Adult Eating Disorder Assessment Study

Evaluation of Eating Difficulties Assessment Measures in Clinical Practice and in Epidemiological Surveys

The hypothesis of the study is that low-cost self-completion questionnaires relating to eating disorder symptoms will predict the subsequent results of a detailed, semi-structured interview assessment of eating disorder symptoms that has been calibrated according to expert clinical diagnostic case thresholds. Eating disorders are recognised as a research priority among healthcare professionals, adults with lived experience, and their carers alike. There is a need for measurement methods that can reliably and systematically identify symptoms of common forms of eating disorder, including those fulfilling agreed diagnostic criteria for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Effective diagnostic interview tools can facilitate early detection of eating disorders. To develop rules for determining whether diagnostic criteria for eating disorders are met, a study involving adults referred to specialist eating disorder services is required. In this study, assessments by eating disorder clinicians will be compared with researcher assessments using a semi-structured interview assessment, the Schedules for Clinical Assessment in Neuropsychiatry version 3 section 9 (SCANv3s9). The study population will consist of 100 adult patients referred to specialist eating disorder services, including patients whose referrals are accepted by these services, as well as those who are not. Clinical assessments and structured interview assessment findings will also be compared with those from widely used screening tools for eating disorders, the Eating Disorder Examination Questionnaire short-form and the SCOFF (Sick, Control, One, Fat, Food) questionnaire. The aim of this study is to evaluate the accuracy of the Eating Disorder Examination Questionnaire Short-Form (EDE-QS) and the SCOFF (Sick, Control, One, Fat, Food) questionnaire in adults referred to specialist eating disorder services, in a comparison with the Schedules for Clinical Assessment in Neuropsychiatry subsection on eating disorders and specialist NHS clinician assessments of the probability of eating disorder. This will help develop appropriate and accurate benchmarks for estimating the prevalence of eating disorder symptoms and clinical diagnoses, in adults referred to specialist eating disorder services, as well as the wider population (through combining the findings from this study with those of the community 2023 Adult Psychiatric Morbidity Survey).

Study Overview

• Status: Recruiting
• Conditions: Eating Disorders

Detailed Description

Study Analysis Plan

Work Package 1 (WP1) relates to assessment of the entire study clinical population (n = 100). For WP1, the threshold for diagnosis of common forms of eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, and any eating disorder) by clinicians will be used as the reference (criterion) standard, and 95% confidence intervals will be performed for all estimates. Receiver-operating characteristic (ROC) curves and areas under the curve (AUC) will be calculated for all measurement tools (SCANv3s9, EDE-QS, and SCOFF), with reference to the criterion standard, as well as sensitivity, specificity, positive predictive value, and negative predictive values for a range of cut-off scores for these tools. Additionally, correlation coefficients will be calculated with respect to SCANv3s9, EDE-QS, and SCOFF findings, relative to those of the reference standard.

To calibrate the SCANv3s9 interview, symptom findings from the researcher-assessed SCANv3s9 will be compared with NHS clinician's diagnostic thresholds. However, the research team may modify the SCANv3s9 diagnostic algorithms in the event that they diverge substantially from clinician judgment, an approach that has previously been employed when calibrating the Autism Diagnostic Observation Schedule (ADOS) against clinical opinion. Work Package 2 (WP2) relates to retesting of a subsample of the WP1 population (n = 25). For WP2, test-retest reliability will be assessed using Cohen's kappa coefficient (κ), as well as simple percentage agreement calculations.

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: Associate Professor of Psychiatry & Honorary Consultant Psych, MRCPsych,PhD; Phone Number: +44 (0)116 252 5451; Email: st386@leicester.ac.uk
• Study Contact Backup: Name: Traolach S. Brugha, FRCPsych,MD; Phone Number: +44 (0)116 252 3211; Email: tsb@leicester.ac.uk

Study Locations

• United Kingdom
  • Leicester, United Kingdom, LE4 8BL
    • Recruiting
    • Leicestershire Partnership NHS Trust
    • Contact: Dave Clarke, PhD; Phone Number: +44 (0) 7900053538; Email: dave.clarke6@nhs.net

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

Adults resident in the UK who have been referred to NHS Leicestershire Partnership Trust. The study aims to collect data on accepted referrals, which will represent the clinical population, and referrals not accepted into treatment which will represent people more likely to describe eating difficulties in community surveys.

