Article

The SCOFF questionnaire and clinical interview for eating disorders in general practice: comparative study

Department of Psychiatry, St George's Hospital Medical School, University of London, London SW17 0RE.
BMJ (online) (Impact Factor: 16.38). 11/2002; 325(7367):755-6. DOI: 10.1136/bmj.325.7367.755
Source: PubMed

ABSTRACT Standards 2 and 3 of the national service framework for mental health outline the need to improve health care for patients with anorexia nervosa and bulimia nervosa.1 Healthcare workers in primary care are at the forefront of screening and managing these disorders. Assessment tools available to primary healthcare professionals can take a long time to administer and may need to be interpretedby specialists2; this may limit improvements in care. A screening tool was developed, but only to facitate epidemiological research.3The SCOFF questionnaire is a brief and memorable tool designed to detect eating disorders and aid treatment (see figure). It showed excellent validity in a clinical population and reliability in a student population. 4 5 We assessed the SCOFF questionnaire in primary care.
Participants, methods, and results
We invited sequential women attenders (aged 18-50) at two general practices in southwest London to participate. We gave participants information sheets that described the study. Women who verbally consented to participate were asked the SCOFF questions in a separate room; this took about two minutes. A researcher blind to the woman's score on the SCOFF questionnaire conducted a clinical diagnostic interview lasting 10-15 minutes, based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (fourth edition). Women identified by the interview as having an eating disorder were invited to discuss this and were offered the contact number for the Eating Disorders Association. The local research and ethics committee approved the study.
Of the 341 women who agreed to take participate, one (who had a body mass index of 17 (weight (kg)/height (m)2)) had anorexia nervosa, three had bulimia nervosa, and nine had an “eating disorder not otherwise specified.” A receiver operating curve set the optimal threshold for the questionnaire at two or more positive answers to the five questions. With this cut off, the SCOFF questionnaire detected all four cases of anorexia nervosa and bulimia nervosa and seven of nine cases of eating disorders not otherwise specified (figure). The questionnaire had a sensitivity of 84.6% (95% confidence interval 54.6% to 98.1%). In the 328 women confirmed not to have an eating disorder, the questionnaire indicated 34 false positives. It had a specificity of 89.6% (86.3% to 92.9%), positive predictive value of 24.4% (12.9% to 39.5%), and negative predictive value of 99.3% (97.6% to 99.9%).
View larger version:In a new windowDownload as PowerPoint SlideReceiver operating curve showing the effect of cut-off points (1 to 5) for the SCOFF questionnaire to detect cases and non-cases of eating disorders. 1 to 5=minimum number of positive responses to questionnaire

Comments
The SCOFF questionnaire detected all cases of anorexia and bulimia nervosa. It is an efficient screening tool for eating disorders.
Two missed cases of eating disorders not otherwise specified reflect the reality of clinical situations, in which denial or non-disclosure by patients may occur. One of the patients in whom the diagnosis was missed later disclosed disordered eating behaviour. It may be more difficult and perhaps less pertinent to detect patients who do not meet full criteria for anorexia nervosa or bulimia nervosa.
The positive predictive value of the questionnaire is low because of the low prevalence of eating disorders in this sample, which was consistent with the Western population as a whole. Overinclusion is acceptable for screening instruments designed for disorders with high mortality rates, particularly as the questionnaire is short and easy to administer. Positive results should be followed by further questioning rather than by automatic referral.
The SCOFF questionnaire is efficient at detecting cases of eating disorders in adult women in primary care. We recommend its use by healthcare professionals in primary care. Future work will assess the validity of the questionnaire in other populations, such as adolescents, in whom the prevalence may be higher.
Acknowledgments
Study to be attributed to the Department of Psychiatry at St George's Hospital Medical School, University of London, London. We thank K Kennett for her help with data collection. We also thank Wandle Valley Surgery and Brocklebank Group Practice, particularly T Coffey, who provided study patients. We thank the volunteers for their kind participation.
Contributors: All authors contributed to the conception and design of the study. AL, AO'B, JB, and CP were responsible for the collection and management of data. AL, FR, and JM analysed and interpreted data. AL wrote the paper and all other authors oversaw the writing and edited the paper. JM and HL will act as guarantors.
Footnotes

