The Diabetes Eating Problem Survey-Revised (DEPS-R) in a Finnish adolescent and adult population with insulin-dependent diabetes: a validation study in Finland

Background The Diabetes Eating Problem Survey–Revised (DEPS-R) has been widely studied in children and adolescents with type 1 diabetes mellitus (T1D), but fewer studies have validated the DEPS-R in adults. Therefore, this study aimed to examine the factor structure, internal consistency, and criterion validity of the Finnish version of the DEPS-R in adolescents over 16 years of age and adults with insulin dependent diabetes (T1D and T2D). Methods The sample consisted of 201 patients with insulin dependent diabetes, including individuals with T1D (93%) and type 2 diabetes (T2D). Inclusion criteria were age over 16 years. Mean age was 34.5 years (SD 14.7). Both males and females were included (56.7% females). Participants completed DEPS-R and Eating Disorder Examination Questionnaire (EDE-Q). Construct validity and factor structure of the DEPS-R questionnaire was to be explored by conducting confirmatory and exploratory factor analyses. The association between DEPS-R and EDE-Q total scores was calculated using Spearman´s correlation coefficient. Criterion validity analysis with the ROC curve analysis was conducted to investigate the ability of the 16-item Finnish version of DEPS-R to identify respondents with a greater risk of eating disorder. Results Because of the skewness of item distributions, the results of confirmatory factor analyses and exploratory factor analysis were discarded. DEPS-R scores correlation coefficient to EDE-Q score was positive with Spearman’s rho 0.678 ( p < .001). The reliability of the full scale was α = 0.860. In ROC curve analysis, the area under the curve was large (AUC = 0.94%, asymptotic 95% confidence interval 0.89–0.99%). According to Youden’s index, the optimal DEPS-R cut-off score for detecting heightened risk of eating disorder in this study was ≥ 17 points, with that score sensitivity was 0.94 and specificity was 0.82. Conclusions Based on clinical guidelines, a diabetes-specific screening tool for disordered eating behavior is recommended to be used routinely in the clinical care of adults with insulin-dependent diabetes. According to the present study, the Finnish version of DEPS-R shows good criterion validity, when ROC curve was used. Based on this study cut-off score ≥ 17 points may be more suitable than cut-off score ≥ 20 points, but further studies are needed. It is a promising measure for further studies and, with some caveats, it can be used in a clinical context.