2/2-Preventing Eating Disorders and Reducing Comorbidity

描述(由申请人提供)：这项拟议研究的长期目标是改进、评估和传播一种基于互联网的干预措施，以预防大学年龄女性的饮食失调(ED)和合并症。勃起功能障碍在女大学生中非常普遍，可能导致严重的心理和医学后果。在以前的工作中，我们已经表明，基于互联网的干预可以减少特定亚组的EDS的发病，但鉴于其仅关注体重/形状问题(WCS)，干预对这一人群常见的共病影响甚微。我们还确定了三个风险因素，当与WCS的存在结合在一起时，表明ED的风险非常高：抑郁史和/或暴露于老师/教练/兄弟姐妹对体重/饮食的批评评论和/或低水平的补偿行为(例如，呕吐和排泄)。在存在这些危险因素的女性中，两年内EDS的发病率高于30%，而仅存在WCS的参与者的发病率不到4%。我们建议加强我们以前的基于互联网的干预措施，以解决这些风险因素，并维持干预措施的效果，方法是分别包括情感改善和监管模块，并增加一个维护部分。我们的主要假设是，与常规护理组相比，干预参与者在两年的随访中发生EDS的几率将显著降低。我们预计发病率将从预期的30%降至15%。我们还假设，干预将显著减少WCS、不健康的体重调节行为(例如，呕吐、泻药滥用)和饮食限制，同时改善情绪、应对技能和情绪调节。我们预计抑郁、焦虑和物质使用障碍的综合发生率将会降低。还将审查潜在治疗效果的主持人和调解人。为了进一步说明我们向大学传播低成本计划的能力，我们计划实施并检查基于互联网的筛查的敏感性和特异性，以识别患有EDS的风险女性，并仅向WCS较高的女性提供我们最初的预防计划。为了实现这些目标，200名WCS高且至少有一种非常高风险因素的大学年龄女性将被随机分配到干预组或常规护理组，并进行至少两年的跟踪调查。将招募250名WCS高的妇女和100名WCS低的妇女进行筛查和宣传。强化干预将提供12周，随后在随后的8个月内提供4次维护会议，将基础临床研究的结果转化为可传播的干预。如果有效，加强干预提供了一种简单且廉价的方法来减少大学年龄女性ED和ED的共病 与公共健康相关：饮食失调是大学年龄女性中常见的致残问题。研究发现，一群大学年龄的女性患饮食失调和并存疾病的风险特别高。这项研究的目的是确定基于互联网的干预是否可以减少这一高危人群饮食失调的发病，并减少共同发病率。如果是这样的话，这一发现与我们之前的研究相结合，将对降低饮食失调的发生率产生重大的公共健康影响。

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.