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D'Adamo L, Grammer AC, Rackoff GN, Shah J, Firebaugh ML, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Rates and correlates of study enrolment and use of a chatbot aimed to promote mental health services use for eating disorders following online screening. EUROPEAN EATING DISORDERS REVIEW 2024; 32:748-757. [PMID: 38502605 PMCID: PMC11144085 DOI: 10.1002/erv.3082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE We developed a chatbot aimed to facilitate mental health services use for eating disorders (EDs) and offered the opportunity to enrol in a research study and use the chatbot to all adult respondents to a publicly available online ED screen who screened positive for clinical/subclinical EDs and reported not currently being in treatment. We examined the rates and correlates of enrolment in the study and uptake of the chatbot. METHOD Following screening, eligible respondents (≥18 years, screened positive for a clinical/subclinical ED, not in treatment for an ED) were shown the study opportunity. Chi-square tests and logistic regressions explored differences in demographics, ED symptoms, suicidality, weight, and probable ED diagnoses between those who enroled and engaged with the chatbot versus those who did not. RESULTS 6747 respondents were shown the opportunity (80.0% of all adult screens). 3.0% enroled, of whom 90.2% subsequently used the chatbot. Enrolment and chatbot uptake were more common among respondents aged ≥25 years old versus those aged 18-24 and less common among respondents who reported engaging in regular dietary restriction. CONCLUSIONS Overall enrolment was low, yet uptake was high among those that enroled and did not differ across most demographics and symptom presentations. Future directions include evaluating respondents' attitudes towards treatment-promoting tools and removing barriers to uptake.
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Affiliation(s)
- Laura D'Adamo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Center for Weight, Eating, and Lifestyle Science (WELL Center) and Department of Psychological and Brain Sciences, Philadelphia, PA, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavin N Rackoff
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Liao Z, Scaltritti M, Xu Z, Dinh TNX, Chen J, Ghaderi A. A Bibliometric Analysis of Scientific Publications on Eating Disorder Prevention in the Past Three Decades. Nutrients 2024; 16:1111. [PMID: 38674800 PMCID: PMC11054308 DOI: 10.3390/nu16081111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) present a growing concern due to their widespread occurrence and chronic course, the low access to evidence-based treatment, and the significant burden they place on the patients and society. This picture justifies intensive focus on the prevention of EDs. The current study provides the first bibliometric analysis of research on the prevention of EDs, focusing on trends and contributions, to prompt further prevention research. METHODS We conducted a bibliometric analysis of publications on the prevention of EDs using the Web of Science database, from 1993 to 2023. Focusing on universal and selective prevention strategies, our study involved a rigorous selection process, narrowing down from 10,546 to 383 relevant papers through manual screening. The analysis utilized the "bibliometrix" R package (version 4.2.2) and Python (version 3.9.6) for data processing, with VOSviewer employed for mapping collaboration networks. RESULTS Our analysis revealed a consistent annual growth rate of 10.85% in ED prevention research publications, with significant contributions from the "International Journal of Eating Disorders" and some notable authors. The United States emerged as the dominant contributor. The analysis also highlighted key trends, including a surge in publications between 2010 and 2017, and the role of major institutions in advancing research in this field. DISCUSSION The increasing rate of publications on the prevention of EDs is encouraging. However, the actual number of studies on the prevention of EDs are limited, and the majority of this work is performed by a few research groups. Given the high concentration of publications within a few countries and research groups, increased funding, facilitation of prevention research on a wider scale, and engagement of more researchers and further collaboration are called for.
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Affiliation(s)
- Zhenxin Liao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels vag 12A, 17177 Stockholm, Sweden;
| | - Martina Scaltritti
- Department of General Psychology, University of Padua, Via Venezia, 12, 35131 Padua, Italy;
| | - Zhihan Xu
- Division of Network and Systems Engineering (NSE), KTH School of Electrical Engineering and Computer Science, Teknikringen 33, 10044 Stockholm, Sweden;
| | - Thu Ngoc Xuan Dinh
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Nobels vag 6, 17177 Stockholm, Sweden; (T.N.X.D.); (J.C.)
| | - Jiahe Chen
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Nobels vag 6, 17177 Stockholm, Sweden; (T.N.X.D.); (J.C.)
