Assessing eating disorder symptoms in low and middle-income countries: a systematic review of psychometric studies of commonly used instruments

Abstract

Background Various well-validated interview and self-report instruments are available to assess eating disorder symptomatology. However, most psychometric studies have been conducted in high-income countries. The aim of the present study was to systematically review the available psychometric studies conducted in low- and middle-income countries on well-known measures for assessing eating disorder symptoms. Methods Psychometric studies with the following instruments were included: the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Disorder Inventory (EDI), the Eating Attitudes Test (EAT), and the Children’s Eating Attitudes Test (ChEAT). Searches were conducted on August 30, 2021, in the following databases: MEDLINE, EMBASE, LILACS, Web of Science, PsycINFO, and CABI. The methodological quality of the studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were considered to have conducted the minimum psychometric evaluation if they assessed at least the three types of validity (content, criteria, and construct) or diagnostic performance. The psychometric properties were also evaluated considering the cut-off points described in the literature for each of the analysis methods used to evaluate validity and reliability and two reviewers independently selected the studies and evaluated the quality criteria. Results A total of 28 studies were included. The studies were conducted in 13 countries (10 middle income and 3 low income). The instruments that were most used in the studies were the EAT and EDE-Q. According to the overall COSMIN assessment, in most (57%) of the studies the psychometric properties assessed were not described. Forty-three percent of the studies conducted the minimum psychometric evaluation. However, according to the described cut-off points, the results for the psychometric properties assessed showed, in general, acceptable validity and reliability. Conclusion The results of this review suggest a lack of studies with the recommended psychometric properties in low- and middle-income countries on these commonly used instruments. With the steady increase in the prevalence of eating disorders globally, psychometric investigations of instruments for measuring eating disorder symptoms in these countries should be encouraged to promote their early detection and treatment.

The need for epidemiological research on eating disorders in Africa and the Caribbean

“…An important consideration when examining conditions across cultures and contexts is whether existing measures are valid for a population of interest. Two primary concerns are: (1) comparability of the language of the original measure with a translation and the appropriateness of the translated version in its new language, and (2) the applicability of original test norms in the target population (Ayala et al, 2022).…”

“…In a systematic review, Ayala et al (2022) examined the validity of the psychometric instruments used to evaluate eating disorder symptomatology in low‐ and middle‐income countries. They identified 28 studies that evaluated the Eating Disorder Examination (EDE) (Cooper & Fairburn, 1987), the Eating Disorder Examination‐Questionnaire (EDE‐Q) (Fairburn & Beglin, 1994), the EDI, the EAT, and the Children's Eating Disorder Examination (Bryant‐Waugh et al, 1996).…”

Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions

“…Eating Disorder Examination Questionnaire Version 6. The EDE-Q is a self-report measure commonly used for diagnostic and screening and for assessment of ED severity (cognitions and behaviors) either in terms of treatment outcome or in terms of research purposes (Ayala et al, 2022;Mond et al, 2004). As a self-report alternative to the EDE, the 28-item questionnaire is similarly composed of four subscales measuring dietary restraint and eating, weight, and shape concerns, and utilizes the same 28-day time frame as the EDE.…”

Network-based validation of the psychometric questionnaire EDI-3 for the assessment of eating disorders

“…Although the accurate detection of symptoms, behaviors, physical signs, syndrome combinations, and duration by a trained clinician is essential for a correct diagnosis, some instruments have been designed in support of clinical experience for the recognition of the clinical signs of eating disorders. The Eating Disorder Inventory 3 (EDI-3 11 – 13 ) is among the tools commonly used to evaluate EDs 14 . The EDI-3 is a standardized, self-report measure that has the advantage of assessing eating disorder symptoms and associated psychological characteristics, in contrast to other measures that are limited to assessing eating disorder symptoms 15 , 16 .…”