A Novel Intervention Promoting Eating Disorder Treatment among College Students

描述(由申请人提供)：饮食失调(EDS)是所有精神疾病中死亡率最高的。ED的发病年龄与本科年龄(18-25岁)一致。因此，大学提供了接触大量易受流行病影响的人群的机会，并提供了一个独特的干预机会。在大学校园里，14%的女生和4%的男生筛查出具有临床意义的ED。据估计，这些学生中有80%没有接受治疗。留下未治疗的ED通常会变得更加严重和难以治疗。寻求帮助的干预措施通常侧重于将污名降至最低，提高知识水平，并解决经典健康行为理论所强调的其他障碍。总体而言，这些干预措施未能提高绝大多数有勃起功能障碍症状的学生的治疗利用率。迫切需要创新的方法来缩小大学校园中的ED治疗差距。这项拟议的研究建立在迄今为止关于大学生心理健康服务利用情况的最全面研究的基础上，这项研究是我和我的赞助人共同开发的。我们的发现揭示了对ED治疗差距的新见解：患有未接受治疗的ED的学生报告说，他们没有寻求帮助的原因包括缺乏时间、缺乏感知的需求、对需求的严重性的矛盾心理、相信问题不需要治疗就会自行解决，以及希望“自己”处理问题。这些原因意味着缺乏紧迫感，但不一定对接受治疗有很强的抵抗力。在类似的健康环境中(例如，饮食/锻炼、预防性护理的使用)，行为经济干预通过利用两种认知偏差产生了积极的结果：(1)默认偏差(个人‘顺应’预设选项的流动)和(2)符号效应(损失(消极结果)比同等规模的收益(积极结果)在心理上付出的代价要高得多)。有了这笔奖学金，我将测试针对缺乏紧迫感的干预措施，并推广可用的治疗方案，以努力增加患有ED症状的学生寻求帮助的情况(如在线屏幕所示)。干预部分将在12周内以电子信息的形式开始运作。这项建议有2个具体目标和1个分目标。在目标1中，我将测试干预的可行性。结果将为目标2的修改提供信息，目标2是使用析因设计检查干预的效果 关于ED治疗利用的组成部分(主要结果)。我还将对在研究期间没有使用治疗的学生进行半结构化访谈，以确定可以使干预更有效的方法(Sub-Aim)。这种性质的干预(低成本、在线)可以很容易地大规模传播，以在更广泛的大学生和青少年和年轻人群体中促进对精神障碍和其他心理健康问题的求助。通过加强循证ED治疗的采用，我的建议直接满足了NIMH的目标，即“帮助缩小新的、经过研究测试的干预措施的开发与最有需要的人广泛使用之间的差距。”

DESCRIPTION (provided by applicant): Eating disorders (EDs) have the highest rate of mortality of any mental illness. ED age of onset coincides with the undergraduate years (ages 18-25). As such, colleges provide access to a large, epidemiologically vulnerable population and present a unique opportunity for intervention. On college campuses, 14% of female and 4% of male students screen positive for clinically significant EDs. An estimated 80% of these students do not receive treatment. Left untreated EDs typically become more severe and refractory to treatment. Help-seeking interventions typically focus on minimizing stigma, improving knowledge, and addressing other barriers emphasized by classic theories of health behavior. On the whole, these interventions have failed to increase treatment utilization for the vast majority of students with ED symptoms. Innovative approaches are urgently needed to narrow the ED treatment gap on college campuses. The proposed study builds on the most comprehensive research to date on mental health service utilization in college populations, which I have helped develop with my sponsor. Our findings reveal new insight into the ED treatment gap: students with untreated EDs report not seeking help for reasons such as lack of time, lack of perceived need, ambivalence about the severity of need, belief that the problem will resolve itself without treatment, and a desire to deal with issues "on my own." These reasons imply a lack of urgency but not necessarily a strong resistance to receiving treatment. In similar health contexts (e.g., for diet/exercise, use of preventative care), behavioral economic interventions have produced positive results by exploiting two cognitive biases: (1) the default bias (individuals 'go with the flow' of preset options) and (2) sign effect (losses (negative outcomes) are substantially more psychologically costly than gains (positive outcomes) of equal magnitude). With this fellowship, I will test intervention components addressing lack of urgency and promoting available treatment options in an effort to increase help-seeking among students with untreated ED symptoms (as identified in an online screen). Intervention components will be operationalized in electronic messages delivered over 12- weeks. This proposal has 2 specific aims and 1 sub-aim. In Aim 1, I will test the feasibility of the intervention. Results will inform modifications for Aim 2, which is to examine, using a factorial design, effects of the intervention components on ED treatment utilization (primary outcome). I will also conduct semi-structured interviews with students who do not use treatment during the study period to identify ways in which the intervention could be made more effective (Sub-aim). An intervention of this nature (low-cost, online) could easily be disseminated on a large-scale to promote help-seeking for EDs and other mental health conditions among college students and adolescent and young adult populations more broadly. By enhancing uptake of evidence-based ED treatment, my proposal directly addresses NIMH's objective to "help close the gap between the development of new, research-tested interventions and their widespread use by those most in need."