Title: The Bergen Facebook Addiction Scale: Its psychometric properties and invariance among
women with eating disorders
Version: 3 Date: 03 Nov 2021
Reviewer's report:
OVERVIEW
This has the potential to be of interest to BMC Women's Health readers. In a cross-sectional
study, the authors aim to examine the psychometric properties of a questionnaire of Facebook
addiction, using a clinical sample of 123 patients with eating disorders (EDs). The statistical
analysis strategy is sound, and this study contributes to the existent literature by adding the
usefulness of a Facebook addiction measure in a clinical sample of people with eating disorders.
However, there are some concerns with the manuscript, and I am unable to recommend it
be accepted as is. Specifically, there is no strong rationale for examining the psychometric
properties of the questionnaire in patients with EDs. There is no consistency of ideas throughout
the literature review and the authors include previous research involving adolescents, college
students, and healthy adults as evidence of psychometrics; however, the data do not support the
case for evaluating the structure of the questionnaire and its invariance among patients with EDs.
Furthermore, the approach of disordered eating is limited, and its measurement is not mentioned.
Other issues exist for the manuscript. As example, the authors state that "no ethical approval
was attained for the present study since the analysis is based on a publicly accessible dataset". I
don't think an accessible dataset is enough to disregard ethical approval. This is a fundamental
ethical concern. Some findings also do not seem to be properly interpreted. Finally, discussion
on the relevance of examining the psychometric properties of the questionnaire in a sample of
EDs is lacking, and the manuscript practically does not address the clinical implications. Most
notably, I still believe that the manuscript can benefit from English language editing. Thus, the
manuscript needs further work to represent previous literature more accurately as well as to
present their findings more richly.
Major issues
The manuscript had some important issues that would need to be addressed before one could
assess its viability for publication. Those issues are:
ABSTRACT
• Given that patients with EDs are the target of the study, the objective should be more focused on
this population than on "patient groups" in general. When reading the abstract, I don't understand
the relevance of examining the psychometric properties in a sample with EDs.
• In the methods, authors must specify whether the participants are outpatients or inpatients.
• The abstract should include the name of the scale used in the criterion validity of the BFAS
to give the reader a more precise information.
• I believe that in the results there is a mistake when the authors say, "A single factor explained
85.3% the invariance in the BFAS". It is "…85.3% of the variance", correct?
• Also, the conclusion should be specifically focused on the usefulness of BFAS in patients with
EDs and not only in psychiatric patients.
• Why the keyword "Spain/Spanish"? Although the study was conducted with a sample recruited
in Spain, it does not seem appropriate to use this keyword, as it is not a variable in the study.
INTRODUCTION
• In the first sentence of the introduction, the authors write that “The symptoms and the progress
of eating disorders (EDs) may be frustrating and odd for patients’ family members who may
tend to react…” Why start the introduction from the impact of the symptoms and progress of
EDs on family members? I suggest starting with a more general sentence, which addresses the
severity of EDs and their impact on personal and interpersonal functioning. So, the reaction of
family members can be approached as an example of the impact on interpersonal functioning.
• There are also some "leaps". For example, there is no connection or continuity between the
paragraphs relating to social deficits in EDs and social networking sites.
• Overall, the authors should offer a stronger rationale for the choice of the population object of
the study. This is perhaps the main gap in the study.
METHOD
• The age range is rather wide. Does this matter that some are younger than 18? How many
young people are a part of the 123 participants? Does the proportion of adolescents affect the
results at all?
• How were the participants diagnosed? Are diagnoses based on DSM-5 criteria?
• One of the inclusion criteria is to accept to sign an informed consent. The sample includes
minors and they do not sign consent. Parents or legal guardians must sign the informed consent.
This should be specified.
• The authors state that "no ethical approval was attained for the present study since the analysis
is based on a publicly accessible dataset". What this means? I don't think an accessible dataset
is enough to disregard ethical approval. This is a fundamental ethical concern.
