COVID-19 Pandemisi Döneminde Yeme Bozukluğu Yaygınlığı: İki Aşamalı Bir Çalışma

Öz

Amaç: COVID-19 pandemi döneminde pek çok psikolojik rahatsızlıkta olduğu gibi Yeme bozukluklarının da daha yaygın görüldüğüne işaret eden sonuçlar vardır. Bu dönemde kişilerin deneyimlediği kilo değişimine, yeme tutum ve davranışlarında bozulmanın eşlik edebildiği anlaşılmaktadır. Bu araştırmada; COVID-19 sürecinde yeme tutum ve davranışlarının cinsiyete ve kilo değişimine göre nasıl farklılaştığını ve Yeme Bozukluğu (YB) yaygınlığını saptamak amaçlanarak iki aşamalı toplum temelli bir çalışma yürütülmüştür. Yöntem: İlk aşamada 771 kişi Sosyo-demografik- Klinik Bilgi Formu, Yeme Tutum Testi-26 (YTT-26) ve Yeme Bozukluğu Değerlendirme Ölçeğini (YBDÖ) doldurmuştur. YTT-26 ve YBDÖ’den yüksek puan alan katılımcılara, ikinci aşamada DSM-5 için Yarı Yapılandırılmış Yeme Bozukluğu Görüşme Formu (EDA-5) bu alanda uzman klinisyen tarafından çevrim içi olarak uygulanmıştır. Web tabanlı bir görüşme olan EDA-5, son üç aylık periyodu, DSM-5 YB tanı kriterlerine göre tarayarak kişiye uygun YB tanısını belirlemeyi sağlamaktadır. Bulgular: Araştırma bulguları katılımcıların YTT-26 ve YBDÖ puanlarının cinsiyete ve pandemide deneyimlenen kilo değişimine göre anlamlı olarak farklılaştığına işaret etmektedir. DSM-5’e göre YB yaygınlığı %3 (N=20) olarak bulunmuştur. YB türlerine göre; Tıkınırcasına Yeme Bozukluğu %1,3 (N=9), Bulimiya Nervoza (N=5) %0,7, Anoreksiya Nervoza (N=3) %0,4, eşik altı Tıkınırcasına Yeme Bozukluğu (N=3) %0,4, eşik altı Bulimiya Nervoza yaygınlığı (N=1) ise %0,14, YB tanı kriterlerini karşılamasa da bozulmuş̧ yeme davranışı gösteren kişilerin oranı (N=2) %0,29 olarak görülmüştür. Sonuç: Türkiye’de pandemi döneminde tanı koyucu klinik görüşmeyle veri toplayan ilk çalışma olan bu araştırmanın sonuçları, ülkemizde pandemide saptanan YB yaygınlığının önceki yaygınlık çalışmalarından daha yüksek olduğuna işaret etmektedir. Bu sonuçların COVID-19 döneminde literatürde belirtildiği gibi YB yaygınlığının arttığına dair kanıt olabileceği düşünülmektedir.