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels vag 9, 17177 Stockholm, Sweden
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Daugelat MC, Pruccoli J, Schag K, Giel KE. Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives. EUROPEAN EATING DISORDERS REVIEW 2023; 31:752-768. [PMID: 37352132 DOI: 10.1002/erv.2999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals. METHOD This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies. RESULTS A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking. DISCUSSION Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.
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Affiliation(s)
- Melissa-Claire Daugelat
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
| | - Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, Pediatric Neuropsychiatry Unit, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
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Fitzsimmons-Craft EE. Decreasing the public health burden of eating disorders: Commentary Schleider et al. (2023). Int J Eat Disord 2023; 56:871-874. [PMID: 37006194 PMCID: PMC10185407 DOI: 10.1002/eat.23954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
Eating disorders (EDs) are common, disabling, and costly; yet, less than 20% of those with EDs receive treatment. EDs have also skyrocketed in the COVID-19 pandemic, with access to care worse than ever, further solidifying the need to not only make EDs a priority but also embrace new approaches to address this major public health problem. Schleider et al. argue for the single-session intervention (SSI) as one such option and outline an agenda that would aid in building the evidence base and realizing the promise of SSIs for EDs. This commentary details three additional key issues that need to be addressed in order to realize the full potential of SSIs and related approaches and ultimately decrease the public health burden of EDs. These include conducting work to optimize interventions for greatest effectiveness, recognizing the value and working to massively increase reach of interventions like SSIs that can scale and meet diverse needs, and engaging in the work needed to address structural barriers to widespread dissemination of these approaches. Through this agenda, we will do more than embrace a single-session "mindset" and will catalyze the work needed to disseminate SSIs and related approaches at massive scale and maximize their impact.
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Kruzan KP, Fitzsimmons-Craft EE, Dobias M, Schleider JL, Pratap A. Developing, Deploying, and Evaluating Digital Mental Health Interventions in Spaces of Online Help- and Information-Seeking. PROCEDIA COMPUTER SCIENCE 2022; 206:6-22. [PMID: 37063642 PMCID: PMC10104522 DOI: 10.1016/j.procs.2022.09.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The internet is frequently the first point of contact for people seeking support for their mental health symptoms. Digital interventions designed to be deployed through the internet have significant promise to reach diverse populations who may not have access to, or are not yet engaged in, treatment and deliver evidence-based resources to address symptoms. The liminal nature of online interactions requires designing to prioritize needs detection, intervention potency, and efficiency. Real-world implementation, data privacy and safety are equally important and can involve transparent partnerships with stakeholders in industry and non-profit organizations. This commentary highlights challenges and opportunities for research in this space, grounded in learnings from multiple research projects and teams aligned with this effort.
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Affiliation(s)
- Kaylee P. Kruzan
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Mallory Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Abhishek Pratap
- Center for Addiction and Mental Health, Toronto, ON, M5T 1R8 Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, M5T 1R8, Canada
- Kings College London, London, WC2R 2LS, UK
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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Hay P, Hart LM, Wade TD. Beyond screening in primary practice settings: Time to stop fiddling while Rome is burning. Int J Eat Disord 2022; 55:1194-1201. [PMID: 35633193 DOI: 10.1002/eat.23735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This forum presents the current state of research in the screening and identification of people with eating disorders in community and primary care, taking a longer-term perspective that highlights the slow rate of progression in development of instruments, and impact on polices and practice. METHOD An historical overview is presented, followed by a critique of contemporary instruments and practice, and barriers to case detection and appropriate referral pathways. RESULTS There are now many instruments but all lack high levels of positive predictive power. However, some do have high sensitivity. Barriers contributing to poor detection and the treatment gap include need for improved education and support for primary care professionals and lack of confidence of individuals with eating disorders to initiate a discussion with health professionals. The best screening instrument would not overcome either of these barriers. DISCUSSION We purport there is an urgent need to improve current screening instruments (not to develop more), particularly those with high sensitivity. These should be being employed alongside programs to both improve primary care professionals' skills in assessment and management of people with eating disorders, and to empower consumers to navigate care pathways. PUBLIC SIGNIFICANCE STATEMENT We argue that further screening instruments for eating disorders are not needed. Rather, it is more urgent to have a greater research focus on how to encourage primary care workers to ask about eating and body image and how to best translate that to more individuals with eating disorders being offered treatment. This work needs to be linked with tools that empower consumers to navigate care pathways.
