2/2-Preventing Eating Disorders and Reducing Comorbidity

描述（由申请人提供）：拟议研究的长期目标是完善，评估和传播基于互联网的干预措施，以预防大学年龄女性的饮食失调（EDs）和合并症。急症在女大学生中非常普遍，并可能导致严重的心理和医学后果。在之前的研究中，我们已经表明，基于互联网的干预可以减少特定亚组中ed的发病，但由于其仅关注体重/形状问题（WCS），干预对该人群常见的合并症影响甚微。我们还确定了三个风险因素，当与WCS的存在相结合时，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/饮食的批评和/或低水平的补偿行为（如呕吐和排便）。伴有这些危险因素的女性在2年内发生ed的比率大于30%，而仅伴有WCS的女性的发生率不到4%。我们建议加强以前基于互联网的干预措施，以解决这些风险因素，并通过分别增加影响改善和监管模块以及增加维护组件来维持干预措施的效果。我们的主要假设是，与常规护理组相比，干预组的参与者在两年的随访中将有明显较低的ed发生率。我们期望将发病率从预期的30%降低到15%。我们还假设干预将显著减少WCS、不健康的体重调节行为（如呕吐、滥用泻药）和饮食限制，同时改善情绪、应对技能和情绪调节。我们期望降低抑郁、焦虑和物质使用障碍的综合发病率。潜在治疗效果的调节因子和中介因子也将被检查。为了进一步说明我们向大学传播低成本项目的能力，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，以识别有ed风险的女性，并仅向WCS高的女性提供我们的原始预防项目。为了实现这些目标，200名具有高WCS和至少一种高危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，并随访至少两年。为了筛查和传播的目的，将征聘250名仅具有高WCS的妇女和100名低WCS的妇女。强化干预将持续12周，随后在随后的8个月内提供4次维持期，将基础临床研究的结果转化为可传播的干预。如果有效，强化干预提供了一个简单和廉价的方法来减少ED和ED合并症在大学年龄的妇女

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.