Leveraging Social Media to Identify and Connect Teens With Eating Disorders to a Mobile Guided Self-Help Mobile Intervention

Clinical or subclinical eating disorders (EDs) impact 10% of individuals in their lifetime and are marked by significant functional impairment, early mortality, chronicity, and emotional distress. ED symptoms often emerge in adolescence, with peak onset age in the teenage years. Early recognition and treatment of these devastating illnesses are needed to prevent long-term consequences and a chronic course. Most (80%) individuals with EDs, including teens with EDs (TwEDs), do not receive treatment. Due to major barriers to access and to the delivery of treatment for TwEDs, there is a need for a new model of service delivery that can identify and help TwEDs. We demonstrated our ability to harness social media to identify and efficiently recruit large numbers of TwEDs. Our team has successfully developed a guided self-help cognitive behavioral therapy (CBT)-based mobile app for previous studies and have adapted this app to address the specific needs of TwEDs. In proposed study, we will test this updated mHealth intervention, which includes simplified language and tailored content relevant to adolescent issues and a social networking feature designed to facilitate group exchanges. This mHealth intervention will be investigated among 161 TwEDs recruited from Instagram/Facebook to test preliminary efficacy and feasibility of this mHealth intervention to improved eating disorder symptoms among TwEDs not currently engaged in treatment. We will also garnering feedback via a mixed methods approach on the efficiency, technical effectiveness, and satisfaction with mHealth intervention content and features. Participants will be randomized to one of 3 study arms, including a control group (self-help version of the app), a group with access to the coached mobile app only, and a group with access to the coached mobile app plus social networking feature. We hypothesized that those with access to the coached mobile app intervention will have improved ED outcomes in comparison to the control group, and that those with access to the additional social networking feature will have the most improvement in ED symptoms out of all three groups.

Study Overview

• Status: Completed
• Conditions: Eating Disorders
• Intervention / Treatment: Device: Space From Body and Eating Concerns- Teen

• Study Type: Interventional
• Enrollment (Actual): 161
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Missouri
    • St Louis, Missouri, United States, 63110
      • Washington University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 17 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• US Resident
• Owns or has daily access to an iOS or Android smartphone
• English-speaking
• Screen Positive for a DSM-5 subclinical/clinical eating disorder other than anorexia nervosa (AN) or at high risk for an eating disorder

Exclusion Criteria:

• Currently Engaged in eating disorder treatment
• Screen Positive for Anorexia Nervosa
• Wards of the State or Foster Children

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; Access to a self-help version of Space From Body and Eating Concerns Program on SilverCloud Health App
Experimental: Experimental Group A- Mobile App with Social Networking Feature; Access to a coached Space From Body and Eating Concerns program on SilverCloud Health App with private social media group for social networking support.	Device: Space From Body and Eating Concerns- Teen; Mobile application with coaching component
Experimental: Experimental Group B- Mobile App Only; Access to a coached Space From Body and Eating Concerns program on SilverCloud Health App.	Device: Space From Body and Eating Concerns- Teen; Mobile application with coaching component

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Eating Disorder Psychopathology	Eating disorder psychopathology was assessed using the self-report Eating Disorder Examination Questionnaire (EDE-Q). The EDE-Q Global score was calculated as the mean of the Restraint, Eating Concern, Shape Concern, and Weight Concern subscales (items scored 0-6), with higher scores indicating greater severity of eating disorder symptoms.	Baseline, 6 weeks, 3 months, 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life Scores	Health-related quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales. The total score ranges from 0 to 100 and is calculated as the mean of all answered items (i.e., sum of transformed item scores divided by the number of items answered), with higher scores indicating better quality of life (fewer problems).	Baseline, 6 weeks, 3 months, 6 months
Total Time Spent on the App	Among participants who logged in at least once, the total time spent on the app was collected and measured in seconds.	3 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depression Symptoms	Participants' depression symptoms were assessed using the Patient Health Questionnaire (PHQ-8). This questionnaire includes eight items with scores ranging from 0 to 24 (the ninth item assessing suicidal ideation was removed, consistent with other remote and digital health studies among teens). The total score ranges from 0 to 24, with a higher score indicating more severe depressive symptoms.	Baseline, 6 weeks, 3 months, 6 months
Anxiety Symptoms	Anxiety symptoms were assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED; 41 items). Participants rated each item based on how true it was for the last 3 months (0 = not true/hardly ever true, 1 = somewhat true/sometimes true, 2 = very true/often true). The total score is the sum of all items (range 0-82). Higher scores indicate more severe anxiety symptoms.	Baseline, 6 weeks, 3 months, 6 months

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: National Institute of Mental Health (NIMH); Palo Alto University; SilverCloud Health

Study record dates

Study Major Dates

• Study Start (Actual): December 18, 2020
• Primary Completion (Actual): December 16, 2022
• Study Completion (Actual): December 18, 2023

Study Registration Dates

• First Submitted: November 13, 2020
• First Submitted That Met QC Criteria: November 13, 2020
• First Posted (Actual): November 19, 2020

Study Record Updates

• Last Update Posted (Actual): March 9, 2026
• Last Update Submitted That Met QC Criteria: February 16, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: mHealth; adolescents; social media; eating disorders; bulimia nervosa; binge eating disorder; teens
• Additional Relevant MeSH Terms: Mental Disorders; Signs and Symptoms, Digestive; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Binge-Eating Disorder; Feeding and Eating Disorders; Bulimia Nervosa
• Other Study ID Numbers: 1R34MH119170-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All data will be deidentified and uploaded into data sharing structures on the NIMH Data Archive as compliant with funding source requirements.
• IPD Sharing Time Frame: Summary data will be available on NIMH Data Archive as compliant with funding source requirements.
• IPD Sharing Access Criteria: Summary data will be available on NIMH Data Archive as compliant with funding source requirements.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No