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Affiliation(s)
- Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia.,Camden and Campbelltown Hospitals, SWSLHD, Sydney, New South Wales, Australia
| | - Laura M Hart
- Centre for Mental Health, Melbourne School of Population Health, University of Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne Victoria, Australia
| | - Tracey D Wade
- Blackbird Initiative, Órama Institute, Flinders University, Australia
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Shah J, DePietro B, D’Adamo L, Firebaugh ML, Laing O, Fowler LA, Smolar L, Sadeh-Sharvit S, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Development and usability testing of a chatbot to promote mental health services use among individuals with eating disorders following screening. Int J Eat Disord 2022; 55:1229-1244. [PMID: 36056648 PMCID: PMC10053367 DOI: 10.1002/eat.23798] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A significant gap exists between those who need and those who receive care for eating disorders (EDs). Novel solutions are needed to encourage service use and address treatment barriers. This study developed and evaluated the usability of a chatbot designed for pairing with online ED screening. The tool aimed to promote mental health service utilization by improving motivation for treatment and self-efficacy among individuals with EDs. METHODS A chatbot prototype, Alex, was designed using decision trees and theoretically-informed components: psychoeducation, motivational interviewing, personalized recommendations, and repeated administration. Usability testing was conducted over four iterative cycles, with user feedback informing refinements to the next iteration. Post-testing, participants (N= 21) completed the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), and a semi-structured interview. RESULTS Interview feedback detailed chatbot aspects participants enjoyed and aspects necessitating improvement. Feedback converged on four themes: user experience, chatbot qualities, chatbot content, and ease of use. Following refinements, users described Alex as humanlike, supportive, and encouraging. Content was perceived as novel and personally relevant. USE scores across domains were generally above average (~5 out of 7), and SUS scores indicated "good" to "excellent" usability across cycles, with the final iteration receiving the highest average score. DISCUSSION Overall, participants generally reflected positively on interactions with Alex, including the initial version. Refinements between cycles further improved user experiences. This study provides preliminary evidence of the feasibility and acceptance of a chatbot designed to promote motivation for and use of services among individuals with EDs. PUBLIC SIGNIFICANCE Low rates of service utilization and treatment have been observed among individuals following online eating disorder screening. Tools are needed, including scalable, digital options, that can be easily paired with screening, to improve motivation for addressing eating disorders and promote service utilization.
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Affiliation(s)
- Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Bianca DePietro
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York City, NY, USA
| | | | - C. Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Grammer AC, Shah J, Laboe AA, McGinnis CG, Balantekin KN, Graham AK, Smolar L, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Predictors of treatment seeking and uptake among respondents to a widely disseminated online eating disorders screen in the United States. Int J Eat Disord 2022; 55:1252-1258. [PMID: 35719123 PMCID: PMC9444923 DOI: 10.1002/eat.23760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 06/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore predictors of treatment seeking and uptake among individuals following an online eating disorders (EDs) screen in the U.S. disseminated by the National Eating Disorders Association. METHOD Respondents who screened at risk or positive for a probable ED from 04/2019 to 05/2021 (N = 263,530) were eligible to complete a 2-month follow-up survey that assessed treatment seeking and uptake after being offered referral options following screening. Analyses were conducted using chi-square tests or logistic regressions. RESULTS Sixty thousand thirty-four respondents (22.8%) opted-in to the follow-up survey, of whom 2276 (3.8%) completed it. Of the final analytic sample (n = 1922), 35.7% of respondents reported seeking and 22.4% reported receiving treatment. Treatment seeking and uptake were more common among respondents who were female, White, or >24 years of age; uptake was more common among respondents who were non-Hispanic or higher income. Elevated shape/weight concerns were significantly, albeit modestly, associated with reduced likelihood to receive treatment. DISCUSSION Demographic differences in treatment seeking and uptake highlight the need to optimize ED screening tools/feedback to meet the needs of underserved groups and to address stereotypes and structural barriers that may interfere. Research is also needed to identify barriers to uptake among those with elevated shape/weight concerns. PUBLIC SIGNIFICANCE Relatively low rates of treatment seeking and uptake were observed, particularly among underserved groups, 2 months following a widely disseminated online eating disorders screen. Optimization of online eating disorder screening tools and delivery of feedback and referral information may be needed to increase health care utilization.