Eating disorder hospitalizations up nearly 60 per cent among girls age 10-17

Hospital visits by young girls and teens for eating disorders increased across Canada in the first year of the pandemic and have remained high. These rates are likely driven by isolation, uncertainty and increased exposure to social media, experts say.

The data was revealed Thursday in a report by the Canadian Institute for Health Information (CIHI). It showed a nearly 60 per cent increase in hospitalizations for eating disorders among girls aged 10 to 17 between March 2020 and March 2021.

The report provides a comprehensive, Canada-wide look at the impact of the first year of the COVID-19 pandemic on youth mental health, as seen by the country’s hospital systems. In multiple surveys since 2020, including one by Statistics Canadayouth have reported a rise in anxiety and depression levels and an overall decline in their mental well-being.

The hospital data paints a complex picture of where some of that impact was felt the most: among young women and girls, as well as youth who live in poorer neighborhoods.

“We are only looking at hospital stays and emergency department visits, and that’s really the tip of the iceberg,” said Tracy Johnson, director of health system analytics at CIHI, adding that youth have also sought care through community services and family doctors.

The first year of the pandemic saw a decline in hospitalizations and visits to emergency departments for all health problems among Canadians aged five to 24. For overall mental health-related visits, a slight decline was observed for that age group. Despite this, the proportion of hospital visits for mental health reasons has increased since 2019, to 23 per cent from 21 per cent.

Among young people hospitalized in 2020, one in four were admitted for a mental health condition, the CIHI data showed. Women and girls made up the majority of those hospitalizations at 58 per cent. In particular, females aged 15 to 17 were twice as likely to be hospitalized as males that age.

These hospitalizations include a stark increase in eating disorder admissions observed across the country since the onset of COVID-19. Dr. Leanna Isserlin, the psychiatric director of the eating disorders program at the Children’s Hospital of Eastern Ontario (CHEO), said this is primarily driven by social isolation, loss of extracurriculars like sports, and pressure from social media as younger people spend more time on-line.

The rise in eating disorders has also been linked to periods of uncertainty. Johnson said that as COVID waves grew throughout the pandemic, so did hospital visits for eating disorders. Uncertainty is also growing now that people are returning to more in-person activities, Isserlin said, and hospitalizations at CHEO due to eating disorders remain high.

This is observed at other major children’s hospitals in Ontario: McMaster Children’s Hospital in Hamilton saw a 67 per cent increase in eating disorder admissions from September to December 2021 compared to the same time period in 2020. The Hospital for Sick Children in Toronto saw a 39 per cent increase in admissions from April 2021 to January, compared to the year before.

The CIHI data also showed that young female patients used mood and anxiety medication at a rate twice as high as that of male patients. The dispensing of these medications continues to grow steadily since 2016.

Of children and youth hospitalized for a mental health condition, more than 25 per cent come from the lowest-income neighborhoods.

The disproportionate number of lower-income children and youth in hospital points to issues around the social determinants of health, Johnson said. Kids whose families struggle with paying rent or putting food on the table are more likely to experience stress. They are also less likely to have the means needed to seek care outside of the hospital system, and end up in the emergency department when their mental health issues have worsened.

“We also see that COVID disproportionately affected marginalized groups,” Johnson said.

The higher proportion of mental health-related hospital visits is alarming experts, who say the system has been overwhelmed with demand for services. This is particularly felt at eating disorder units.

At CHEO, Isserlin said the hospital has had to triage eating disorder patients based on severity, and has only been able to admit children and youth who are very ill. This has delayed care for others who also need it, but whose medical condition might not be as urgent.

“We’re still having to turn away 70 per cent of the referrals that we’re receiving,” Isserlin said.

She added that this is a big cause for concern in the long term, as patients have the best chance of recovery from an eating disorder if they seek help within the first year of their illness. If they wait longer, a full recovery is more difficult to achieve. Some who were referred in 2020 are still waiting well over two years for care, she said.

Overall, Johnson said hospital and emergency department data point to a significant gap when it comes to mental health care in the community, as these admissions represent “the sickest of sick kids.”

“If you were seeing an increase in sick kids who have to be admitted for eating disorders, then they’re not being caught soon enough somewhere else,” Johnson said.

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