Evidence tells us the COVID pandemic and measures put in place to contain the virus negatively affected the mental health of adolescents and young people in the UK and elsewhere. One review study published in August 2021 estimated that the global prevalence of children and adolescents with depression and anxiety had doubled since the start of the pandemic.
Self-harm and eating disorders typically start during adolescence or early adulthood. As well as being major health issues, both are coping mechanisms that often indicate underlying psychological distress.
In a new study, we found that GPs in the UK recorded a large rise in eating disorder diagnoses and self-harm episodes among teenage girls in the first two years of the pandemic.
The study was conducted jointly by the University of Manchester, Keele University, the University of Exeter and the McPin Foundation, a mental health research charity. We also worked with an advisory group of young people with lived experience of mental health difficulties, as well as parents and carers.
Comparing predictions and observed case numbers
We used data from the Clinical Practice Research Datalink, a database of anonymised primary care electronic health records. We included over 9 million patients aged ten to 24 (both males and females) from 1,881 general practices across the UK.
We calculated the monthly incidence rates of eating disorder diagnoses and self-harm episodes from January 2010 through to March 2022. Based on data from the ten years preceding the pandemic, and using statistical models, we predicted what the rates of eating disorders and self-harm would be had the pre-pandemic trends continued. We then compared the rates actually observed in March 2020 until March 2022 with these predictions.
In the two years after the onset of the pandemic, we found that eating disorder diagnoses were 42% higher than would be expected for girls aged 13–16, and 32% higher for girls aged 17–19. There was little difference between observed and expected incidence for the other age groups.
The increase in rates of self-harm was also greatest among girls aged 13–16, 38% higher than expected. There was no evidence of an increase in self-harm in females in the other age groups.
Among males, the rates of eating disorders and self-harm were lower than, or close to, the expected rates across all age groups.
Read more: People with eating disorders saw their symptoms worsen during the pandemic – new study
In the ten years before the pandemic, eating disorder diagnoses in females were more common among those from less-deprived areas than those from more-deprived communities. This socioeconomic difference widened following the onset of the pandemic. Since March 2020, eating disorder diagnoses for females living in the least-deprived communities were 52% higher than expected, compared with 22% higher for those in the most-deprived areas.
In contrast, self-harm rates before the pandemic were higher for those in the most-deprived compared with the least-deprived areas. Since March 2020, self-harm incidence for females in the least-deprived areas was 31% higher than expected, while there was no significant difference between observed and expected incidence for those in the most-deprived areas, therefore narrowing the pre-pandemic gap.
Limitations and possible explanations
Our study is large, but episodes of self-harm that were not treated by health services were not captured in our data, so the rise in self-harm incidence might have been even greater than we observed. However, it’s also possible that cases of self-harm not coming to the attention of services might have exhibited a different pattern.
Previous studies have reported increased hospital admissions and presentations to emergency departments for self-harm and symptoms of eating disorders among teenage girls during the COVID pandemic. Our study complements these findings.
The reasons for the increase in eating disorder diagnoses and self-harm episodes among teenage girls are likely to be complex and could be due to a combination of factors. These include social isolation, anxiety resulting from changing routines, disruption to education, unhealthy social media influences, and increased awareness of mental health difficulties.
It’s also pertinent to note that youth mental health had been deteriorating even in the years before the pandemic in the UK, though at a less substantial rate of change.
The greater increases in eating disorders and self-harm among female teenagers living in less-deprived areas, relative to those in more-deprived areas, may reflect differences in service provision and access to clinical care between these areas.
Read more: Melatonin use may reduce self-harm in young people, research shows
What next?
The substantial rise in eating disorder diagnoses and self-harm episodes among teenage girls highlights an urgent need for intervention. Early identification of mental health difficulties in children and young people by primary care clinicians (including GPs, nurses and psychologists) is extremely important, as this facilitates timely access to treatment.
Potential barriers to help-seeking, including fear of stigma and concerns about long waiting lists to access services, need to be tackled. Given the current pressures on the NHS in both primary and specialist care, our study emphasises the need for sufficient capacity in mental health services to meet growing demand.