Agreement between DSM-5 and DSM-IV measures of substance use disorders in a sample of adult substance users.

Agreement between DSM-5 and DSM-IV measures of substance use disorders in a sample of adult substance users.
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DOI:
10.1016/j.drugalcdep.2021.108958
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发表时间:
2021-10-01
影响因子:
4.2
通讯作者:
Hasin D
Hasin D
中科院分区:
医学2区
文献类型:
--
作者:
Livne O;Shmulewitz D;Stohl M;Mannes Z;Aharonovich E;Hasin D

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在 DSM-5 中,物质使用障碍 (SUD) 的定义与 DSM-IV 相比发生了很大变化,但人们对 DSM-IV 和 DSM-5 SUD 诊断在物质使用者之间的一致性程度知之甚少。由于许多研究的数据均基于 DSM-IV 诊断标准,因此了解 DSM-5 和 DSM-IV SUD 诊断之间的一致性以及这些诊断之间不一致的原因对于比较不同研究的结果至关重要。使用半结构化访谈 (PRISM-5),对郊区住院成瘾项目和城市医疗中心的 588 名物质使用者进行了 DSM-5 SUD 和 DSM-IV 物质依赖的患病率和机会校正一致性评估。对酒精、烟草、大麻、可卡因、海洛因、阿片类药物、镇静剂和兴奋剂使用障碍进行了检查。 Cohen’s kappa 用于评估 DSM-5 和 DSM-IV SUD(滥用或依赖)、DSM-5 SUD 和 DSM-IV 依赖以及 DSM-5 中度/重度 SUD 和 DSM-IV 依赖之间的一致性。除大麻和烟草(分别为 κ = 0.75 和 0.80)外,DSM-5 和 DSM-IV SUD 之间的一致性对于所有物质(κ = 0.84–0.99)都非常一致。诊断差异的最常见原因是 DSM-5 SUD 诊断呈阳性,但由于 DSM-5 SUD 阈值降低而没有 DSM-IV 诊断。除酒精、烟草和大麻 (κ = 0.63–0.75) 外,所有物质 (κ = 0.88–0.94) 的 DSM-5 SUD 和 DSM-IV 依赖性之间的一致性非常好。所有物质的中度/重度 DSM-5 SUD 和 DSM-IV 依赖性之间的一致性非常好。虽然在解释使用不同方法的研究结果时应谨慎,但依赖 DSM-IV 或 DSM-5 SUD 诊断标准的研究提供了类似的信息,因此可以在积累大量证据时进行比较。
In DSM-5, definitions of substance use disorders (SUD) were changed considerably from DSM-IV, yet little is known about how well DSM-IV and DSM-5 SUD diagnoses agree among substance users. Because data from many studies are based on DSM-IV diagnostic criteria, understanding the agreement between DSM-5 and DSM-IV SUD diagnoses and reasons for discordance between these diagnoses is crucial for comparing results across studies. Prevalences and chance-corrected agreement of DSM-5 SUD and DSM-IV substance dependence were evaluated in 588 substance users in a suburban inpatient addiction program and an urban medical center, using a semi-structured interview (PRISM-5). Alcohol, tobacco, cannabis, cocaine, heroin, opioid, sedative, and stimulant use disorders were examined. Cohen’s kappa was used to assess agreement between DSM-5 and DSM-IV SUD (abuse or dependence), DSM-5 SUD and DSM-IV dependence, and DSM-5 moderate/severe SUD and DSM-IV dependence. Agreement between DSM-5 and DSM-IV SUD was excellent for all substances (κ = 0.84–0.99), except for cannabis and tobacco (κ = 0.75; 0.80, respectively). The most common reason for diagnostic discrepancies was a positive DSM-5 SUD diagnosis but no DSM-IV diagnosis, due to the lowered DSM-5 SUD threshold. Agreement between DSM-5 SUD and DSM-IV dependence was excellent for all substances (κ = 0.88–0.94), except for alcohol, tobacco, and cannabis (κ = 0.63–0.75). Agreement between moderate/severe DSM-5 SUD and DSM-IV dependence was excellent across all substances. While care should be used in interpreting results of studies using different methods, studies relying on DSM-IV or DSM-5 SUD diagnostic criteria offer similar information and thus can be compared when accumulating a body of evidence.
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