Original ArticleValidation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care
Introduction
Eating disorders (EDs) constitute a group of psychiatric disorders clinically important for their prevalence in young females and for the social concern they produce. The overall prevalence of EDs in the female population in the community in Spain is 4.1% (95% CI, 3.4–4.9) [1]. The disorder-specific prevalence in our country is as follows: bulimia nervosa 0.8% (95% CI, 0.5–1.2), anorexia nervosa 0.3% (95% CI, 0.1–0.6) and ED not otherwise specified (EDNOS) 3.1% (95% CI, 2.5–3.8) [1]. We have no data on prevalence of these disorders in the Spanish primary care population but some studies in Great Britain calculate an incidence of 4.2 per 100,000 population for anorexia nervosa and 12.2 per 100,000 for bulimia nervosa [2].
It is widely accepted that early recognition of, and intervention with, these patients may have an important influence on the course of EDs, and thus EDs should be considered a substantial medical concern from a primary care health perspective [3]. One of the most commonly used screening tests for the detection of anorexia nervosa [4] is the Eating Attitude Test (EAT) [5]. However, doubts have been expressed about the predictive value of the EAT in different populations, as only a small percentage of the EAT-screened positive scores will have an actual ED [6]. The Drive for Thinness subscale of the Eating Disorder Inventory (EDI) [7] and the Bulimic Investigatory Test Edinburgh (BITE) [8] have also been used as screening tests but, at the moment, none of these questionnaires have been clearly recommended for this use. Recently, the SCOFF questionnaire, a simple and easy to memorize five-question test, has been proposed as a screening test for EDs with adequate psychometric characteristics in its British version [9], [10].
The aim of this study is to assess the validity and clinical usefulness of the Spanish version of the SCOFF for the detection of EDs in primary care settings.
Section snippets
Translation of the questionnaire
Transcultural validation of the SCOFF test for its use in the Spanish population included the following steps: (1) Translation from English into Spanish by two Spanish psychiatrists independently. The differences were solved by agreement. (2) Back translation from Spanish into English by one British and one American psychologist. Again, the differences were solved by agreement. (3) Pilot study on a sample of 20 Spanish patients to assess if the SCOFF questionnaire was acceptable and
Results
All the 203 participants of the sample were women, with a mean age of 29.2 years (S.D. 7.9 years, range 15–53). The diagnostic distribution of the sample is summarized in Table 1.
Table 2 summarizes sensibility, specificity, positive predictive value and negative predictive value of the SCOFF questionnaire for the detection of EDs (in general) in primary care.
Tables 3 and 4 describe sensitivity and specificity of the SCOFF for the detection of bulimia, anorexia and EDNOS in primary care.
The
Discussion
The validation study of the Spanish version of the SCOFF test demonstrates that this questionnaire presents excellent psychometric properties for the detection of patients with ED in primary care settings. The main strengths of this validation study are the following: (1) the size of the sample (N=203) of probable ED analyzed and (2) the validation methodologies according to their recommended clinical use. Other previous validations of this questionnaire have been made in cases and controls [9]
Acknowledgments
The authors thank John F. Morgan, Senior Lecturer in Liaison Psychiatry, Department of Psychiatry, St. George's Hospital Medical School, London, UK, for his valuable comments on a draft of the paper.
This work has been possible thanks to the Red Temática de Investigación Cooperativa: “Psiquiatría de Enlace” (No. Expediente G03/128) and to the Red de Investigación en Actividades de Prevención y Promoción de la Salud (REDIAPP-G03/170), nodo de Aragón, from Instituto de Salud Carlos III, Madrid,
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