Udine, Italy
                [5 ]GRID grid.5390.f, ISNI 0000 0001 2113 062X, Unit of Psychiatry, DAME, , University of Udine, ; Udine, Italy
                [6 ]Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
                [7 ]GRID grid.7763.5, ISNI 0000 0004 1755 3242, Section of Psychiatry, Department of Medical Sciences and Public Health, , University of Cagliari, ; Cagliari, Italy
                [8 ]GRID grid.8404.8, ISNI 0000 0004 1757 2304, Psychiatry Unit, Department of Neurological and Psychiatric Sciences, , University of Florence, ; Florence, Italy
                [9 ]European Biomedical Research Institute of Salerno (EBRIS), Salerno, Italy
                [10 ]Center for the Treatment and Research on Eating Disorders, Mental Health Department, ASL Lecce, Lecce, Italy
                [11 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Department of Neuroscience, , University of Padova, ; Padua, Italy
                [12 ]GRID grid.16563.37, ISNI 0000000121663741, Psychiatry Institute, Department of Translational Medicine, , Università del Piemonte Orientale, ; Novara, Italy
                [13 ]Eating Disorders Unit, Casa di Cura “Villa Margherita”, Arcugnano, Italy
                [14 ]Department of Mental Health, Asl Salerno, Salerno, Italy
                [15 ]Dental Health Department, AV2 ASUR Marche, Jesi, Italy
                [16 ]GRID grid.411489.1, ISNI 0000 0001 2168 2547, Department of Health Sciences, , University Magna Graecia of Catanzaro, ; Catanzaro, Italy
                [17 ]Eating Disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Catanzaro, Italy
                [18 ]GRID grid.411489.1, ISNI 0000 0001 2168 2547, Department of Medical and Surgical Sciences, , University Magna Graecia of Catanzaro, ; Catanzaro, Italy
                [19 ]GRID grid.7010.6, ISNI 0000 0001 1017 3210, Section of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, , Università Politecnica delle Marche, ; Ancona, Italy
                Author information
                http://orcid.org/0000-0002-6786-4458
                Article
                Publisher ID: 1097
                DOI: 10.1007/s40519-020-01097-x
                PMC ID: 7797193
                PubMed ID: 33426630
                SO-VID: f9fa4d4c-f40c-4ae5-a9eb-ff82ceeac97b
                Copyright © © The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 6 November 2020
                Date accepted : 14 December 2020
                Categories
                Subject: Original Article

                Keywords: eating disorders,covid-19,risk factors,vulnerability,resilience,psychopathology
                Data availability:
                Keywords: eating disorders, covid-19, risk factors, vulnerability, resilience, psychopathology

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