NIHR | Manchester Biomedical Research Centre

Researchers chart large rise in eating disorders and self-harm amongst teenage girls

General practices have recorded a large rise in eating disorder diagnoses and self-harm episodes amongst teenage girls in the UK in the years since the COVID-19 pandemic, a research team has found.

The study conducted jointly by The University of Manchester, Keele University, University of Exeter, and mental health research charity The McPin Foundation is published in the Lancet Child and Adolescent Health today (20/06/23).

The analysis of UK GP records of young people aged 10 to 24 years between 2010 and 2022 showed that since March 2020, eating disorders were 42% higher than would be expected based on previous trends for females aged 13-16, and 32% higher for those aged 17-19.

The increase in incidence of self-harm was also greatest among females aged 13-16, with the number of episodes being 38% greater than expected.

In contrast, there was no evidence of an increase in self-harm incidence in females in the other age groups and no increase in rates of eating disorders or self-harm was observed in males.

For the 10-year period before the pandemic, diagnoses of eating disorders in females were more common in those from more affluent backgrounds than those from more deprived communities, say the team.

This socioeconomic difference has 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 living in the most deprived areas.

Unlike eating disorders, rates of self-harm were higher in the most deprived areas in the 10-year period prior to the pandemic, but unlike for eating disorders, the socioeconomic differences narrowed rather than widened after March 2020.

Self-harm and eating disorders, as well as being major health issues in their own right, are coping mechanisms that are often indicative of underlying psychological distress, and they share multiple risk factors.

The study is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Research Collaboration.

Lead author Dr Pearl Mok from The University of Manchester said: “The reasons for the increase in eating disorder diagnoses and self-harm episodes amongst teenage girls during the pandemic are likely to be complex and could be due to a mixture of issues such as social isolation, anxiety resulting from changing routines, disruption in education, unhealthy social media influences, and increased clinical awareness.

“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 is also possible that cases of self-harm not coming to the attention of services may have exhibited a different pattern.

“We found that the increase in eating disorders and self-harm was greater in less deprived than in more deprived areas. This may reflect differences in service provision and challenges in accessing clinical care, rather than greater increases in risks for self-harm and eating disorders during the pandemic amongst those living in the least than in the most deprived communities.”

The study was conducted using a database of anonymised primary care electronic health records of over 9 million patients aged 10-24 years from 1881 general practices in the UK.

The team of researchers tracked the number of eating disorder diagnoses and self-harm recorded monthly by GPs from January 2010 through March 2022, around ten years before the onset of the COVID-19 pandemic and two years after its start.

Rates of eating disorders and self-harm episodes observed since the onset of the pandemic from March 2020 to March 2022 were compared with the numbers predicted using data from the ten years before. Differences between observed and predicted number of cases were assessed to give an indication of the pandemic’s potential influence on outcome incidence.

An advisory group of young people with lived experience of mental health difficulties, parents, and carers, helped shape the study and interpret the findings.

Dr Shruti Garg, Child and Adolescent Psychiatrist and Principal Investigator within the Mental Health Theme as part of the NIHR Manchester Biomedical Research Centre (BRC) said: “The staggering rise in eating disorder diagnoses and self-harm episodes among teenage females highlights an urgent need to improve early access to services and for timely intervention.”

Prof Carolyn Chew-Graham, academic GP and co-investigator from Keele University said: “Early identification of mental health difficulties in children and young people by primary care clinicians is extremely important as this facilitates timely access to treatments. Sufficient support, however, from GPs and mental health services needs to be available to manage those presenting. 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.”

Emma Garavini, Youth Public Involvement in Research Officer at the McPin Foundation and co-ordinator of the advisory group said: “We held regular meetings and communications throughout the project with the advisory group. Having the voices of young people, parents and carers inform the study with their insights and reflections highlights the importance and need for lived experience expertise in mental health research.”

“Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the two years following onset of the COVID-19 pandemic: a population-based study”, is published in the Lancet Child and Adolescent Health.