Anahtar Kelimeler

• COVID-19 pandemisi
• yeme bozuklukları
• yeme tutumları
• Anoreksiya nervoza

Eating Disorder Prevalence during the COVID-19 Pandemic: A Two-Phase Study

Abstract

Objective: An increase in the prevalence of many psychological problems including Eating Disorders (EDs) during COVID-19 pandemic is noteworthy. Weight change experienced by many people in this period is accompanied by a deterioration in eating attitudes and behaviors. The aim of this study is to determine how eating attitudes and behaviors differ according to gender and weight change, and the prevalence of EDs during COVID-19 pandemic. Method: Firstly, Socio-demographic-Clinical Information Form, Eating Attitude Test-26 (EAT-26), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to 771 participants. Then, the Eating Disorder Assessment for DSM-5 (EDA-5) was conducted as a semi-structured online clinical interview with the participants’ at-risk group. EDA-5 is a web-based diagnostic clinical interview which scans the last three-month according to the DSM-5 Eating Disorders diagnostic criteria that is administered by a clinician specialized in EDs. Results: Research findings indicated that participants' EAT-26 and EDE-Q scores differ significantly according to gender and weight change experienced during the pandemic. The prevalence of ED was 3% (N=20). According to sub types, Binge Eating Disorder was 1.3% (N=9), Bulimia Nervosa was 0.7% (N=5), Anorexia Nervosa was 0.4% (N=3), subthreshold Binge Eating Disorder was 0.4% (N=3), and subthreshold Bulimia Nervosa was 0.14% (N=1). Although not meeting the diagnostic criteria, the number of participants with disordered eating behavior was found to be 0.29% (N=2). Conclusion: A higher prevalence rate was found compared to previous studies in Turkey which is assumed to provide evidence that the prevalence of EDs increased during the COVID-19 period.

Keywords

• COVID-19 pandemic
• eating disorders
• eating attitudes
• anorexia nervosa

Kaynakça

1. Akgül S, Torun Ş, Çınar HÜ, Pehlivantürk Kızılkan M, Derman O (2023) Eating disorder visits increase among adolescents during the COVID‐19 pandemic. Early Interv Psychiatry, 17:837–840.
2. Aksoy H (2018) Yeşil pazarlama çerçevesinde tutum-davranış uyuş̧mazlığına akli hareket kuramı ile yaklaşım. Pazarlama İçgörüsü Üzerine Çalışmalar, 2:13-24.
3. Alfalahi M, Mahadevan S, Balushi RA, Chan MF, Saadon MA, Al-Adawi S et al. (2022) Prevalence of eating disorders and disordered eating in Western Asia: a systematic review and meta-analysis. Eat Disord, 30:556-585.
4. Alp Ş, Ünal S (2020) Yeni koronavirüs (SARS-CoV-2) kaynaklı pandemi: Gelişmeler ve güncel durum. Flora Dergisi, 25:1-10.
5. APA (2013) Diagnostic and Statistical Manual of Psychiatric Disorders , 5 th edition (DSM-5). Washington DC, American Psychiatric Association. .
6. Ammar A, Brach M, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L et al. (2020) Effects of COVID-19 home confinement on eating behaviour and physical activity: Results of the ECLB-COVID19 International Online Survey. Nutrients, 12:1583.
7. Baktıroğlu G (2019) Yeme Bozukluğu Değerlendirme Ölçeğinin yetişkinler üzerinde geçerlik, güvenirlik ve norm çalışması. (Doktora tezi), İstanbul, İstanbul Üniversitesi.
8. Beyhan Y, Erkut E (2021) Pandemi sürecinde duygusal yeme. Haliç Üniversitesi Sağlık Bilimleri Dergisi, 4:109-114.