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Agatha A Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Claire G McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, New York, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Bryant E, Spielman K, Le A, Marks P, Touyz S, Maguire S, Brennan L, Bryant E, Byrne S, Caldwell B, Calvert S, Carroll B, Castle D, Caterson I, Chelius B, Chiem L, Clarke S, Conti J, Crouch L, Dammery G, Dzajkovski N, Fardouly J, Feneley J, Foroughi N, Fuller-Tyszkiewicz M, Fursland A, Gonzalez-Arce V, Gouldthorp B, Griffin K, Griffiths S, Hambleton A, Hannigan A, Hart M, Hart S, Hay P, Hickie I, Kay-Lambkin F, King R, Kohn M, Koreshe E, Krug I, Le A, Linardon J, Long R, Long A, Madden S, Maguire S, Maloney D, Marks P, McLean S, Meddick T, Miskovic-Wheatley J, Mitchison D, O’Kearney R, Paterson R, Paxton S, Pehlivan M, Pepin G, Phillipou A, Piccone J, Pinkus R, Raykos B, Rhodes P, Rieger E, Rodan S, Rockett K, Russell J, Russell H, Salter F, Sawyer S, Shelton B, Singh U, Smith S, Smith E, Spielman K, Squire S, Thomson J, Tiggemann M, Touyz S, Utpala R, Vartanian L, Wallis A, Ward W, Wells S, Wertheim E, Wilksch S, Williams M, Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord 2022; 10:78. [PMID: 35672777 PMCID: PMC9175461 DOI: 10.1186/s40337-022-00597-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. METHODS This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. RESULTS Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. CONCLUSIONS A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karen Spielman
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, New South Wales Health, Sydney, Australia
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Kruzan KP, Meyerhoff J, Nguyen T, Mohr DC, Reddy M, Kornfield R. "I Wanted to See How Bad it Was": Online Self-screening as a Critical Transition Point Among Young Adults with Common Mental Health Conditions. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2022; 2022:328. [PMID: 35531062 PMCID: PMC9075814 DOI: 10.1145/3491102.3501976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Young adults have high rates of mental health conditions, yet they are the age group least likely to seek traditional treatment. They do, however, seek information about their mental health online, including by filling out online mental health screeners. To better understand online self-screening, and its role in help-seeking, we conducted focus groups with 50 young adults who voluntarily completed a mental health screener hosted on an advocacy website. We explored (1) catalysts for taking the screener, (2) anticipated outcomes, (3) reactions to the results, and (4) desired next steps. For many participants, the screener results validated their lived experiences of symptoms, but they were nevertheless unsure how to use the information to improve their mental health moving forward. Our findings suggest that online screeners can serve as a transition point in young people's mental health journeys. We discuss design implications for online screeners, post-screener feedback, and digital interventions broadly.
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Affiliation(s)
| | | | | | | | - Madhu Reddy
- University of California-Irvine, Irvine, California, USA
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Nicula M, Pellegrini D, Grennan L, Bhatnagar N, McVey G, Couturier J. Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review. J Eat Disord 2022; 10:21. [PMID: 35164872 PMCID: PMC8845232 DOI: 10.1186/s40337-022-00543-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier. METHODS Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18-25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review. RESULTS Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns. CONCLUSIONS The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone-like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.
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Affiliation(s)
- Maria Nicula
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | | | - Laura Grennan
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Neera Bhatnagar
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Gail McVey
- University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Jennifer Couturier
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada. .,McMaster Children's Hospital, Hamilton, ON, Canada.