Funding None

Competing interests None declaredReferences1.↵Department of Health.A national service framework for mental health: modern standards and service models. London:Stationery Office,1999.2.↵Garner DM, Olmstead MA, Polivy J.Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.Int J Eat Disord 1983; 2:15–34.3.↵Beglin SJ, Fairburn CG.Evaluation of a new instrument for the detection of eating disorders in community samples.Psychiatry Res 1992; 44:191–201.OpenUrlCrossRefMedlineWeb of Science4.↵Morgan JF, Reid F, Lacey JH.The SCOFF questionnaire: assessment of a new screening tool for eating disorders.BMJ 1999; 319:1467–1468.OpenUrlFREE Full Text5.↵Perry L, Morgan J, Reid F, O'Brien A, Brunton J, Luck A, et al.Oral versus written administration of the SCOFF.Int J Eating Disorders (in press).

2 Followers
 · 
274 Views
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with eating disorder (ED) often remain unrecognized in many settings. Few studies have explored the use of eating measures in an adult male population. This study aimed to examine the comparative validity of the SCOFF questionnaire for detecting ED cases in men and women in the psychiatric outpatient setting.Method Psychiatric outpatients, including 605 men and 936 women, aged 18–45 years, completed the paper form SCOFF and were interviewed using the ED Module of the Structured Clinical Interview for the DSM-IV-TR. A subgroup of patients completed several additional self-reported questionnaires concerning eating and general psychopathology.ResultsScores of 2 and 3 on the SCOFF were the optimal cutoff values for determining ED among men (sensitivity 86% and specificity 74%) and women (sensitivity 80% and specificity 86%), respectively. While age did not significantly affect the validity indices, the SCOFF as a screening tool for ED in obese men was underperformed.Conclusions The Mandarin Chinese version of the SCOFF is a potentially valid tool to detect ED in both genders in the psychiatric outpatient settings. By helping to detect hidden ED morbidity, the SCOFF can enhance diagnostic accuracy and facilitate comprehensive treatment among psychiatric outpatients.
    Comprehensive Psychiatry 11/2014; 57. DOI:10.1016/j.comppsych.2014.11.014 · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Despite modern therapeutic regimens, youths with Type 1 diabetes may be at increased risk of mental and behavioral disorders. In this study, the prevalence of disordered eating behavior (DEB) in intensely treated children and adolescents with early-onset Type 1 diabetes and peers from the general population was compared. Method Data from 629 patients from a population-based, nationwide survey (54.1% male, mean age 15.3 years) with early-onset Type 1 diabetes of at least 10 years duration were compared with data from 6,813 participants of the German KiGGS study (51.3% male, mean age 14.6 years). The generic SCOFF questionnaire was used as screening instrument to identify participants with symptoms of DEB. Both groups were compared with multivariable regression analysis adjusting for sociodemographic covariates. Results31.2% of the female and 11.7% of the male diabetic patients and 28.9% of the females and 15.2% of the males in the comparison group were SCOFF-positive (SCOFF score ≥2; p > .05). The odds for symptoms of eating disorders were 3.7% higher in female and 4.3% lower in male patients with diabetes than in the comparison group, but the differences were not significant. 20.5% of the female and 18.5% of the male diabetic patients reported insulin restriction at least three times per week. DiscussionChildren and adolescents with early-onset Type 1 diabetes of long duration do not seem to be more frequently SCOFF-positive than peers. However, as insulin restriction is practiced in a substantial portion of patients, attention for insulin restriction in diabetes care is essential. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013)
    International Journal of Eating Disorders 05/2014; 47(4). DOI:10.1002/eat.22238 · 3.03 Impact Factor

Full-text (3 Sources)

Download
556 Downloads
Available from
Jun 1, 2014