Eating disorders (EDs) have the highest rate of mortality of any mental illness. ED age of onset coincides with the undergraduate years (ages 18-25). As such, colleges provide access to a large, epidemiologically vulnerable population and present a unique opportunity for intervention. On college campuses, 14% of female and 4% of male students screen positive for clinically significant EDs. An estimated 80% of these students do not receive treatment. Left untreated EDs typically become more severe and refractory to treatment. Help-seeking interventions typically focus on minimizing stigma, improving knowledge, and addressing other barriers emphasized by classic theories of health behavior. On the whole, these interventions have failed to increase treatment utilization for the vast majority of students with ED symptoms. Innovative approaches are urgently needed to narrow the ED treatment gap on college campuses. The proposed study builds on the most comprehensive research to date on mental health service utilization in college populations, which I have helped develop with my sponsor. Our findings reveal new insight into the ED treatment gap: students with untreated EDs report not seeking help for reasons such as lack of time, lack of perceived need, ambivalence about the severity of need, belief that the problem will resolve itself without treatment, and a desire to deal with issues on my own. These reasons imply a lack of urgency but not necessarily a strong resistance to receiving treatment. In similar health contexts (e.g., for diet/exercise, use of preventative care), behavioral economic interventions have produced positive results by exploiting two cognitive biases: (1) the default bias (individuals 'go with the flow' of preset options) and (2) sign effect (losses (negative outcomes) are substantially more psychologically costly than gains (positive outcomes) of equal magnitude). With this fellowship, I will test intervention components addressing lack of urgency and promoting available treatment options in an effort to increase help-seeking among students with untreated ED symptoms (as identified in an online screen). Intervention components will be operationalized in electronic messages delivered over 12- weeks. This proposal has 2 specific aims and 1 sub-aim.
In Aim 1, I will test the feasibility of the intervention. Results will inform modifications for Aim 2, which is to examine, using a factorial design, effects of the intervention components on ED treatment utilization (primary outcome). I will also conduct semi-structured interviews with students who do not use treatment during the study period to identify ways in which the intervention could be made more effective (Sub-aim). An intervention of this nature (low-cost, online) could easily be disseminated on a large-scale to promote help-seeking for EDs and other mental health conditions among college students and adolescent and young adult populations more broadly. By enhancing uptake of evidence-based ED treatment, my proposal directly addresses NIMH's objective to help close the gap between the development of new, research-tested interventions and their widespread use by those most in need.
Eating disorders have the highest rate of mortality of any mental illness. On U.S. college campuses, an estimated 80% students with clinically significant eating disorder symptoms do not receive treatment. There are likely more than one million students whose eating disorders go untreated in any given year. Left untreated EDs typically become more severe and refractory to treatment. Given the impact of eating disorders on mental and physical health and the connection therein with social, academic, and economic outcomes, an effective intervention to increase rates of treatment utilization would have broad societal effects extending well beyond the campus setting.
