Craig B. Taylor - US grants

DESCRIPTION (provided by applicant): The long-range objective of the proposed research is to refine, evaluate, and disseminate an Internet-based intervention to prevent eating disorders (EDs) and comorbidities in college-age women. EDs are highly prevalent among college women and can lead to serious psychological and medical consequences. In previous work, we have shown that an Internet-based intervention can reduce onset of EDs in select subgroups but, given its focus solely on weight/shape concerns (WCS), the intervention had little impact on comorbidities common to this population. We have also identified three risk factors which, when combined with the presence of WCS, indicate very high risk for an ED: a history of depression and/or exposure to critical comments about weight/eating from teachers/coaches/siblings and/or low-level compensatory behaviors (e.g., vomiting and purging). The rate of onset of EDs in women presenting with these risk factors is greater than 30% over 2 years, compared to less than 4% in participants presenting with WCS only. We propose to enhance our previous Internet-based intervention to address these risk factors, and to sustain the effects of the intervention, by including affect improvement and regulation modules, and by adding a maintenance component, respectively. Our primary hypothesis is that, compared to a usual care group, participants in the intervention will have a significantly lower incidence of EDs at two-year follow-up. We expect to lower the incidence from an anticipated rate of 30% to 15%. We also hypothesize that the intervention will significantly reduce WCS, unhealthy weight regulation behaviors (e.g., vomiting, laxative abuse), and dietary restriction while improving mood, coping skills, and emotion regulation. We expect reductions in the combined incidence of depressive, anxiety, and substance use disorders. Moderators and mediators of potential treatment effects will be examined as well. In order to further illustrate our ability to disseminate a low-cost program to universities, we plan to implement and examine the sensitivity and specificity of an Internet-based screen to identify women at risk for EDs and to provide our original prevention program to women with high WCS only. To achieve these aims, 200 college-age women with both high WCS and at least one of the very high risk factors will be randomized to the intervention or a usual care group and followed for at least two years. 250 women with high WCS only and 100 women with low WCS will be recruited for the purpose of screening and dissemination aims. The enhanced intervention, which will be provided for 12 weeks, followed by four maintenance sessions provided over the subsequent eight months, translates findings from basic clinical studies into a disseminable intervention. If effective, the enhanced intervention provides an easy and inexpensive method to reduce EDs and ED comorbidity in college-age women PUBLIC HEALTH RELEVANCE: Eating disorders are common and disabling problems among college-age women. Research has identified a group of college age women at particularly high risk for eating disorders and co-morbid conditions. The purpose of this study is to determine if an internet-based intervention can reduce the onset of eating disorders among this highest risk population and also reduce co-morbidity. If so, this finding, combined with our previous research would have a major public health impact on reducing eating disorder rates.

DESCRIPTION (provided by applicant): 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.

PROJECT SUMMARY/ABSTRACT The prevalence of mental health problems among college populations has risen steadily in recent decades, with one-third of college students struggling with anxiety, depression, or an eating disorder. Yet, only 20-40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach for detecting mental health problems and engaging college students in services. We have developed a transdiagnostic, low-cost mobile health targeted prevention and intervention platform that uses population-level screening for engaging college students in tailored services that address common mental health problems. This care delivery system represents an ideal model for service delivery given its use of our promising, evidence-based mobile programs, a transdiagnostic approach that addresses comorbid mental health issues, and personalized screening and intervention to increase service uptake, enhance engagement, and improve outcomes. Further, our service delivery model harnesses the expertise of our team of leaders in behavioral science, college student mental health, technology, and health economics, and bridges our team's work over the past 25 years in successfully implementing a population-based screening program in over 160 colleges and demonstrating the effectiveness of Internet-based programs for targeted prevention and intervention for anxiety, depression, and eating disorders in over 40 colleges. We propose to test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20 colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or eating disorders (excluding anorexia nervosa, for which more intensive medical monitoring is warranted), which account for a substantial proportion of the mental health burden on college campuses, and who are not currently engaged in mental health services (N=7,884; of 146,000 initially screened) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to usual care, is associated with improved uptake (i.e., individuals beginning treatment) (Aim 1), reduced clinical cases and disorder-specific symptoms (Aims 2a, 2b), and improved quality of life and functioning (Aim 2c). We will also test putative targets/mechanisms, other mediators, predictors, and moderators of improved mental health outcomes (Aim 3) as well as stakeholder- relevant outcomes, including cost-effectiveness and academic performance (Aim 4). Our comprehensive mental health care platform can yield clinical benefit to students, appeal to university stakeholders, minimize barriers to implementation sustainability on campuses, and produce an economic return on investment compared to usual care. This population-level approach to service engagement has the potential to improve mental health outcomes for the 20+ million students enrolled in U.S. colleges and universities.