Description

Inclusion Criteria:

• Individuals aged 16 years or older (on the date of referral to specialist eating disorder services)
• Individuals referred to specialist adult eating disorder services during the study period

Exclusion Criteria:

• Patients under 16 years old and having not been referred to specialist eating disorder services.
• Patients with a clinical diagnosis of intellectual disability will be excluded on the basis that the SCAN is not intended for use in this patient group.
• Patients lacking capacity to consent to take part.
• Participants who lose capacity during their participation will be withdrawn from the study (with data collected up until the point of withdrawal being retained).
• Participants who are unable to understand written and verbal English.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Adults referred to eating disorder services; A cohort of adults referred to a specialist adult eating disorders service will be recruited. A stratified sample of patients will be approached about participating in the study, providing the study inclusion criteria are met, and their responsible clinician does not express concerns about their participation. All study participants will be assessed with the SCAN semi-structured interview (including version 2 of the SCAN, SCANv3s0, SCANv3s1, and SCANv3s9) and will also complete two self-completion measures, the EDE-QS and the SCOFF, randomly ordered. The SCAN items will be asked about in the context of the past 4 weeks and the directly preceding 11 months (i.e., the past year), unless otherwise stated. Additionally, a subset of study participants (n = 25) will be reassessed with the SCANv3s0, SCANv3s1, SCANv3s9, EDE-QS, and SCOFF, for test-retest reliability.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The threshold on the questionnaires and SCAN examination output algorithm scores calibrated against the clinician diagnostic thresholds for eating disorder, taking account of the level of agreement between the questionnaires and SCAN	The SCAN assesses most forms of mental and neurodevelopmental disorders. SCANv3s9 is designed to measure eating disorder symptoms and the output numerical scores will be calibrated against clinician diagnostic thresholds for eating disorder (the criterion standard). The study will also ask about history of mental and physical health conditions	The WP1 SCAN interview battery (60-84 minutes)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The threshold on the EDE-QS examination output algorithm scores calibrated against the clinician diagnostic thresholds for eating disorder, taking account of the level of agreement between the EDE-QS and SCAN	The Eating Disorder Examination Short (EDE-QS) is a 12-item self-report questionnaire on eating disorder symptoms, and providing an overall numerical score. It showed high internal consistency, with reduced administration time.	The EDE-QS will take about 2.7 minutes to be completed
The threshold on the SCOFF examination output algorithm scores calibrated against the clinician diagnostic thresholds for eating disorder, taking account of the level of agreement between the SCOFF and SCAN	The SCOFF questionnaire was used in the APMS survey in 2007, to screen for eating disorders. It is a 5-item measure, designed to detect eating disorders within a primary care setting. Please note that the respective measures of eating problems (SCAN, EDE-QS, and SCOFF) will be compared against the criterion standard (clinical diagnostic thresholds), but will not be aggregated to arrive at a singular reported value.	The SCOFF (1.3 minutes) and basic demographic details form (3.7 minutes), completed by each participant
A retest comparison of findings from the SCAN among a subgroup of participants subject to repeated assessment	A total of 25 participants will take part in WP2, all of whom will have previously participated in WP1. Most WP2 assessment will take place within 2-3 weeks of WP1 assessment. Although the WP2 research team assessments will also take place either in a clinical setting or the participant's home, as described in WP1, the participant in WP2 will be assessed by a different research team member than they were for WP1.	The reduced time of assessment due to repeat SCAN testing with SCANv3s0 and SCANv3s9, will take 20-28 minutes.
A retest comparison of findings from the EDE-QS among a subgroup of participants subject to repeated assessment	The Eating Disorder Examination Questionnaire (EDE-Q) is a 28-item self-report questionnaire, comprising fixed worded questions on eating disorder symptoms, and providing an overall score. A shortened version, the 12-item Eating Disorder Examination Short (EDE-QS) will be used	The EDE-QS will take about 2.7 minutes to be completed
A retest comparison of findings from the SCOFF among a subgroup of participants subject to repeated assessment	The SCOFF questionnaire is a 5-item measure, designed to detect eating disorders within a primary care setting, with good validity when compared (for accuracy) with clinical diagnosis (DSM-IV). Please note that the respective measures of eating problems (SCAN, EDE-QS, and SCOFF) will be compared against the criterion standard (clinical diagnostic thresholds), but will not be aggregated to arrive at a singular reported value.	The SCOFF (1.3 minutes) and basic demographic details form (3.7 minutes), completed by each participant

