Longer-term follow-up of college students screening positive for anorexia nervosa: psychopathology, help seeking, and barriers to treatment

ABSTRACT

The purpose of this study was to conduct a longer-term (i.e., 9-month) follow-up of students identified with possible anorexia nervosa (AN) as part of the Healthy Body Image Program, an online platform for screening and delivering tailored feedback and interventions, offered at 36 US universities. Participants were 61 individuals who screened positive for AN and who completed the follow-up. Regarding results, some indices of ED pathology and psychiatric comorbidity decreased over time, while others did not. Participants most commonly endorsed feeling ashamed, nervous, validated, and sad in response to receiving the referral. One-third (33%) reported already being in treatment at the time they received the referral, 26% initiated treatment since that time, and 41% did not initiate treatment. The most common reasons for seeking treatment were emotional distress, concern with eating, and health concerns. The strongest treatment barriers were believing one should be able to help themselves, believing the problem was not serious enough to warrant treatment, and not having time. Findings highlight the high level of pathology in students identified with possible AN, even nine months after they were first identified and provided resources, and the relatively low rates of treatment utilization given the seriousness of these illnesses.

Acknowledgments

This research was supported by R01 MH100455, K23 DK114480, T32 HL007456 from the National Institutes of Health, as well as by MOA 2013—MMHF/WU, MMHF—2016-1 Eating Disorders, and MMHF—2016-2 Eating Disorders from the Missouri Eating Disorders Council/Missouri Mental Health Foundation.

Notes

1. We note that across the two initiatives (i.e., a statewide initiative in Missouri [N = 8 participating universities] and a national randomized controlled trial [N = 28 participating universities]), the HBI screen was completed 7,647 times but 299 of these responses were detected as being duplicate responses; that is, it was determined that these responses were from individuals who had previously completed the HBI screen based on the use of the same name and/or email address. When there were duplicate responses for the same individual, the first response was kept in the dataset unless: a) the second response suggested the individual had an ED and, in the case of the Missouri initiative, created an account for the recommended mobile program; or b) the second response suggested the individual had an ED and, in the case randomized controlled trial, proceeded to enroll in the trial and be randomized. In those instances, only the second response was kept in the dataset. After removing the 299 duplicate responses, this left us with 7,348 unique responses to the HBI screen across the two initiatives.