Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences

Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N = 122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps < .001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2 ≥ 0.035; all pseudo ΔR2's ≤ 0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities

Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men

Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men

Eating Pathology Symptoms Inventory – Clinician Rated Version (EPSI-CRV)

The files in this record contain supplemental information about the EPSI-CRV including: a copy of the EPSI-CRV, suggested training plan, training videos with an example of completed ratings, and a list of items that were removed during the final development process.The Eating Pathology Symptoms Inventory – Clinician Rated Version (EPSI-CRV) is a semi-structured interview that was designed to assess dimensional constructs of eating-disorder psychopathology and generate current Diagnostic and Statistical Manual- Fifth Edition (DSM-5) eating-disorder diagnoses. The EPSI-CRV is based on the self-report version of the EPSI (Forbush et al., 2013). There are 13 modules (or sections) within the EPSI-CRV. Eight modules measure content that is assessed in the self-report version of the EPSI, including: Body Dissatisfaction, Binge Eating, Cognitive Restraint, Excessive Exercise, Restricting, Purging, Muscle Building, and Negative Attitudes Towards Obesity. Five additional modules are included to derive DSM-5 diagnoses. The five DSM-5 modules include: Subjective Binge Episodes, Binge Eating Disorder, Low Weight, Overvaluation of Weight and Shape, and Fear of Weight Gain. The average administration time is approximately 38 minutes. The EPSI-CRV is designed to be used by clinicians and researchers working with adults with eating disorders across a range of settings. The interview may be useful for making admissions decisions, treatment planning, and discharge planning, as well as for research studies

The Building Healthy Eating and Self-Esteem Together for University Students Mobile App to Treat Eating Disorders: User-Centered Research Design and Feasibility Study

Background: University students are an at-risk group for the development of eating disorders (EDs); however, many college campuses lack sufficient resources to provide ED specialty care. Students report unique reasons for not seeking ED treatment, including the desire to solve the problem on their own (eg, seeking help from friends, self-medicating, or waiting to see if their problems improve), inability to afford treatment, lack of time to participate in the treatment, fear of seeing their primary care physician, and lack of recognition of their issues as an ED. Mobile health (mHealth) apps may be a cost-effective, helpful adjunctive tool to overcome personal and systemic barriers and encourage help seeking. Objective: This paper describes the development, usability, and acceptability of the Building Healthy Eating and Self-Esteem Together for University Students (BEST-U) mHealth smartphone app, which is designed to fill critical gaps in access to ED treatment on college campuses. Methods: We undertook a 4-phase iterative development process that focused on user-centered design. The 4 phases included needs assessment based on literature reviews, prototype development and initial evaluation in a pilot trial, redesign, and further pilot-testing to assess the usability and acceptability of the final version of the mHealth app. Acceptability and user satisfaction were assessed using an ad hoc survey that ranged from 1 (strongly disagree) to 7 (strongly agree). Results: Our needs assessment identified a lack of accessible and affordable treatments for university students. To help meet this need, the BEST-U prototype was designed as an 11-week program that provided interactive, weekly modules that focused on second- and third-wave cognitive behavioral skills. The modules focused on topics such as psychoeducation, reducing thought distortions and body checking, improving body image, interpersonal effectiveness, and behavior chain analysis. The content included interactive quizzes, short answer questions, daily and weekly logs, and surveys completed in the app. BEST-U was paired with brief 25-30 minutes of weekly telehealth coaching sessions provided by a licensed provider or supervised trainee. Pilot-testing revealed minor issues with one module of the app content, which some participants viewed as having low relevance to their experience and therapist concerns about the organization of the app content. These issues were addressed through the removal, addition, and reorganization of BEST-U modules, with the help of therapists-in-training across 2 workshops. The revised version of the BEST-U app had a grand mean acceptability rating of 5.73 out of 7. The participants completed 90.1% (694/770) of the BEST-U modules, indicating high compliance. Conclusions: BEST-U is a new, acceptable, and user-friendly mHealth app to help therapists deliver brief, evidence-based cognitive behavioral interventions. Owing to its acceptability and user-friendly nature, BEST-U has high user compliance and holds promise for future implementation and dissemination in university mental health settings

Developmental Disability and Athletic Populations

Presented at “Topics in Eating Disorder Treatment: Developmental Disability and Athletic Populations,” University of Kansas, November 21, 2022. Center for the Advancement of Research on Eating Disorders (CARE): https://care.ku.edu/ Dr. Kelsie Forbush is a Professor of Clinical Child Psychology and the CARE and COPE Lab Director at the University of Kansas Dr. Dani Chapa is a postdoctoral fellow at Western Psychiatric Hospital Dr. Brianne Richson is a postdoctoral fellow at Sanford Research in North Dakota.In the third part of the panel discussion series, Dr. Kelsie Forbush meets with Dr. Dani Chapa and Dr. Brianne Richson to discuss eating disorders within developmental disability and athletic populations. Dr. Chapa has expertise in exercise behaviors in people with eating disorders. Dr. Richson has expertise in pediatric care of children with neurodevelopmental disorders alongside an eating disorder. Topics discussed include CBT for ARFID, weight restoration, preferences in treatment, relative energy deficiency in sport, sport continuation, cental coherence, adapting higher levels of care for autistic patients, and diet cultures effect on the identification of DEBs and exercise misuse

Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences

Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N&nbsp;=&nbsp;122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps&nbsp;&lt;&nbsp;.001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2&nbsp;≥&nbsp;0.035; all pseudo ΔR2's&nbsp;≤&nbsp;0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities

Predicting probable eating disorder case-status in men using the Clinical Impairment Assessment: Evidence for a gender-specific threshold

The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CIA has been conducted in majority-women samples. Preliminary research on gender differences in CIA scores suggested men with EDs report less impairment on the CIA relative to women with EDs. Thus, the purpose of this study was to test if a different impairment threshold is needed to identify cases of men with EDs. We hypothesized that a lower CIA threshold, relative to that identified in majority-women samples, would most accurately identify men with EDs. Participants (N = 162) were men from our university-based and general community-based ED participant registry who completed the CIA and Eating Disorder Diagnostic Scale. Both precision-recall and receiver operating characteristic curves assessed what CIA global score threshold most accurately identified men with EDs. Both analytic approaches indicated that a CIA global score of 13 best predicted ED case-status in men. Consistent with past research, men with a clinically significant ED appear to report lower impairment on the CIA. Results have implications for screening and assessing for substantial ED-related impairment in men. Additionally, past research using the CIA to identify men with EDs may have under-identified men with clinically significant symptoms

Cognitive networks identify dimensions of distress in suicide notes: Anxiety, emotional profiles, and "words not said"

Suicide remains a serious public-health concern that is difficult to accurately predict in real-world settings. To identify potential predictors of suicide, we examined the emotional content of suicide notes using methods from cognitive network science. Specifically, we compared the co-occurrence networks of suicide notes with those constructed out of emotion words written by individuals scoring low or high on measures of depression, anxiety, and stress. Our objective was to identify which networks were most similar to the suicide notes network, in particular with regard to the connectivity between words and their emotional contents. We also investigated what types of words remained in the high/low emotion networks after controlling for the words present in the suicide notes, which we conceptualize as the “words not said” in the suicide notes. We found that patterns of connectivity among emotion words in suicide notes were most similar to those in texts written by low-anxiety individuals. However, upon analyzing the “words not said” in suicide notes, we observed that the remaining collection of emotions in suicide notes was most similar to those expressed by high-anxiety individuals. We discuss how these findings relate with existing clinical psychological literature as well as their potential implications for predicting suicidal behavior