How the pandemic lockdowns affected the issues that these young people faced was unknown, however - as was the potential of the widely promoted lifestyle changes to moderate any further issues. Dr Naomi Warne, from the Bristol Medical School at the University of Bristol, used a grant from the Elizabeth Blackwell Institute COVID-19 Rapid Research Call, and Quality-Related Strategic Priorities Fund to gain some answers.
“There’s been so much discussion in the clinical and research literature regarding the risk levels of those individuals with eating disorders and self-harming behaviours,” said Dr Warne. “So that was in the forefront of my mind that these may be risk groups and their mental health may be impacted by the pandemic. The Elizabeth Blackwell Institute call for funding came up, and I thought this might be the perfect chance for me to explore the issue.
“Much of the previous research had been done in small samples - what we call convenience samples; essentially asking anyone who's happy to participate. However, we had access to the ALSPAC resource, which is a fantastic opportunity to look at a wide variety of measures from before the pandemic and then all the way through the various lockdowns.”
Generational insights
ALSPAC, or the Avon Longitudinal Study of Parents And Children, is a birth-cohort study which follows more than 14,000 women, and their partners and children (and now, grandchildren). It allows for the study of environmental and genetic factors that can affect a person’s health and development; it currently stands at just under 28,000 participants across three generations. It’s a vastly versatile resource that lets researchers, for example, identify different genetic variables, and then cross reference them with behaviours and predispositions and see how they play out over time. In this study, Dr Warne and her research team found that, at age 25, 32% of the young adults she studied had previously reported eating disorder symptoms in the last year, 9% reported self-harm and 5.5% reported both.
“We found that, during the pandemic, those with previously reported eating disorder symptoms or self-harming behaviours had more symptoms of depression and anxiety and worse mental wellbeing than those who didn’t report these previous problems.”
However, Dr Warne and her team discovered that common mid—pandemic lifestyle changes often thought to help mental health problems appeared to have little effect on the increased risk.
“There was little data to suggest that relaxation techniques or visiting green spaces had any effect,” said Dr Warne. “We did, however, find some suggestion that maintaining the same sleep levels might perhaps be good for anxiety symptoms in individuals with eating disorder symptoms, but as this is only exploratory substantial further work would be needed to verify this finding.”
Impact and policy
The results have been published in the Journal of Eating Disorders, and the work has been prepared as a policy briefing from PolicyBristol, an initiative set up by the University of Bristol which aims to enhance the influence and impact of its research on policy and practice at the local, national and international level.
“The Elizabeth Blackwell Institute funding also allowed me to undergo formal training on policy engagement with PolicyBristol, and this really helped with drafting the policy briefing document. This was distributed to key identified stakeholders, such as the All Party Parliamentary Groups for Eating Disorders and Self-Harm, local eating disorder and self-harm Health Integration Teams, the Royal College of Psychiatrists, and relevant charities and specific policymakers such as Baroness Parminter.”
Dr Warne’s work has also been incorporated into a Houses of Parliament policy postnote from the Parliamentary Office for Science and Technology with the title ‘Mental health impacts of the COVID-19 pandemic on adults’. Postnotes are impartial and peer-reviewed four page documents distributed to members of the Houses of Commons and Lords, as well as UK Parliament staff, to help them understand complex research topics. Dr Warne also has upcoming meetings to discuss her work with the South East NHS eating disorder research network; it is hoped that this will start to increase understanding of the issues nationally.
“My hope is that mine and others’ work, long term, will start to raise awareness at the highest levels. We need to attain sufficient traction for increased funding for mental health services, which are particularly underfunded and overstretched. It's not just our research that suggests this; it's research from all areas of mental health. Moreover, although more service provision is desperately needed, in terms of training, increased access to referral teams and the filling of vacant psychiatrist posts, we also need to look into more preventative techniques and policies - to lessen the burden in the health services in the first place.”
What can we do?
Although there’s not yet been sufficient time to determine all of the downstream impacts of the research, Dr Warne considers it critical to help develop more preventive steps to help young adults with these issues.
“Eating disorders and self-harm behaviour are, in my view, mental health problems that need a lot of oversight in terms of health provision. Of course, most mental health issues are vastly underfunded in terms of service and care, but when it comes to eating disorders, there's so little understanding of these issues at the primary care level. And if an individual does manage to get referral, in many cases specialist care is limited, or simply not available. There are so many consultant psychiatrist posts that are still vacant, in eating disorder services in particular, and it has a huge impact on service provision.
“With regard to self-harming behaviours, a common way that these are picked up is in hospital emergency departments. Here too, when people present with self-harming behaviours, they're not always given a psychosocial assessment (standard care) or referred to psychiatric teams. Primary care, front-line clinicians in emergency departments and liaison psychiatry teams would also hugely benefit from more funding - for staff training and other expansions of service provision in this area.”
Naomi Warne has bee awarded a 3-year Fellowship funded by the Prudence Trust entitled 'Preventing anxiety and depression in schools: Co-production of a novel arts-based programme' She starts on 1 November 2022.