Asian Journal of Psychiatry 7 (2014) 97–98

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Letter to Editor Utility of one item self-rating to screen for eating disorders: An investigation of Japanese university students

Keywords: Anorexia nervosa Bulimia nervosa EDNOS Questionnaire Campus health

As eating disorders (EDs) could lead to serious physical complications, social dysfunction, and psychological disturbances and require multifarious treatment approaches, and EDs are common in youths (e.g., Treasure et al., 2010). Reasonably, university students are considered to be at high risk; for instance, the prevalence of subclinical eating disorders among them is approximately 60% (Nelson et al., 1999). It is thus crucial to detect EDs or subclinical cases effectively in Asian countries. This letter introduces the characteristics and screening utility of a brief selfrating item for EDs in a Japanese University. Data were collected annually from undergraduates and postgraduates for 2 years (n = 4182, mean ages = 21.3, SD = 2.6 years in 2011; 4163, 21.3, and 2.9 in 2012). A self-administered checklist to rate depression, anxiety, and other psychosomatic symptoms was distributed including the DSM scale for depression (Chen et al., 1998). The E-item, which assesses EDs and which was included in the checklist, asked participants ‘‘Have you worried or thought excessively about your food, body weight, or body shape?’’ The characteristics of the E-item and its correlation with the associated features were analyzed. According to the requirements such as students who gave higher ratings, reported having suicidal thoughts, or desired to consult a psychiatrist, were contacted for interviews. Sixty-four and 57 students finally responded in 2011 and 2012, and ED episodes meeting the DSM-IV (APA, 2000) were diagnosed. Preliminarily, its sensitivity and specificity were determined with this high-risk sample. The annual health examination was conducted by the General Health Support Center at Gunma University for all students to improve and maintain physical and mental health. It was approved by the university committee for the management of this center every fiscal year. All students were instructed to participate the mental health screening as part of the regular medical examination. Participants were informed that participation was voluntary and that their data, which were protected by a privacy policy, were to be used only for providing health services and improving health research at the university. The information was printed above the questionnaire format, and each student signs on this checklist paper. In 2011, 119 (2.8%) students gave a rating of four and 328 (7.9%) gave a rating of three. The percentage of female increased with 1876-2018/$ – see front matter ß 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2013.08.003

higher points on the E-item (x2 = 184.6, p < .0001). In 2012, 127 (3.1%) students gave a rating of 4 and 320 (7.7%) gave a rating of 3. The percentage of female students increased with higher points on the E-item (x2 = 121.7, p < .0001). The multiple regression analysis for 2011 indicated significant independent variables such as psychosomatic distress, pessimism, sadness, irritability, insomnia, ideas of reference, anxiety, decrease in concentration, younger age, and being female (adjusted R2 = 0.23, F = 127.1, p < .001). For 2012, the significant regression model included anxiety, psychosomatic distress, sadness, ideas of reference, decrease in concentration, elevated mood, pessimism, irritability, hallucination, insomnia, age, and being female (adjusted R2 = 0.24, F = 102.0, p < .001). In 2011, six students were clinically diagnosed with EDs (1AN, 2BN, 3EDNOS). The E-item’s sensitivity and specificity were 0.83 and 0.72 respectively with 4 as the cut-off point. In 2011, 7 students were clinically diagnosed with EDs (1AN, 1BN, 5EDNOS). The E-item’s sensitivity and specificity were 0.86 and 0.78 respectively with 4 as the cut-off point and 0.86. The likelihood ratio of a positive test (LR) was 3.02 in 2011 and 3.90 in 2012. Students who responded ‘‘frequently’’ or ‘‘always’’ to the E-item constituted approximately 11% of the sample, and the proportion of women increased significantly with increasing scores on the Eitem. Specific psychopathological symptoms were associated with the E-item. Using 4 as the cut-off point, the LR were from 3.0 to 3.9. A simple and brief self-rating for detecting excessive concern with eating, body shape, or weight showed substantial ability to screen EDs in subjects; therefore, further applications should be developed.

Competing interests The author discloses no financial and non-financial competing interests.

Author’s contributions The author T.U. is responsible for the conception and design of the study, acquisition of data, analysis and interpretation of data; drafted and revised the manuscript; and has approved of the version of the manuscript to be published. The author K.O. is responsible to supervise and direct the health examination and has approved of the version of the manuscript to be submitted and published.

Funding body This study was partially supported by a Grant-in-Aid for Challenging Exploratory Research (26592092-22659209-2).

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Letter to Editor / Asian Journal of Psychiatry 7 (2014) 97–98

Acknowledgements The author thanks Professor and Director Osamu Ishikawa, clinical psychology staffs (Ms. Shizu Suzuki, Ms. Emri Osuga, Mr. Akihiro Sakai, Ms. Satomi Morohashi, and Ms. Mika Yatabe), and nursing staffs (Ms. Satoko Yaegashi, Ms. Satomi Onozato, and Ms. Kumika Kemmochi) for cooperating in this research and their contributions toward the improvement of students’ mental health. References American Psychiatric Association, 2000. DSM-IV-TR. APA, Washington D.C.. Chen, I.G., Roberts, R.E., Aday, L.A., 1998. Ethnicity and adolescent depression: the case of Chinese Americans. J. Nerv. Ment. Dis. 186, 623L 630. Nelson, W.L., Hughes, H.M., Katz, B., Searight, H.R., 1999. Anorexic eating attitudes and behaviors of male and female college students. Adolescence 34, 621–634. Treasure, J., Claudino, A.M., Zucker, N., 2010. Eating disorders. Lancet 375, 583–593.

Toru Uehara* Graduate School of Health and Welfare, Takasaki University of Health and Welfare, Takasaki, Gunma 3700033, Japan Kihachi Oshima General Health Support Center, Gunma University, Maebashi, Gunma 3718510, Japan *Corresponding author at: Department of Social Welfare, Graduate School of Health and Welfare, Takasaki University of Health and Welfare, Nakaorui 37-1, Takasaki, Gunma 3700033, Japan. Tel.: +81 27352 1290; fax: +81 27353 2055 E-mail address: [email protected] (T. Uehara) 20 May 2013 25 July 2013 Accepted 4 August 2013

Utility of one item self-rating to screen for eating disorders: an investigation of Japanese university students.

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