Screening for Eating Disorders on College Campuses

The article we will be discussing this week reviews the important topic of evaluating the presence of eating disorders on college campuses. This article, titled Screening for Eating Disorders on College Campuses: a Review of the Recent Literature was published in the Journal of Current Psychiatry Reports in September 2019.

What did they do?

Using data published between 2009 and 2019 on the topic of screening for eating disorders on college campuses, the authors synthesized existing screening, methodological, and treatment practices specific to eating disorders on college campuses. 

Why did they do it?

As stated by the authors, eating disorders are more prevalent on college campuses than in the general population. Given this, the ability to screen for and thus accurately identify the presence or emergence of an eating disorder is crucial in this population, as it can lead to effective early intervention. Relatedly, the authors highlight the treatment gap that exists with regard to eating disorders, such that the number of individuals with an eating disorder who actually receive treatment is quite low, and thus the need to not only identify the presence of a problem but also provide scalable intervention, is apparent.

How did they do it?

Within their literature search, the authors identified two main programs of research that have focused on eating disorder screening on college campuses. The first is the Healthy Body Image Program (HBI), which is an online screening and intervention platform created specifically for use on college campuses. The second is research conducted by the Healthy Mind Network, which runs the Healthy Minds Study (HMS). HMS is also web-based, and is focused on examining mental health, service utilization, and related issues among undergraduate and graduate students on college campuses. The authors focused a large portion of their review parsing apart these two lines of research and examining the strengths and weaknesses of each. The authors also extend this review to include common assessment tools used to screen for eating disorders among college students, as well as ongoing efforts on college campuses to improve screening and intervention outcomes.

What did they find?

HBI studies, which utilized recruitment methods that rely on participant self-selection, resulted in greater rates of eating disorder pathology. The authors highlight that this may be a strength to the design, such that relying on participant self-selection may attract students with elevated pathology, which may represent important detection tools or designs. However, the authors also indicate that this type of self-selection procedure makes it much more challenging to draw accurate conclusions about eating disorders at the college population level (i.e., the sample is unlikely to represent the population of college students). 

Another discrepancy highlighted between HBI and HMS studies was the implementation approach. For HBI studies, a dedicated team is necessary for successful implementation (e.g., posting flyers, posting social media advertisements, identifying student groups for recruitment). Conversely, the HMS approach requires only the use of student emails. The authors explain that while the latter approach may be less time intensive, it typically requires higher-level administrative support for screening and access to student emails. 

More general findings from this study included:

• There is an elevated prevalence of eating disorders among college students relative to the general population. 
• Approximately 20% or less of students screening positive for an eating disorder reported having received treatment. 
• The most common measures used to screen for eating disorders on college campuses were:
• Eating Attitudes Test-26 (EAT-26)
• Eating Disorder Examination-Questionnaire (EDE-Q)
• SCOFF
• Stanford-Washington University Eating Disorder Screen (SWED)
• Strengths and weaknesses of each aforementioned measure was provided in table format in the article (we encourage you to have a look!)
• A recent study indicated that only 22% of colleges reported offering year-round eating disorder screening opportunities and only 45% offered screenings once per year or once per semester, despite the fact that 87% of respondents believed screening was important. 

What does it all mean (our take)?

This was a fantastic review article - hats off to these authors. From my perspective, the article drives home one (of many) critically important take home points: amidst the well documented high prevalence of eating disorders on college campuses, as well as the presence of a variety of screening tools in the literature, screening for eating disorders on college campuses is uncommon. But why? Is it a cost issue? Is it impractical? 

There are likely many reasons to explain why this is the case, but we think a better question is, how can we help? In a world driven by technology, it is possible to screen college students for a variety of mental health conditions (including eating disorders) AND provide scalable intervention solutions. Given college students are often among the most technologically savvy individuals, a technology-based solution here seems to be a perfect fit. After all, it would provide a safe, private, affordable, and accessible medium to evaluation and treatment.

At the end of the day though, there is still the issue of stigma and other barriers that are playing a key role in the general hesitation to pursue mental health evaluation or treatment. While we (as a company, and as a field) are doing our best to provide a safe and secure environment for people to engage services, we really must also continue in our efforts to normalize the importance of mental health assessment and treatment. It seems that if we can accomplish that tall task, the rest will fall into place.