The impact of the COVID-19 pandemic on help-seeking behaviors in individuals suffering from eating disorders and their caregivers

May combine two claims.

The acceptability and effectiveness of e-health interventions in eating disorders is limited and needs significant improvement.

“both the acceptability and effectiveness of such interventions in the field of EDs has been shown to be limited and in need of significant improvement [17].”

• cites [17] sourcePartly supported

  The Discussion’s Effectiveness section says effectiveness appears limited, and its Acceptability section calls for ways to increase acceptability. But the Abstract’s Discussion says the *evidence* for acceptability is very limited, not that acceptability itself has been shown to be limited; the Abstract’s Results report mixed acceptability findings. The claim overstates that part of the review’s conclusion. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Eating disorders are chronic mental disorders associated with high relapse rates, high treatment costs, diminished quality of life, and medical morbidity and mortality.

“EDs are chronic mental disorders associated with high relapse rates, high treatment costs, diminished quality of life [3] but also medical morbidity and mortality [4,5].”

• cites [3] sourcePartly supported

  The Abstract’s Results and the Plain English Summary report poor health-related quality of life among people with several eating disorders, supporting that part of the statement. The cited paper does not establish that eating disorders are chronic or have high relapse rates or high treatment costs. Medical morbidity and mortality are attributed to different citations [4,5] in the printed sentence and are not judged here. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [4] sourceNot checked — no full text of the source
• cites [5] sourceNot checked — no full text of the source

May combine two claims.

Recent papers describe online delivery of evidence-based eating disorder treatments, but these treatments are not available or accessible to all patients.

“while several recent papers [18,19] have been published about the online delivery of evidence-based treatments for eating disorders, these treatments are not available or accessible to all patients.”

• cites [18] sourceSupported
• cites [19] sourceNot checked — no full text of the source

May combine two claims.

In a separate analysis of five of nineteen included studies, anxiety symptoms ranged from 6.33% to 18.7%, depressive symptoms from 14.6% to 32.8%, stress symptoms were 27.2%, and PTSD symptoms were 7%.

“the rates of anxiety symptoms ranged from 6.33% to 18.7%, depressive symptoms from 14.6% to 32.8%, stress symptoms were 27.2%, and PTSD symptoms were 7%.”

• cites [16] sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Xiong et al. found a high prevalence of adverse psychiatric symptoms in most studies across eight countries.

“Xiong et al. [16] found that a high prevalence of adverse psychiatric symptoms was reported in most studies conducted across eight countries.”

• cites [16] sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Pierce et al. found the population prevalence of clinically significant mental distress rose about 10%, from 18.9% in 2018-19 to 27.3% in April 2020.

“Pierce et al. [15] found that the population prevalence of clinically significant levels of mental distress rose about 10%, from 18.9% in 2018–19 to 27.3% in April 2020.”

• cites [15] sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Eating disorders affect a significant portion of the global population, with lifetime prevalence of 1% to 4% in epidemiological studies.

“Eating disorders (EDs) affect a significant portion of the global population, with lifetime prevalence rates ranging from 1% to 4% in epidemiological studies [1].”

• cites [1] sourcePartly supported

  The Prevalence section (page not supplied) reports lifetime prevalence figures around 1%–4% for particular eating disorders in specific cohorts and countries. It does not establish a 1%–4% lifetime prevalence for eating disorders collectively across the global population. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Four themes emerged from these 56 chats: lack of access to treatment, worsening of symptoms, feeling out of control, and need for support.

“Among these 56 chats, four emerging themes were identified: 1) lack of access to treatment, 2) worsening of symptoms, 3) feeling out of control, and 4) need for support.”

May combine two claims.

Teenager contacts differed significantly between years (X2(2)=87.56, p<.001), highest in 2020 (n=126; 28.7%) versus 2018 (n=25; 12.7%) and 2019 (n=35; 11.2%).