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12
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Flatt RE, Norman E, Thornton LM, Fitzsimmons-Craft EE, Balantekin KN, Smolar L, Mysko C, Wilfley DE, Taylor CB, Bulik CM. Eating disorder behaviors and treatment seeking in self-identified military personnel and veterans: Results of the National Eating Disorders Association online screening. Eat Behav 2021; 43:101562. [PMID: 34534875 PMCID: PMC8952181 DOI: 10.1016/j.eatbeh.2021.101562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize disordered eating behaviors, eating disorder (ED) risk and diagnosis, and treatment seeking behaviors in active-duty military personnel/veterans compared with civilians. METHOD Self-selecting participants (n = 113,388; 1744 were military personnel/veterans) 18+ years old completed the National Eating Disorders Association's online screen. Engagement in and frequencies of disordered eating behaviors were compared across military/veteran and civilian groups and were stratified by gender. ED risk and diagnosis and treatment seeking behaviors were also compared. RESULTS Individuals in the military/veteran group were more likely to engage in diuretic/laxative use and excessive exercise compared with civilians. Compared with civilians, the military/veteran group had a lower percentage who screened "at risk for an ED" and a higher percentage who screened for "no risk". Females in the military/veteran group were more likely to engage in diuretic/laxative use, excessive exercise, and fasting compared with female civilians; males in the military/veteran group were more likely to engage in excessive exercise and less likely to engage in vomiting than male civilians. Of the self-identified military personnel/veterans who screened positive for any ED, 86% had never received treatment, which did not differ significantly from civilians. Notably, 56.7% of those (54.1% of military/veteran group; 56.7% of civilians) who completed an optional item on intention to seek treatment (n = 5312) indicated they would not seek treatment. CONCLUSIONS Disordered eating and ED profiles, but not treatment seeking, may differ between military personnel/veterans and civilians who complete an online ED screen. Future work should emphasize treatment options and connecting respondents directly to tailored resources.
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Affiliation(s)
- Rachael E Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Elliott Norman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lauren Smolar
- National Eating Disorders Association, New York City, NY, USA
| | - Claire Mysko
- National Eating Disorders Association, New York City, NY, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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13
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Kasson E, Vázquez MM, Doroshenko C, Fitzsimmons-Craft EE, Wilfley DE, Taylor CB, Cavazos-Rehg PA. Exploring Social Media Recruitment Strategies and Preliminary Acceptability of an mHealth Tool for Teens with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7979. [PMID: 34360270 PMCID: PMC8345665 DOI: 10.3390/ijerph18157979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
(1) Background: The current study leveraged social media to connect with teens with EDs to identify population specific characteristics and to gather feedback on an mHealth intervention. (2) Methods: We recruited teens with EDs from social media in two phases: (1) Discovery Group, (2) Testing Group. The Discovery Group (n = 14) participants were recruited from Facebook/Instagram and were asked to review the app for up to one week and provide qualitative feedback. After incorporating feedback from the Discovery Group, we refined our social media outreach methods to connect with 30 teens with EDs to pilot this mobile app. Recruitment from a variety of platforms on social media was successful, with the majority of enrolled participants in the Testing Group coming from Snapchat (60%) and a large percentage of participants belonging to gender and sexual minority groups (63%). (3) Results: Participants from both groups experienced extremely high rates of depression (100% Discovery, 90% Testing) and/or anxiety symptoms (100% Discovery, 93% Testing) in addition to ED symptoms, and noted this as a possible barrier to app engagement. (4) Conclusion: Use of social media for recruitment of teens with EDs is feasible and may connect with groups who may be more difficult to reach using traditional recruitment methods. Among the Discovery Group there was high acceptability of and interest in an app to support ED recovery, and characteristics of both groups demonstrated need for support in other mental health domains. Future studies should evaluate the preliminary efficacy of such tools among teens to determine the effects of such interventions on ED symptoms and other mental health outcomes.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Melissa M. Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Christine Doroshenko
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Center for m2Health, Palo Alto University, Palo Alto, CA 94304, USA
| | - Patricia A. Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
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14
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Flatt RE, Thornton LM, Fitzsimmons-Craft EE, Balantekin KN, Smolar L, Mysko C, Wilfley DE, Taylor CB, DeFreese JD, Bardone-Cone AM, Bulik CM. Comparing eating disorder characteristics and treatment in self-identified competitive athletes and non-athletes from the National Eating Disorders Association online screening tool. Int J Eat Disord 2021; 54:365-375. [PMID: 33252150 PMCID: PMC8006447 DOI: 10.1002/eat.23415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/28/2020] [Accepted: 10/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We compared eating disorder (ED) characteristics and treatment seeking behaviors between self-identified competitive athletes and non-athletes in a large, community-based sample. METHOD During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment. RESULTS The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non-athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge-eating episodes compared with non-athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non-athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non-athletes emerged on treatment history or intention to seek treatment post-screen (less than 30%). DISCUSSION Although the distribution of probable ED diagnoses was similar in athletes and non-athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport-specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.
