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BackgroundUniversity students are an at-risk group for the development of eating disorders (EDs); however, many college campuses lack sufficient resources to provide ED specialty care. Students report unique reasons for not seeking ED treatment, including the desire to solve the problem on their own (eg, seeking help from friends, self-medicating, or waiting to see if their problems improve), inability to afford treatment, lack of time to participate in the treatment, fear of seeing their primary care physician, and lack of recognition of their issues as an ED. Mobile health (mHealth) apps may be a cost-effective, helpful adjunctive tool to overcome personal and systemic barriers and encourage help seeking. ObjectiveThis paper describes the development, usability, and acceptability of the Building Healthy Eating and Self-Esteem Together for University Students (BEST-U) mHealth smartphone app, which is designed to fill critical gaps in access to ED treatment on college campuses. MethodsWe undertook a 4-phase iterative development process that focused on user-centered design. The 4 phases included needs assessment based on literature reviews, prototype development and initial evaluation in a pilot trial, redesign, and further pilot-testing to assess the usability and acceptability of the final version of the mHealth app. Acceptability and user satisfaction were assessed using an ad hoc survey that ranged from 1 (strongly disagree) to 7 (strongly agree). ResultsOur needs assessment identified a lack of accessible and affordable treatments for university students. To help meet this need, the BEST-U prototype was designed as an 11-week program that provided interactive, weekly modules that focused on second- and third-wave cognitive behavioral skills. The modules focused on topics such as psychoeducation, reducing thought distortions and body checking, improving body image, interpersonal effectiveness, and behavior chain analysis. The content included interactive quizzes, short answer questions, daily and weekly logs, and surveys completed in the app. BEST-U was paired with brief 25-30 minutes of weekly telehealth coaching sessions provided by a licensed provider or supervised trainee. Pilot-testing revealed minor issues with one module of the app content, which some participants viewed as having low relevance to their experience and therapist concerns about the organization of the app content. These issues were addressed through the removal, addition, and reorganization of BEST-U modules, with the help of therapists-in-training across 2 workshops. The revised version of the BEST-U app had a grand mean acceptability rating of 5.73 out of 7. The participants completed 90.1% (694/770) of the BEST-U modules, indicating high compliance. ConclusionsBEST-U is a new, acceptable, and user-friendly mHealth app to help therapists deliver brief, evidence-based cognitive behavioral interventions. Owing to its acceptability and user-friendly nature, BEST-U has high user compliance and holds promise for future implementation and dissemination in university mental health settings.

Abstract Purpose Researchers have theorized that interactions between appetitive and circadian disruptions result in increased eating disorder (ED) symptoms and insomnia. However, it is unclear how specific insomnia symptoms present among people with EDs and if the latent structure of insomnia in this population is similar to that of people with insomnia disorder. Methods We conducted a secondary analysis of data collected on ED and insomnia symptoms using a subset of students (N = 547; 79.52% female) with probable EDs at a large Midwestern American university. Item response theory (IRT) for polytomous items was performed to identify item difficulty, discrimination, and information parameters for the Insomnia Severity Index (ISI). IRT parameters were compared to those established in a 2011 study of people diagnosed with insomnia disorder by Morin and colleagues. Results Clinically significant insomnia symptoms were common among students with ED pathology and symptom endorsement for each ISI item ranged from 40.77 to 86.65%. ISI items assessing insomnia-related impairment and distress showed better discriminative capacities and had higher item information than items assessing sleep behavior alterations (i.e., difficulties falling asleep, difficulties maintaining sleep, waking too early). Item discrimination was largely similar among the ED sample compared to previous IRT analyses in an insomnia disorder sample. Conclusion Insomnia symptoms are common among university students with probable EDs and similar to those reported by people with insomnia disorder. When considering insomnia assessment, items assessing sleep behaviors alone are likely inadequate to provide information about insomnia severity among people with EDs. Level V Evidence obtained from a cross-sectional descriptive study.

Abstract Objectives Both disordered eating and disturbed sleep represent significant threats to mental health. Accumulating evidence suggests that disordered eating behaviors and sleep problems co-occur. A majority of current research, however, has focused on these behaviors as components of eating disorder diagnoses, rather than investigating the independent associations of transdiagnostic disordered eating behaviors and sleep. The present study sought to examine fasting, binge eating, self-induced vomiting, laxative or diuretic misuse, and driven exercise as predictors of sleep quality complaints. Method An online sample of 648 U.S. adults completed the Eating Disorder Examination - Questionnaire, the Pittsburgh Sleep Quality Index, and the Patient Health Care Questionnaire-2 as part of a larger parent study. Results Results of a hierarchical linear regression revealed that, collectively, disordered eating behaviors predicted worse sleep quality [R2 = 0.30, F(7, 640) = 31.21, p