Eating Disorder Screening and Diagnostic Tools for the Veteran Healthcare System

NIH RePORTER · VA · I01 · · view on reporter.nih.gov ↗

Abstract

Eating disorders are serious psychiatric disorders that are associated with a range of significant health problems, including elevated mortality and suicide rates. A recent systematic review found prevalence rates of eating disorders among Veteran and Service Members to be comparable to or higher than prevalence estimates for the general population. Our pilot data, as well as published data by others, has demonstrated that 15-25% of Veterans meet diagnostic criteria for eating disorders when assessed, in contrast to Veteran electronic medical record data that reveals eating disorders are underdiagnosed. At the same time, the proportion of Veterans in the Veterans Health Administration (VHA) with eating disorders are increasing due to several factors, including the growing number of women in the military, expansions of eating disorder diagnostic criteria, and increasing numbers of Veterans affected by risk factors for eating disorders that are characteristic of military life. Although eating disorders are not thought of as service-related conditions that may also impact male Veterans, poor eating habits under stressful conditions while in the military can set the foundation for disordered eating behavior and trajectories of weight gain post-military in both female and male Veterans. Currently, there are no VHA recommended guidelines for eating disorder screening or diagnosis. Consequently, eating disorders in Veterans may be undetected, resulting in insufficient or delayed treatment, and in the worst case, premature death. Eating disorders identification and treatment has been identified as a top priority by facility-level stakeholders from mental health. In response, VHA Mental Health Services and Women’s Health Services are disseminating a clinician training program for the multidisciplinary care of eating disorders. While the ultimate goal is to implement this training nationwide, the health services challenge is how to best establish a clinical pathway that includes targeted screening and diagnosis to best identify Veterans who need this specialty care. Our goal is to develop an evidence-based clinical pathway to identify eating disorders in the Veteran population that will aid in standardizing care and improving outcomes for Veterans. We will use a mixed methods approach with three specific aims. The first aim will be to further develop and validate a primary care eating disorder screen for DSM-5 that is generalizable for Veterans. The second aim will be to validate a self-report measure of eating disorders that assesses for all DSM-5 diagnostic criteria and is generalizable for Veterans. The third aim will be to assess how to best implement the screen and measure across VHA for clinical practice. In our quantitative study (Aims 1 and 2), we will recruit Veterans from the San Francisco VA Healthcare System and VA Connecticut Healthcare System. Veterans (N=400) will complete a series of questionnaires to identify eating disorder symptoms. A ra...

Key facts

NIH application ID
10125826
Project number
5I01HX002563-03
Recipient
VA CONNECTICUT HEALTHCARE SYSTEM
Principal Investigator
Shira Maguen
Activity code
I01
Funding institute
VA
Fiscal year
2022
Award amount
Award type
5
Project period
2018-12-01 → 2023-09-30