Collaborators and Investigators

• Sponsor: University of Leicester
• Collaborators: University of London; City, University of London; Leicestershire Partnership NHS Trust, UK; National Centre for Social Research, London, UK
• Investigators: Principal Investigator: Samuel J. Tromans, University of Leicester

Publications and helpful links

General Publications

• Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord. 2010 May;43(4):344-51. doi: 10.1002/eat.20679.
• Lord C, Risi S, Lambrecht L, Cook EH Jr, Leventhal BL, DiLavore PC, Pickles A, Rutter M. The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord. 2000 Jun;30(3):205-23.
• Brugha TS, McManus S, Smith J, Scott FJ, Meltzer H, Purdon S, Berney T, Tantam D, Robinson J, Radley J, Bankart J. Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community. Psychol Med. 2012 Mar;42(3):647-56. doi: 10.1017/S0033291711001292. Epub 2011 Jul 29.
• Fairburn CG, Cooper Z, O'Connor M. The eating disorder examination. 1993;6:1-8.
• McManus S, Bebbington PE, Jenkins R, Morgan Z, Brown L, Collinson D, Brugha T. Data Resource Profile: Adult Psychiatric Morbidity Survey (APMS). Int J Epidemiol. 2020 Apr 1;49(2):361-362e. doi: 10.1093/ije/dyz224. No abstract available.
• Gideon N, Hawkes N, Mond J, Saunders R, Tchanturia K, Serpell L. Development and Psychometric Validation of the EDE-QS, a 12 Item Short Form of the Eating Disorder Examination Questionnaire (EDE-Q). PLoS One. 2016 May 3;11(5):e0152744. doi: 10.1371/journal.pone.0152744. eCollection 2016. Erratum In: PLoS One. 2018 Nov 5;13(11):e0207256.
• Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. West J Med. 2000 Mar;172(3):164-5. doi: 10.1136/ewjm.172.3.164. No abstract available.
• American Psychiatric Association D, Association AP. Diagnostic and statistical manual of mental disorders: DSM-5. American psychiatric association Washington, DC; 2013.

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2024
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): May 1, 2027

Study Registration Dates

• First Submitted: July 25, 2023
• First Submitted That Met QC Criteria: October 24, 2023
• First Posted (Actual): October 27, 2023

Study Record Updates

• Last Update Posted (Actual): February 14, 2024
• Last Update Submitted That Met QC Criteria: February 13, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Bulimia nervosa; Epidemiology; Eating disorders; Binge eating disorder; Anorexia nervosa; Public health; Calibration; Adult psychiatry
• Additional Relevant MeSH Terms: Mental Disorders; Feeding and Eating Disorders
• Other Study ID Numbers: 0897

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Upon completion of the study, the data that support the findings of this study will be available to other researchers in deidentified form from the NHS Data Access Request Service or from another official data depository as yet to be determined.
• IPD Sharing Time Frame: This will be made available starting January 2026
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Study Data/Documents

1. Individual Participant Data Set
2. Study Protocol
3. Statistical Analysis Plan
4. Informed Consent Form

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No