“Of note, the number of teenagers who contacted NEDIC significantly differed between years (X2(2) = 87.56, p < .001), with the highest number (n = 126; 28.7%) in 2020, versus n = 25 in 2018 (12.7%) and n = 35 in 2019 (11.2%).”

May combine two claims.

In the prior two years, most affected individuals were adults (48.2% in 2018; 47.8% in 2019) and young adults (21.8% in 2018; 19.9% in 2019).

“However, the majority of affected individuals in the prior two years were by far adults (48.2%, n = 95 in 2018; 47.8%, n = 149 in 2019) and young adults (age 20–25; 21.8%, n = 43 in 2018; 19.9%, n = 62 in 2019).”

Probably not a substantial claim: may not pass S3 (load-bearing).

In previous years, most affected individuals were also women (86.8% in 2018; 77.6% in 2019).

“These findings are comparable with previous years, in which the majority of affected individuals were also women (86.8%, n = 173 in 2018; 77.6%, n = 242 in 2019)”

May combine two claims.

In previous years, the most common self-reported diagnoses were AN (31.4% in 2018; 29.7% in 2019) and BED (41.2% in 2018; 43.8% in 2019).

“the most prevalent self-reported diagnoses were AN (31.4%, n = 32 in 2018; 29.7%, n = 55 in 2019) and BED (41.2%, n = 42 in 2018; 43.8%, n = 81 in 2019).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most caregivers (72.6%, n=90) were women.

“The majority of caregivers (72.6%, n = 90) were women”

May combine two claims.

Among affected individuals, contacts differed significantly across years (X2(2)=92.74, p<.001), highest in the pandemic (n=439), lowest in 2018 (n=197), and moderate in 2019 (n=312).

“Among affected individuals, the number of contacts differed significantly across the years (X2(2) = 92.74, p < .001), with the highest frequency of contacts in the pandemic period (n = 439), the lowest in 2018 (n = 197), and a moderate amount in 2019 (n = 312; 2020 > 2019, 2020 > 2018, 2019 > 2018).”

May combine two claims.

46% of chatters (n=26) experienced help-seeking delays and treatment program suspensions due to COVID-19, leaving them with limited or no access to regular supports.

“In detail, 46% of chatters (n = 26) experienced help-seeking delays and treatment program suspensions in the context of COVID-19 which left them with limited or no access to their regular supports.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most caregivers (67.7%, n=84) were adults aged 26+.

“Additionally, the majority of caregivers (67.7%, n = 84) were adults (age 26+).”

May combine two claims.

Differences in symptom frequencies are driven by 2020>2018 and 2020>2019; changes between 2018 and 2019 were not significant.

“On the other hand, the differences in symptom frequencies are driven by differences between 2020 > 2018 and 2020 > 2019; the changes between 2018 and 2019 were not significant.”

May combine two claims.

Only 2% of affected individuals self-disclosed OSFED, while 53% were undiagnosed or did not want to disclose.

“while only 2% of affected individuals self-disclosed to suffer from OSFED, 53% reported to be undiagnosed or did not want to disclose their diagnosis.”

May combine two claims.

Government-funded treatment options have taken longer to implement, leaving many patients without the financial means to pay for treatment.

“the provision of government-funded treatment options have taken longer to implement, leaving many patients without the financial means to pay for treatment, without access to accessible care [20].”

• cites [20] sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Chat transcripts were independently coded by two authors, concepts were grouped into themes and named by both, and data were discussed among all authors to ensure they reflected the original data.

“Chat transcripts were read by two authors (CR, MP) who independently coded text into concepts; concepts were subsequently examined for their meanings, grouped into related themes, and named by both authors. Data were discussed between all authors to ensure they appropriately reflected the original data.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The increased teenager contacts could reflect increased needs for support in this age group during the pandemic.

“This finding could be reflective of increased needs for support in this age group during the pandemic.”

May combine two claims.

Affected individuals either do not seek ED-specific treatment or do not receive appropriate care when they seek it.

“it has repeatedly been shown that affected individuals either do not seek ED-specific treatment, or do not receive appropriate care when it is sought [6,7].”

