The correlation between anxiety and depression levels with bulimic symptomatology and body mass index during COVID-19 quarantine measures: A 2-month follow-up study

Year 2025, EARLY ONLINE, 1 - 9

Ayşe Erdoğan Kaya , Çağlar Turan , Yavuz Selim Oğur , Nurullah Yavaş , Atila Erol

https://doi.org/10.18621/eurj.1594539

Abstract

Objective: This study aims to investigate the relationship between anxiety and depression levels with bulimia symptoms and body mass index (BMI) during the quarantine measures.

Methods: Voluntary individuals were included, and individuals were evaluated before and after 2-month quarantine period, and self-report questionnaires were administered. In addition to the sociodemographic data form, Hospital Anxiety and Depression Scale (HADS) and Bulimic Investigatory Test, Edinburgh (BITE) were applied twice to the participants and their BMI were recorded.

Results: An increase in HADS-A scores was observed after quarantine (z=-6.456, P<0.001). Upon comparing the scale scores, and BMI values recorded at the onset of the quarantine period and two months later, a negative correlation was observed between the BITE-2 (after 2-month follow-up) score and both the BMI-2 value and the HADS-A1 (baseline measurement) score, with correlation coefficients of r =-0.493, P<0.001, and r =-0.267, P=0.041, respectively. Additionally, BMI-1 values were positively correlated with HADS-D1 (r=0.186, P=0.028) and negatively correlated with BITE-1 score (r=-0.323, P<0.001).

Conclusions: The finding of higher BMI in individuals with high depressive symptom severity, the negative correlation of bulimic symptoms with BMI, and higher anxiety levels after quarantine period reveal the impact of mental health on eating behavior and effect of pandemic on psychiatric symptoms. Our study can provide a unique perspective on eating behaviors and psychiatric symptomatology due to quarantine measures.

Keywords

Eating disorder, anxiety, depression, COVID-19, bulimia nervosa

Ethical Statement

Ethics committee approval was received from Sakarya University Faculty of Medicine non-invasive research ethics committee with date and decision number: 22.05.2020/316. The study was conducted in compliance with the Declaration of Helsinki. Informed consent was obtained from all subjects involved in the study.

References

• 1. Organization WH. Coronavirus disease (COVID-19), 12 October 2020. 2020.
• 2. Kelly BD. Quarantine, restrictions and mental health in the COVID-19 pandemic. QJM. 2021;114(2):93-94. doi: 10.1093/qjmed/hcaa322.
• 3. Sun S, Goldberg SB, Lin D, Qiao S, Operario D. Psychiatric symptoms, risk, and protective factors among university students in quarantine during the COVID-19 pandemic in China. Global Health. 2021 Jan 25;17(1):15. doi: 10.1186/s12992-021-00663-x.
• 4. Wang Y, Shi L, Que J, et al. The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic. Mol Psychiatry. 2021;26(9):4813-4822. doi: 10.1038/s41380-021-01019-y.
• 5. Alharbi AS, Alshahrani SM, Alsaadi MM, Al-Jahdali HH, Wali SO, BaHammam AS. Sleep quality and insomnia during the COVID-19 lockdown among the Saudi public: A cross-sectional study. Saudi Med J. 2021;42(4):384-390. doi: 10.15537/smj.2021.42.4.20200735.
• 6. Touyz S, Lacey H, Hay P. Eating disorders in the time of COVID-19. J Eat Disord. 2020;8:19. doi: 10.1186/s40337-020-00295-3.
• 7. Gorgas DL. Eating Disorders. Emerg Med Clin North Am. 2024 Feb;42(1):163-179. doi: 10.1016/j.emc.2023.06.024.
• 8. Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020;50(1):24-29. doi: 10.1111/imj.14691.
• 9. Faraji H, Firat B. [Eating Disorders and Emotions]. Fenerbahçe Üniversitesi Sosyal Bilimler Dergisi. 2022;2(1):153-174. [Article in Turkish]
• 10. Torun ŞE, Çınar HÜ, Kızılkan MP, Akgül S, Derman O. [The effect of the covid-19 pandemic on eating disorders]. Çocuk Sağlığı ve Hastalıkları Dergisi 2022; 65: 1-7. [Article in Turkish]
• 11. Aydemir Ö, Guvenir T, Kuey L, Kultur S. [Validity and reliability of Turkish version of hospital anxiety and depression scale]. Turk Psikiyatri Derg. 1997;8(4):280-287. [Article in Turkish]
• 12. Kiran S, Agargun M, Kara H, Kutanis R, editors. Eating attitudes and dissociative experiences in college students. 36th National Psychiatry Congress, Antalya, Turkey; 2000.
• 13. Türkili S, Aslan E, Şenel T, et al. [Examination of challenges, anxiety and burnout among assistant physicians due to corona virus outbreak]. Anadolu Kliniği Tıp Bilimleri Dergisi. 2022;27(2):103-114. doi: 10.21673/anadoluklin.1005533. [Article in Turkish]
• 14. Özkan Y, Danişmaz Sevin M, Avcı Ü. [Hapiness in the Refrigerator: The Effects of Depression, Anxiety and Stress on Emotional Eating Disorder in the Whole Covid-19 Pandemic]. Toplum ve Sosyal Hizmet. 2021;1 (Covid-19 Special Issue):183-200. doi: 10.33417/tsh.1004373. [Article in Turkish]
• 15. Süel E, Şengür E, Turasan Í. [Investigation of the Eating Attitude Status of Students Faculty of Sports Sciences During the Covıd-19 Epidemic]. Int J Sport Exerc Train Sci-IJSETS. 2021;7(4):148-154. doi: 10.18826/useeabd.1016716. [Article in Turkish]
• 16. Taquet M, Geddes JR, Luciano S, Harrison PJ. Incidence and outcomes of eating disorders during the COVID-19 pandemic. Br J Psychiatry. 2021;220(5):1-3. doi: 10.1192/bjp.2021.105.
• 17. Cooper M, Reilly EE, Siegel JA, et al. Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. Eat Disord. 2022;30(1):54-76. doi: 10.1080/10640266.2020.1790271.
• 18. Zipfel S, Schmidt U, Giel KE. The hidden burden of eating disorders during the COVID-19 pandemic. Lancet Psychiatry. 2022;9(1):9-11. doi: 10.1016/S2215-0366(21)00435-1.
• 19. Castellini G, Cassioli E, Rossi E, et al. The impact of COVID-19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls. Int J Eat Disord. 2020;53(11):1855-1862. doi: 10.1002/eat.23368.
• 20. Schlegl S, Maier J, Meule A, Voderholzer U. Eating disorders in times of the COVID-19 pandemic-Results from an online survey of patients with anorexia nervosa. Int J Eat Disord. 2020;53(11):1791-1800. doi: 10.1002/eat.23374.
• 21. Haghshomar M, Shobeiri P, Brand S, Rossell SL, Akhavan Malayeri A, Rezaei N. Changes of symptoms of eating disorders (ED) and their related psychological health issues during the COVID-19 pandemic: a systematic review and meta-analysis. J Eat Disord. 2022;10(1):51. doi: 10.1186/s40337-022-00550-9.
• 22. Schafer KM, Lieberman A, Sever AC, Joiner T. Prevalence rates of anxiety, depressive, and eating pathology symptoms between the pre- and peri-COVID-19 eras: A meta-analysis. J Affect Disord. 2022;298(Pt A):364-372. doi: 10.1016/j.jad.2021.10.115.