A Rasch model analysis of DSM-IV alcohol abuse and dependence items in the National Epidemiological Survey on Alcohol and Related Conditions
A Rasch model analysis of DSM-IV alcohol abuse and dependence items in the National Epidemiological Survey on Alcohol and Related Conditions
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DOI：
10.1111/j.1530-0277.2006.00140.x
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发表时间：
2006-07-01
期刊：
影响因子：
--
通讯作者：
Strong, David R.
中科院分区：
文献类型：
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作者：
Kahler, Christopher W.;Strong, David R.
背景资料：关于精神障碍诊断与统计手册第四版（DSM-IV）定义的酒精滥用和酒精依赖的诊断问题仍然存在。这些问题围绕着个人酒精使用障碍（AUD）标准的表现和用于评估这些标准的项目的性质。在这项研究中，我们进行深入分析的访谈项目，用于评估酒精滥用和dependency.Method：我们进行了Rasch模型分析的响应33个项目评估酒精滥用和依赖的标准在全国流行病学调查酒精和相关条件，全国代表性的样本34,550名参与者。我们还检查了项目是否因性别、种族/民族、年龄、教育和评估时间范围（即，结果：一个单一的潜在维度解释了绝大多数项目之间的共享方差。滥用症状的严重程度并不总是低于依赖症状，有些症状在各亚组中总是倾向于功能差异。与耐受性相关的项目在亚组中也有差异，特别是在年轻人（18-24岁）和老年人之间的过去一年症状的比较中。项目差异很大，在他们的经验估计的严重程度，即使当他们打算评估相同的DSM-IV criterion.Conclusions：使用Rasch模型分析表明，AUD标准的基本一维性和缺乏滥用和依赖标准之间的层次排序，以及潜在的来源的偏见，滥用诊断和耐受性标准。研究结果强调，AUD标准的患病率甚至含义可能会因用于评估它们的项目的措辞而大不相同。具体的DSM标准的评估和DSM-V的发展的影响进行了讨论。
Background: Questions persist about the diagnoses of alcohol abuse and alcohol dependence as defined by Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV). These questions center around the performance of individual alcohol use disorder (AUD) criteria and the nature of items used to assess them. In this study, we conduct in-depth analyses of interview items used to assess alcohol abuse and dependence.Method: We conducted Rasch model analyses of responses to 33 items assessing alcohol abuse and dependence criteria in the National Epidemiological Survey on Alcohol and Related Conditions, a nationally representative sample of 34,550 participants. We also examined whether items performed differentially by gender, race/ethnicity, age, education, and time frame of assessment (i.e., past year vs lifetime).Results: A single latent dimension explained the vast majority of shared variance among the items. Abuse symptoms were not of consistently lower severity than dependence symptoms, and some were consistently prone to differential functioning across subgroups. Items related to tolerance also functioned differentially across subgroups especially in the comparison of past-year symptoms between young adults (ages 18-24) and older adults. Items differed widely in their empirically estimated severity, even when they were intended to assess the same DSM-IV criterion.Conclusions: The use of Rasch model analyses demonstrated the essential unidimensionality of AUD criteria and the lack of hierarchical ordering between abuse and dependence criteria, as well as potential sources of bias in the abuse diagnosis and the tolerance criterion. Results highlight that the prevalence and even the meaning of AUD criteria can differ substantially depending on the wording of items used to assess them. Implications for assessment of specific DSM criteria and for development of DSM-V are discussed.