9. Breiner CE, Miller ML, Hormes JM (2021) Changes in eating and exercise behaviors during the COVID-19 pandemic in a community sample: A retrospective report. Eat Behav, 42:101539.
10. Castellini G, Cassioli E, Rossi E, Innocenti M, Gironi V, Sanfilippo G et al. (2020) 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, 53:1855–1862.
11. Cerniglia L, Cimino S (2023) Eating disorders and internalizing/externalizing symptoms in adolescents before and during the COVID-19 pandemic. J Am Nutr Assoc, 42:445-451.
12. Chew HSJ, Lopez V (2021) Global impact of Covıd-19 on weight and weight- related behaviors in the adult population: A scoping review. Int J Environ Res Public Health, 18:1876.
13. Çelik S, Yoldaşcan EB, Okyay RA, Özenli Y (2016) Kadın üniversite öğrencilerinde yeme bozukluğunun yaygınlığı ve etkileyen etkenler. Anadolu Psikiyatri Derg, 17:42-50.
14. Dahlgren CL, Reneflot A, Brunborg C, Wennersberg AL, Wisting L (2023) Estimated prevalence of DSM‐5 eating disorders in Norwegian adolescents: A community based two‐phase study. Int J Eat Disord, 56:2062-2073.
15. Dakanalis A, Pla-Sanjuanelo J, Caslini M, Volpato C, Riva G, Clerici M et al. (2016) Predicting onset and maintenance of men's eating disorders. Int J Clin Health Psychol, 16:247–255.
16. Deveci E (2020) Üniversite öğrencilerinde yeme bozukluğunun görülme sıklığı ve psikososyokültürel yordayıcıları: İstanbul örneklemi. (Doktora tezi) İstanbul, İstanbul Üniversitesi.
17. Deveci E, Sertel Berk HÖ (2019) DSM-5 için yarı yapılandırılmış yeme bozukluğu görüşme formu (EDA-5) Türkçe uyarlaması: Pilot çalışma bulguları. IX. Işık Savaşır Klinik Psikoloji Sempozyumu Poster Bildirisi.
18. Devoe D, Han A, Anderson A, Katzman DK, Patten SB, Soumbasis A et al. (2023) The impact of the COVID‐19 pandemic on eating disorders: A systematic review. Int J Eat Disord, 56:5-25.
19. Du C, Adjepong M, Zan MCH, Cho MJ, Fenton JI, Hsiao PY et al. (2022) Gender differences in the relationships between perceived stress, eating behaviors, sleep, dietary risk, and body mass index. Nutrients, 14:1045.
20. Erdoğan-Yüce G, Muz G (2021) COVID-19 pandemisinin yetişkinlerin diyet davranışları, fiziksel aktivite ve stres düzeyleri üzerine etkisi. Cukurova Medical Journal, 46:283-291.
21. Ergüney Okumuş FE (2017) Tutumlar, inançlar ve üst bilişlerin yeme davranışı üzerindeki yordayıcı etkileri (Doktora tezi), İstanbul,İ̇stanbul Üniversitesi.
22. Ergüney Okumuş FE, Sertel Berk HÖ (2020) Yeme Tutum Testi Kısa Formunun (YTT-26) üniversite örnekleminde Türkçeye uyarlanması ve psikometrik özelliklerinin değerlendirilmesi. Psikoloji Çalışmaları, 40:57-78.
23. Fairburn CG, Beglin J (2008) Eating Disorder Examination Questionnaire, In Cognitive Behavior Therapy and Eating Disorders. (Eds CG Fairburn) :309-313. New York, Guilford Press.
24. Fairburn CG, Cooper Z, O’Connor M (1993) The eating disorder examination. Int J Eat Disord, 6:1-8.
25. Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behav Res Ther, 4:509–528.
26. Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet, 361:407–416.
27. Garner DM, Bemis KM (1982) A cognitive-behavioral approach to anorexia nervosa. Cognit Ther Res, 6:123–150.
28. Garner D, Garfinkel P (1979) The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychol Med, 9:273-279.
29. Gilsbach S, Herpertz-Dahlmann B (2023) “What made my eating disorder worse?” The impact of the Covıd-19 pandemic from the perspective of adolescents with anorexia nervosa. Nutrients, 15:1242.
