Eating disorders (EDs) are severe mental disorders associated with high morbidity and mortality, affecting an estimated 13.5% and 3.6% of US college-age women and men, respectively. Colleges are faced with an elevated prevalence of EDs, yet less than 20% of students report receiving treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for improved modalities for screening and intervention. Online interventions have been used to treat and prevent EDs with high user acceptability given their accessible and anonymous format. However, an online platform through which screening and tailored interventions are provided to individuals with EDs has not been deployed. Such a platform can be readily disseminated and easily adopted by organizations for independent use, reducing burden for mental health services while increasing access to care. Over the past 20 years, our team's programmatic line of research has resulted in a comprehensive, online platform through which we identify and offer tailored evidence-based interventions to individuals across the ED risk and diagnostic spectrum, using minimal person-based resources. The newest intervention in our suite of programs, Student Bodies-Eating Disorders (SB-ED), has not yet been tested in a large-scale trial or via platform delivery.
The aim of this study is to conduct the first national deployment of our comprehensive platform and demonstrate that our transdiagnostic guided self-help program, SB-ED, yields measurable and significant improvements in access, costs, and outcomes for ED treatment over referral to usual care (i.e., treatment per protocol at students'corresponding college's mental health services center). Technological enhancements include mobile technology and clinical management tools. Twenty-six colleges will be randomly assigned to receive either SB-ED or referral to usual care. We will enroll at least 650 students from these campuses who screen positive for a DSM-5 clinical or subclinical ED (excluding anorexia nervosa, which warrants more intensive medical monitoring). Consistent with a stepped care approach, students who do not report clinically- significant improvements in ED symptoms mid- and post-intervention will be offered an on-campus referral. We hypothesize that SB-ED, as compared to referral to usual care, will produce significant improvements in treatment access (receipt of ED treatment), costs (positive net-benefit from a health care payor's perspective), and outcomes (decrease in ED pathology and functional impairment). We have assembled an expert team of leaders in behavioral science, technology, college health systems of care, and economics to achieve these aims. If successful, our model extends current recommendations for ED treatments to offer an innovative solution to challenges faced by mental health care delivery. Screening and intervention for other mental illnesses can be incorporated, with the goal of scale-up for national dissemination across all 50 states, with the potential to reach the 20 million students enrolled in US colleges and universities.

Public Health Relevance

Eating disorders (EDs) are severe mental disorders associated with marked psychosocial impairment, low self- esteem, and psychiatric comorbidity. College campuses are faced with an elevated prevalence of EDs, yet most students with EDs do not receive treatment. The aim of the proposed study is to demonstrate that a technologically-enhanced, guided self-help program, Student Bodies-Eating Disorders (SB-ED), which includes mobile technology and clinical management tools, produces measurable and significant improvements in access, costs, and outcomes for ED treatment over usual care. If successful, SB-ED will provide a cost-effective, cutting-edge, and highly-relevant solution that can generalize across other mental illnesses and operating systems.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-I (01))
Program Officer
Sherrill, Joel
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Washington University
Schools of Medicine
Saint Louis
United States
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Fitzsimmons-Craft, Ellen E; Firebaugh, Marie-Laure; Graham, Andrea K et al. (2018) State-wide university implementation of an online platform for eating disorders screening and intervention. Psychol Serv :
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Fitzsimmons-Craft, Ellen E; Eichen, Dawn M; Kass, Andrea E et al. (2017) Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset. Eat Weight Disord :
Kass, Andrea E; Balantekin, Katherine N; Fitzsimmons-Craft, Ellen E et al. (2017) The economic case for digital interventions for eating disorders among United States college students. Int J Eat Disord 50:250-258
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Nitsch, Martina; Dimopoulos, Christina N; Flaschberger, Edith et al. (2016) A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study. J Med Internet Res 18:e7

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