Uncovering hidden eating disorders using the SCOFF questionnaire: Cross-sectional survey of adolescents and comparison with nurse assessments

Abstract

Background The majority of individuals with an eating disorder remain undetected in healthcare. To improve the situation, screening for eating disorder symptoms is suggested to be a routine part of the health examination of adolescents. Given the busy practice of school healthcare, the screening tool needs to be brief and efficient. Objectives To evaluate the feasibility of the Finnish version of the SCOFF questionnaire in screening for eating disorder symptoms among adolescents. Design A natural design with cross-sectional surveys. Setting School healthcare in a major city in southwestern Finland. Participants Students, aged 14–16 years, attending the 8th grade ( n = 1036, response rate = 71%) and the 9th grade ( n = 855, response rate = 62%) at Finnish-speaking secondary schools during the academic years 2003–2005, and their school nurses ( n = 14). Adolescents attending special classes for those with learning disabilities were excluded from the study. Methods Students self-administered the SCOFF questionnaire as part of a health examination. Background information was obtained from the students’ healthcare records. Data from school nurses were collected with semi-structured questionnaires designed for this study. Confirmatory factor analysis was used to identify the best factor model of SCOFF for girls and boys. Descriptive statistics were used to assess the efficiency of SCOFF in comparison with established health examination practice for the purpose of detecting potential eating disorder cases among adolescents. Results Confirmatory factor analyses indicated a good fit of both the unidimensional and a two-factor model of SCOFF and yielded support for the gender-free interpretation of the screening results in mid-adolescent populations. Altogether 81% of the students who self-reported eating disorder symptoms in SCOFF remained undetected in a health examination where no eating disorder questionnaire was used. Conclusions SCOFF was found to be an appropriate instrument for screening for eating disorder symptoms in mid-adolescent populations within school healthcare. It may be a useful tool for detecting disordered eating, especially when no objective features of eating disorders appear. However, screening shall not replace a health examination but it is recommended to include it to health examinations so as to best take advantage of both procedures.