30. Güney Coşkun M (2021) Covid-19 pandemisinde evden çalışanların stres ve fiziksel aktivite durumu değişikliklerinin beslenme ile ilişkisinin değerlendirilmesi. (Yüksek lisans tezi). İstanbul, İstanbul Medipol Üniversitesi.
31. Güzel A, Mutlu NL, Molendijk M (2023) COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses. Eat Weight Disord, 28:19.
32. Haghshomar M, Shobeiri P, Brand S, Rossell SL, Akhavan Malayeri A, Rezaei N (2022) 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, 10:51.
33. Haddad C, Zakhour M, Bou Kheir M, Haddad R, Al Hachach M, Sacre H et al. (2020) Association between eating behavior and quarantine/confinement stressors during the coronavirus disease 2019 outbreak. J Eat Disord, 8:40.
34. Harmancı H, Akdeniz S, Ahçı Gültekin Z (2021) Prevalence of eating disorders: Its relationship with alexithymia and mental complaints. Cyprus Turkish Journal of Psychiatry & Psychology, 3:30-36.
35. Hay P (2020) Current approach to eating disorders: a clinical update. Intern Med J, 50:24-29.
36. Hay P, Girosi F, Mond J (2015) Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord, 3:19.
37. Herpertz-Dahlmann B, Dempfle A, Eckardt S (2022) The youngest are hit hardest: The influence of the COVID-19 pandemic on the hospitalization rate for children, adolescents, and young adults with anorexia nervosa in a large German representative sample. Eur Psychiatry, 65:e84.
38. Herzog DB, Eddy KT (2007) Diagnosis, epidemiology, and clinical course of eating disorders. In Clinical Manual Of Eating Disorders (Eds J Yager, PS Powers):1-31. Arlington, American Psychiatric Publishing.
39. Hizal N (2021) COVİD-19 pandemi sürecinde erken dönem şemalarının depresyon ve kaygı ile ilişkisinin incelenmesi. (Yüksek lisans tezi), İstanbul, Üsküdar Üniversitesi.
40. Huryk KM, Drury CR, Loeb KL (2021) Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders. Eat Behav, 43:101548.
41. Kermen S, Kermen U, Dinçer F, Muslu M (2019) Üniversite öğrencilerinde yeme bozukluğu riskinin lojistik regresyon ile belirlenmesi. Yaşam Becerileri Psikoloji Dergisi, 3:149-163.
42. Kurisu K, Matsuoka M, Sato K, Hattori A, Yamanaka Y, Nohara N et al. (2022) Increased prevalence of eating disorders in Japan since the start of the COVID-19 pandemic. Eat Weight Disord, 27:2251-2255.
43. Lin, JA, Hartman-Munick SM, Kells MR, Milliren CE, Slater WA, Woods ER et al. (2021) The impact of the COVID-19 Pandemic on the number of adolescents/young adults seeking eating disorder-related care. J Adolesc Health, 69:660-663.
44. Linardon J, Messer M, Rodgers RF, Fuller-Tyszkiewicz M (2022) A systematic scoping review of research on COVID-19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field. Int J Eat Disord, 55:3-38.
45. Micali N, Hagberg KW, Petersen I, Treasure JL (2013) The incidence of eating disorders in the UK in 2000-2009: Findings from the general practice research database. BMJ Open, 3:e002646..
46. Mitsui T, Yoshida T, Komaki G (2017) Psychometric properties of the eating disorder examination-questionnaire in Japanese adolescents. Biopsychosoc Med, 11:9.
47. Monteleone P (2021) Eating disorders in the era of the COVID-19 pandemic: what have we learned?. Int J Environ Res Public Health, 18:12381.
48. Muscogiuri G, Barrea L, Savastano S, Colao A (2020) Nutritional recommendations for CoVID-19 quarantine. Eur J Clin Nutr, 6:850-851.
49. Öztürk A (2020) Dokuz Eylül Üniversitesi'ne başlayan öğrencilerde aile yapısı ve sosyal görünüş kaygısının yeme bozukluğu riski ile olan ilişkisi. (Uzmanlık tezi). İzmir, Dokuz Eylü̈l Üniversitesi.
50. Phillipou A, Meyer D, Neill E, Tan EJ, Toh WL, Van Rheenen TE et al. (2020) Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Int J Eat Disord, 53:1158-1165.
