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Barnard-Brak L, Yang Z. A 4pL item response theory examination of perceived stigma in the screening of eating disorders with the SCOFF among college students. Eat Weight Disord 2023; 28:79. [PMID: 37792143 PMCID: PMC10550868 DOI: 10.1007/s40519-023-01604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/27/2023] [Indexed: 10/05/2023] Open
Abstract
We examined the psychometric properties of the SCOFF, a screening instrument for eating disorders, with consideration of the perceived stigma of items that can produce socially desirable responding among a sample of college students. The results of the current study suggest evidence of the sufficient psychometric properties of the SCOFF in terms of confirmatory factor and item response theory analyses. However, two items of the SCOFF revealed that individuals who otherwise endorsed other items of the SCOFF were less likely to endorse the items of Fat and Food. It is hypothesized that this is the result of perceived stigma regarding those two items that prompts individuals to respond in a socially desirable way. A weighted scoring procedure was developed to counteract the performance of these two items, but the psychometric performance was only slightly better and there would be a clear tradeoff of specificity over sensitivity if utilized. Future research should consider other ways to counteract such perceived stigma.Level of evidence Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
| | - Zhanxia Yang
- Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
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Burke NL, Hazzard VM, Schaefer LM, Simone M, O’Flynn JL, Rodgers RF. Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity. Psychol Med 2023; 53:4255-4265. [PMID: 35574702 PMCID: PMC9666565 DOI: 10.1017/s0033291722001015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.
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Affiliation(s)
- Natasha L. Burke
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA
| | - Vivienne M. Hazzard
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Lauren M. Schaefer
- Sanford Center for Bio-behavioral Research, 120 Eighth Street South, Fargo, ND 58103, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, 1919 Elm Street N, Fargo, ND, 58102, USA
| | - Melissa Simone
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Jennifer L. O’Flynn
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, MA, 02139, USA
| | - Rachel F. Rodgers
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
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Richson BN, Hazzard VM, Christensen KA, Hagan KE. Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences. Eat Behav 2023; 49:101743. [PMID: 37209568 PMCID: PMC10681748 DOI: 10.1016/j.eatbeh.2023.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/05/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N = 122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps < .001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2 ≥ 0.035; all pseudo ΔR2's ≤ 0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities.
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Affiliation(s)
- Brianne N Richson
- Department of Psychology, University of Kansas, Lawrence, KS, USA; Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, San Diego, CA, USA.
| | - Vivienne M Hazzard
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kara A Christensen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Kelsey E Hagan
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Papini NM, Jung M, Cook A, Lopez NV, Ptomey LT, Herrmann SD, Kang M. Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis. J Eat Disord 2022; 10:62. [PMID: 35509106 PMCID: PMC9069796 DOI: 10.1186/s40337-022-00580-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%). METHODS Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis. RESULTS A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed. CONCLUSION Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.
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Affiliation(s)
- Natalie M Papini
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA.
| | - Myungjin Jung
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
| | - Amanda Cook
- Volunteer Behavioral Health Care System, Murfreesboro, TN, USA
| | - Nanette V Lopez
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
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Correction to Thielemann, Richter, Strauss, Braehler, Altmann, & Berger, 2018. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2019. [DOI: 10.1027/1015-5759/a000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schaefer LM, Anderson LM, Simone M, O’Connor SM, Zickgraf H, Anderson DA, Rodgers RF, Thompson JK. Gender-based differential item functioning in measures of eating pathology. Int J Eat Disord 2019; 52:1047-1051. [PMID: 31233228 PMCID: PMC6815513 DOI: 10.1002/eat.23126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorder (ED) symptoms are common and impairing in males, despite their perception as "female" disorders. As existing self-report symptom measures were developed and primarily validated in women, there is a need to establish the utility of these measures in men. The present study used differential item functioning (DIF) analyses to explore whether item endorsement differed by gender for three commonly used ED symptom measures. METHOD Participants were undergraduate men (n = 1,083) and women (n = 2,424) from three universities in the United States. Global scores on the Eating Attitudes Test-26 (EAT-26), Eating Disorder Examination Questionnaire (EDEQ), and Eating Disorder Diagnostic Scale for DSM-IV (EDDS) were examined. Tests of DIF were conducted by regressing each item against its composite scale score, and then comparing fit and variance explained (R2 ) to a model with the interaction of item*gender. The clinical significance threshold for DIF is ΔR2 ≥ 0.13. RESULTS There was no evidence of clinically significant DIF within the EAT-26, EDEQ, or EDDS. DISCUSSION Findings suggest that the examined measures perform similarly for undergraduate men and women, supporting their use in nonclinical male samples. However, development and testing of items reflecting ED symptoms that more commonly occur in males (e.g., muscularity-oriented behaviors) is encouraged.
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Affiliation(s)
- Lauren M. Schaefer
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Shannon M. O’Connor
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Hana Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Drew A. Anderson
- Department of Psychology, University at Albany-State University of New York, Albany, New York
| | - Rachel F. Rodgers
- Northeastern University, Boston, Massachusetts,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | - J. Kevin Thompson
- Department of Psychology, University of South Florida, Tampa, Florida
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Measurement invariance and psychometric analysis of Kutcher Adolescent Depression Scale across gender and marital status. J Affect Disord 2019; 253:394-401. [PMID: 31103804 DOI: 10.1016/j.jad.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/05/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Kutcher Adolescent Depression Scale (KADS) has been studied across Canada and some other countries during the past almost 15 years. The scale is a self-report tool to diagnose and monitor clinical depression in adolescents. A brief review of previous studies on KADS showed the lack of evaluation of KADS fairness/equivalence in measuring depression among identified groups. METHODS To examine the psychometric properties and measurement invariance of the KADS, responses of 407 participants were analyzed using item response theory (IRT) and ordinal logistic regression (OLR). Relevant measures of effect size were utilized to interpret the results. RESULTS Findings of the parallel factor analysis confirmed unidimensionality of the KADS and the partial credit IRT model found to be the best fitting model for analyzing the scale. OLR analysis detected three items across gender and one item across marital status to function differentially. An assessment of effect sizes implied negligible differences for practical considerations. LIMITATIONS A note of caution is necessary with respect to interpreting results of measurement invariance across Gender. The sample analyzed in this study was predominantly female and this might have affected our findings. A similar analysis with a more balanced sample is recommended. CONCLUSIONS This study was a significant step towards providing theoretical and practical information regarding the assessment of depression among adolescents by presenting adequate evidence regarding the psychometric properties of KADS-11. Future studies may look at different methods for assessing invariance and different groups for strengthening conclusions with respect to the KADS.
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