Development of a Military-Specific Transdiagnostic Eating-Disorder Survey and Screening Tool in a Nationally Representative Sample of Veterans
Abstract
The Fiscal Year 2018 Peer Reviewed Medical Research Program Topic Area of this application is eating disorders (EDs). EDs are serious psychiatric disorders that negatively impact physical health, wellbeing, work productivity, and social relationships. Recent studies show that EDs have a combined prevalence of 13.1%-15% among young women and 3% among young men in the general population. EDs affect people of all ethnicities and socioeconomic levels and occur across the lifespan. EDs are associated with the highest mortality rate of any mental disorder, with standardized mortality ratios that are two times higher than mortality due to heavy smoking. Moreover, EDs are among the main causes of suicide-related mortality in the USA, with suicide rates similar to (or higher than) depression, opioid addiction, or schizophrenia. Military personnel must adhere to body mass index (BMI) and body fat percentage requirements, as well as physical performance standards. Failure to maintain these standards can result in referral to weight-loss programs and, eventually, discharge from service. The emphasis on body weight within the military may promote unhealthy attempts at weight loss and the development of EDs. If left untreated, EDs result in significantly greater Department of Veterans Affairs (VA) healthcare utilization and physical and psychiatric morbidity and mortality. Yet, despite the seriousness of EDs among active duty and Veteran populations, there are no tools that have been developed for use in military personnel or Veterans to screen for possible EDs and there are no national VA treatment programs for EDs. Thus, there is a critical need to develop screening tools to identify and refer Veterans with EDs for treatment. Our central hypothesis is that an integrated transdiagnostic framework for assessing EDs will lead to improvements in the ability to identify Veterans who are most at risk for poor post-discharge psychosocial adjustment who need referral to treatment services. Our preliminary data strongly support our hypothesis, specifically the need for transdiagnostic screening tools to accurately identify disordered eating in Veterans. To address this need, we created a self-report measure – the Eating Pathology Symptoms Inventory (EPSI) – that has been shown to more comprehensively measure disordered eating concerns in both men and women. Our preliminary data showed that Veterans’ scores on certain EPSI scales, including muscle building, excessive exercise, purging, and restricting, were higher than outpatients being treated for an ED. Moreover, our previous work in civilians with EDs showed that by combining the EPSI with a proven measure of depression, anxiety, and trauma (the Inventory of Depression and Anxiety Symptoms – II [IDAS-II]), we were able to predict future recovery and psychosocial adjustment at 3- and 6-month follow-up. Although the EPSI and IDAS-II represent potentially useful screening measures, the total number of items across these measures is 144, which is too long for screening purposes. Thus, our primary objective is to create a short-form screening tool based on the EPSI and IDAS-II to identify Veterans who may have an eating, mood, anxiety, or trauma disorder. Objectives will be achieved through two studies. Study 1: Veterans (N=1,000) will complete the EPSI and IDAS-II at four time points. We will assess the reliability and validity of these measures in Veterans and develop a short-form. Study 2: Veterans (N=400) will complete our new shorter (screening) form of the EPSI and IDAS-II and we will test whether our screen can accurately identify true cases of eating, mood, anxiety, and trauma disorders. Post 9/11 Veterans (separated from service within the past year) will be recruited from the VA/DoD Identity Repository (VADIR). We will oversample women to achieve a 1:1 gender ratio. Secondary objectives are to: (1) test relationships among eating, mood, anxiety, trauma, an
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jul 16, 2019
- Source ID
- W81XWH1910207
Entities
People
- Kelsie Forbush
Organizations
- United States Army
- University of Kansas