• cites [6] sourceNot checked — no full text of the source
• cites [7] sourceNot checked — no full text of the source

May combine two claims.

Fernández-Aranda et al. surveyed 32 ED patients during the first two weeks of the pandemic; most had worries about uncertainty, 12 reported increased ED symptomatology, and 18 reported increased anxiety.

“In a pilot study, Fernández-Aranda et al. surveyed 32 patients with EDs to measure the impact of confinement during the first two weeks of the pandemic. They found most patients presented worries about increased uncertainty in their lives, 12 patients (out of 32) reported increased ED symptomatology, and 18 reported increased anxiety symptoms [14].”

• cites [14] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A possible explanation for increased teenager contacts is that teenagers were not attending school in person, lacking their usual support network and structure.

“A possible explanation may be that teenagers were not attending school in person during the pandemic period, and thus did not have regular access to their usual support network and structure (e.g., guidance counsellors, teachers).”

May combine two claims.

ED diagnoses were self-reported, and a significant percentage of affected individuals did not disclose or had not been formally diagnosed.

“Furthermore, ED diagnoses were self-reported and -due to the voluntary and anonymous disclosure of information- a significant percentage of affected individuals did not disclose a diagnosis and/or had not been formally diagnosed with an ED.”

May combine two claims.

NEDIC service provision changed significantly after December 2017, so data before that time cannot be effectively compared to later data.

“The provision of NEDIC services has changed significantly after December 2017 (structural changes). Thus, data before this timeframe cannot be effectively compared to data gathered afterwards.”

Classified as probably not a substantial claim. May combine two claims.

NEDIC helpline staff are trained to ask about symptoms and systematically record self-reported presence or absence in standardized call statistics forms completed for each contact.

“NEDIC helpline staff are trained to ask clients what behaviors/symptoms they are experiencing and systematically record the self-reported presence (or absence) of the above listed symptoms in standardized call statistics forms, which are completed for each contact.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Strengths include anonymous data collection, assessment of many contacts across ages and roles, and comparison across three consecutive years.

“Strengths of this study include: the collection of anonymous data, which may be regarded as facilitating unbiased responses; the assessment of a significant number of contacts, including all ages (from adolescents to adults) as well as both affected individuals and caregivers; and the comparison between corresponding time periods in three consecutive years.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

Problematic home life with no respite and lack of routine may also be factors in increased teenager contacts.

“Problematic home life with no respite and lack of routine may also be factors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Symptoms were assessed via a standardized call statistics form that may not accurately reflect the entire spectrum of symptoms.

“Symptoms were assessed based on a standardized call statistics form which may have not accurately reflected the entire spectrum of symptoms experienced by clients.”

May combine two claims.

Because NEDIC services are anonymous, the study could not determine if the same individual contacted multiple times; each contact was treated as a separate case.

“Given the anonymous nature of NEDIC's services, we were unable to determine if the same individual(s) contacted NEDIC multiple times. Thus, each contact was considered to be a separate case, which may be considered a limitation.”

The quote only partly states this claim.

The increases in help-seeking and symptoms in this sample are in line with or slightly higher than reports of increases in mental health issues during COVID-19.

“The increases we saw in our sample are in line with, or slightly higher than, the currently available reports of increases in prevalence of mental health issues more broadly during COVID-19.”

• AssumptionRests on an assumption: NEDIC service utilization data reflect help-seeking behaviors of individuals with eating disorders and their caregivers in Canada.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Pre-existing evidence shows the COVID-19 pandemic raised perceived stress, anxiety, and depression levels.

“Our results are in line with pre-existing evidence showing that the COVID-19 pandemic has raised individual's perceived stress, anxiety, and depression levels [10].”

• cites [10] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There is a possibility that increases in total contacts between 2018 and 2020 were caused by a natural trend toward increased symptoms rather than the pandemic.

“Finally, there is a possibility that the increases in total contacts to NEDIC between 2018 and 2020 were caused by a natural trend toward increased symptoms rather than the pandemic, specifically.”