51. Quittkat HL, Düsing R, Holtmann FJ, Buhlmann U, Svaldi J, Vocks S (2020) Perceived impact of Covid-19 across different mental disorders: A study on disorder-specific symptoms, psychosocial stress and behavior. Front Psychol, 11:586246.
52. Racine S, Miller A, Mehak A, Trolio V (2022) Examining risk and protective factors for psychological health during the COVID-19 pandemic. Anxiety Stress Coping, 35:124-140..
53. Romano KA, Lipson SK, Beccia AL, Quatromoni PA, Murgueitio J (2023) Disparities in eating disorder symptoms and mental healthcare engagement prior to and following the onset of the COVID‐19 pandemic: Findings from a national study of US college students. Int J Eat Disord, 56:203-215.
54. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M et al. (2020) Prevalence of stress, anxiety, depression among the general population during the COVID- 19 pandemic: a systematic review and meta-analysis. Global Health, 16:57.
55. Semiz M, Kavakcı Ö, Yağız A, Yontar G, Kuğu N (2013) Sivas il merkezinde yeme bozukluklarının yaygınlığı ve eşlik eden psikiyatrik tanılar. Turk Psikiyatri Derg, 24:149-157.
56. Sideli L, Lo Coco G, Bonfanti RC, Borsarini B, Fortunato L, Sechi C et al. (2021) Effects of COVID‐19 lockdown on eating disorders and obesity: A systematic review and meta‐analysis. Eur Eat Disord Rev, 29:826–841.
57. Süel E, Şengür E, Turasan İ (2021) Covid-19 salgını döneminde spor bilimleri fakültesi öğrencilerinin yeme tutumu durumlarının ı̇ncelenmesi. International Journal of Sport, Exercise & Training Sciences, 7:148-154.
58. Sysko R, Glasofer DR, Hildebrandt T, Klimek P, Mitchell JE, Berg KC et al. (2015) The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders. Int J Eat Disord, 48:452–463.
59. Şanlier N, Türközü D, Toka O (2016) Body image, food addiction, depression, and body mass index in university students. Ecol Food Nutr, 55:491-507.
60. Taquet M, Geddes J, Luciano S, Harrison P (2021) Incidence and outcomes of eating disorders during the COVID-19 pandemic. Br J Psychiatry, 220:1-3.
61. Tavolacci MP, Ladner J, Déchelotte, P (2021) Sharp increase in eating disorders among university students since the COVID-19 pandemic. Nutrients, 13:3415.
62. Termorshuizen JD, Sun Q, Borg S, Mantilla EF, Goode RW, Peat CM et al. (2023) Longer‐term impact of COVID‐19 among individuals with self‐reported eating disorders in the United States, the Netherlands, and Sweden. Int J Eat Disord, 56:80-90.
63. Touyz S, Lacey H, Hay P (2020) Eating disorders in the time of COVID-19. J Eat Disord, 8:19.
64. Tükel R (2020) COVID-19 pandemi sürecinde ruh sağlığı. In COVID-19 Pandemisi Altıncı Ay Değerlendirme Raporu (Ed TTB COVID 19 İzleme Kurulu): 617-628. Ankara, Turk Tabipleri Birliği
65. Vardar E, Erzengin M (2011) Ergenlerde yeme bozukluklarının yaygınlığı ve psikiyatrik eş tanıları ı̇ ki aşamalı toplum merkezli bir çalışma. Turk Psikiyatri Derg, 22:205-212.
66. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS et al. (2020) Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health, 17:1729.
67. WHO (2000). Obesity: Preventing and Managing the Global Epidemic. Geneva, World Health Organization.
68. Yücel B, Polat A, Ikiz T, Pirim Dusgor B, Elif Yavuz A, Sertel Berk O (2011) The Turkish version of The Eating Disorder Examination Questionnaire: reliability and validity in adolescents. Eur Eat Disord Rev, 19:509–511.
69. Zanardo V, Cavaliere A, Giliberti E, Giliberti L, Manghina V, Parotto M et al. (2021) Gestational weight gain and eating-related disorders. J Obstet Gynaecol., 41:1205-1209.