Validated strategies for screening for eating disorders in primary health care: A scoping review with a focus on adolescents and adults
TL;DR
Despite the potential of several instruments, robust evidence on their validity, reliability, and applicability remains limited, particularly in low-and middle-income settings, among underrepresented and adolescent’s populations.
Abstract
Eating disorders are serious, complex, and potentially chronic psychiatric conditions that affect millions of people worldwide. Primary health care plays a strategic role in the early identification and referral, helping to reduce complications, mortality, and health system burden. This scoping review aimed to map the available evidence on validated strategies for screening for eating disorders in adolescents and adults in primary care. The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, with a protocol registered in the Open Science Framework (doi: 10.17605/OSF.IO/498FU). Searches were conducted in MEDLINE, Embase, Latin American and Caribbean Health Sciences Literature, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and gray literature in October 2024. Data selection and extraction were performed by peer reviewers, and findings were synthesized narratively, with tables and figures. Of 2977 documents and 159 full texts assessed, 77 studies met the eligibility criteria, including 56 empirical and 21 nonempirical studies. Eleven validated screening instruments were identified, most frequently the SCOFF followed by the EDE-Q. Most studies used self-administered instruments before the consultation, with completion times ranging from 30 seconds to 15 minutes. Implementation strategies commonly involved the provision of materials and training for health professionals. Instrument robustness was primarily assessed through validity and reliability measures. The EDS-PC, EAT-26 and ADO-BED showed the highest sensitivity (100%), while the SCOFF demonstrated the highest specificity (94.4%). Feasibility was investigated through the identification of cases, team actions, professionals’ perceptions, and barriers and facilitators to implementation. Despite the potential of several instruments, robust evidence on their validity, reliability, and applicability remains limited, particularly in low-and middle-income settings, among underrepresented and adolescent’s populations. Structural and training barriers hinder the effective implementation of screening, highlighting the need for articulated actions between professionals, services, and public policies.