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Affiliation(s)
- Rachael E Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York City, New York, USA
| | - Claire Mysko
- National Eating Disorders Association, New York City, New York, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Latzer Y, Herman E, Ashkenazi R, Atias O, Laufer S, Biran Ovadia A, Oppenheim T, Shimoni M, Uziel M, Stein D. Virtual Online Home-Based Treatment During the COVID-19 Pandemic for Ultra-Orthodox Young Women With Eating Disorders. Front Psychiatry 2021; 12:654589. [PMID: 34108896 PMCID: PMC8180585 DOI: 10.3389/fpsyt.2021.654589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: With the outbreak of the COVID-19 pandemic, the need arose to maintain treatment continuity for religious Jewish Ultra-Orthodox young women with eating disorders (EDs) previously hospitalized in the ED department at the Ultra-Orthodox "Mayanei Hayeshua" medical center in Israel. This need led to the development of home-based online treatment channels, previously unfamiliar, and unaccepted in this population. The implementation of this model had to take into consideration many of the difficulties inherent in the use of online treatment in Jewish Ultra-Orthodox mental health patients. Aims: We sought to investigate our online home-based treatment model implemented during the COVID-19 pandemic in previously hospitalized young Ultra-Orthodox women with EDs. Method: We briefly review the literature on: (1) The Jewish Israeli Ultra-Orthodox culture; (2) Young women in Ultra-Orthodox society; and (3) EDs in Jewish Israeli Ultra-Orthodox women. We then present the inpatient ED department for Ultra-Orthodox young women and describe the online treatment model adapted to this population during the COVID-19 pandemic. We highlight the difficulties, dilemmas, and advantages of our online model with the description of three patients. Findings: Online therapy can serve as a barrier to treatment in some cases, due to physical (lack of suitable online devices except phones), familial (over-crowded families), and religious circumstances, as well as because of the patients' reluctance to take part in this treatment. In other cases, virtual home-based treatment can lead to a positive change. This may be the case in patients who find the distancing online model suitable for them, and in parents who are committed to treatment, using their greater physical and emotional presence at home during the COVID-19 pandemic for the good if their ill-daughters. Discussion: This paper highlights the difficulties and possibilities inherent in a virtual home-based treatment during the COVID-19 pandemic for Ultra-Orthodox young women previously hospitalized because of an ED. This model can be effective for some patients and families if undertaken by a multidisciplinary team that is not only knowledgeable about the treatment of EDs and the use of online strategies but also knowledgeable and culturally sensitive to the specific needs and codes of Ultra-Orthodox populations.
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Affiliation(s)
- Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Psychiatric Division, Eating Disorders Institution, Rambam Health Care Campus, Haifa, Israel
| | - Esther Herman
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Rahel Ashkenazi
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Orna Atias
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Sofia Laufer
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Ateret Biran Ovadia
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Tova Oppenheim
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Meirv Shimoni
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Moria Uziel
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Daniel Stein
- Eating Disorders Department, Maayanei Hayeshuah Medical Center, Bnei Brak, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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