• Authors should clarify the description of the S-IAT, including the score calculation and its
meaning.
• Anorexia nervosa includes the two subtypes – restrictive type and binge/purge type? If so, it
would be appropriate to describe the frequencies of each subtype.
• Could the authors please justify the two main groups of Eds – AN and other EDs
subtypes? Given the sharing of characteristics between diagnoses of EDs, as advanced by the
transdiagnostic approach, will there not be in the group of other EDs subtypes patients with
symptoms of AN?
• Descriptive statistics should be mentioned in the statistical analysis section.
• Is the alpha coefficient used to examine reliability the Cronbach's alpha? If yes, please specify.
RESULTS
• Table 1 - Age is an interval variable. Therefore, it may be more appropriate to describe age in
terms of mean, standard deviation, minimum and maximum.
• Could the authors provide slightly more detail regarding the similarity between item pairs
that exhibited correlated errors to help bolster the theoretical rationale for modelling those
parameters?
• In table 3, what does "C" mean?
• It might be interesting to present the BFAS scores obtained in the study sample. That way we
would have more data about the problematic use of Facebook in the sample, even though this
is not the main objective of the study.
DISCUSSION
• It makes no sense to start the discussion by evidence in college students. These are not the
target population of the study.
• The discussion is really a restatement of the findings. It is not easy to see how this adds to
the existing literature, since the authors draw attention to the similarity with existing studies.
What does this study add to the subject area compared to other published material? This should
be further specified.
• Once again, it is necessary to clarify the relevance of examining the psychometric properties
of the questionnaire in a sample of patients with EDs.
• The authors state in the Discussion “…the BFAS was invariant at the configurable, metric,
scalar, and strict levels across groups of EDs, age, education”. I cannot see how this interpretation
can be drawn from the findings: " As shown in Table 4, the BFAS was invariant at the configural,
metric, scalar, and strict levels across groups of education. #2 was significant in three models
indicating scalar non-invariance across EDs groups and strict non-invariance across groups of
age and marital status”.
• Finally, I think that there could be more discussion of the clinical implications. Maybe the
authors could mention how the use of the BFAS will improve the assessments of patients with
eating disorders.
Minor issues
• In the running title, the last "s" in the word "disorders" is missing.
• In the abstract, I think authors should choose "Pathological Facebook use" or "Facebook
addiction" and use the same term throughout the manuscript.
• In the abstract, in the methods section, the comma after "123 women with EDs" is unnecessary.
• Authors should note that there is no zero before the comma when the value varies only between
-1 and 1 (such as standardized betas, p-values, or r) and that there is zero before the comma when
the value can exceed -1 or 1 (such as the test statistics, F or t, as well as the standard deviations
and the estimates and SE in the tables). Please consider this throughout the manuscript.
• Please use italicized #2, p and r.
• In the abstract, in the sentence "High coefficient alpha (0.96) and item-total correlations
(0.851-0.929) signified excellent reliability and high discrimination index of the BFAS",
"signified" should be replaced by another word, such as "indicated".
• In the introduction, "disease" should be replaced by "disorder".
• In the introduction, re-write the sentence “On the other hand, women with BN exhibited no
behavioral or neural differences…” for clarity.
• Examples such as "e.g., salience, conflict, tolerance" must be enclosed in parentheses.
• Some citations are missing. For example, in the measures section, citations from the authors
of the original versions, as well as from the Griffiths’ addiction component model, are missing.
• Table 1 - Please use an uppercase, italicized N to designate the number of members in the
total sample. Use a lowercase, italicized n to designate the number of members in a subsample
of the total sample.
Overall
• There are spelling, writing, and grammar errors throughout. The language used throughout
the manuscript is not always the most suitable. For example, authors should substitute certain
expressions, such as: "deficient"; "frustrating and odd"; "more superiority". The sentence
"...themselves from friends and family ending with obsessions with their unhealthy eating
behaviors as their sole companion" also suggests limited scientific writing and use of banal
language. The article would benefit from further proofing after any changes.