Alcohol dependence in men: reliability and heritability.
- Authors
- Ystrom, Eivind; Reichborn-Kjennerud, Ted; Aggen, Steven H; Kendler, Kenneth S
- Year
- 2011
- Journal
- Alcoholism, clinical and experimental research
- PMID
- 21676009
- DOI
- 10.1111/j.1530-0277.2011.01518.x
- PMCID
- PMC3166371
BACKGROUND: The assessment of a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) life-time history of alcohol dependence (LTH-AD) has been found to be moderately reliable and substantially heritable. However, in studies of the heritability of LTH-AD, measurement error could not be discriminated from the true unique environmental effects. The aims of this study were to: (i) estimate the reliability of LTH-AD in a population based sample, (ii) identify characteristics of LTH-AD predicting a reliable diagnosis, (iii) investigate the heritability of LTH-AD as a function of diagnostic confidence, and (iv) to estimate the genetic and environmental influences on LTH-AD correcting for measurement error. METHODS: An unselected sample of 4,203 male twins was interviewed twice approximately 1-year apart assessing DSM-IV LTH-AD over the same period of life. Logistic regression was used to identify clinical features that predict a reliable diagnosis LTH-AD. Genetic and environmental influences on reliable LTH-AD were examined using structural equation models. RESULTS: Reliability of the diagnosis of LTH-AD was moderate (κ = 0.54) and was predicted by the number of AD symptoms, treatment seeking, duration of most severe episode, and a great deal of time spent to obtain, use, or recover from alcohol use (DSM-IV AD criterion #5). Using an index of caseness, heritability of LTH-AD increased as a function of diagnostic confidence. Accounting for errors of measurement in a multivariate twin model, the heritability of LTH-AD increased from 55 to 71%. CONCLUSIONS: Reliably diagnosed LTH-AD can be predicted by characteristics relevant to the disorder. LTH-AD appears to be a moderately reliable disorder of high heritability.
(A) A twin model for the heritability of liability to a life-time history (LTH) of alcohol dependence (AD) including occasion-specific influences on the recall and diagnosis of an LTH of AD (i.e., measurement error). In this model, it is assumed that there is a true, latent, liability to an LTH of AD, which is indexed by 2 assessments covering the same life period, measured at time 1 and time 2. The paths λ1 and λ2 illustrate the degree to which these assessments reflect the true liability to LTH of AD and is the square root of the test–retest reliability. The other path influencing LTH of AD, κ1 and κ2, illustrate occasion-specific influences on each assessment of LTH of AD. The model is constrained such that λ12+κ12=1.0. The liability to LTH-AD is modeled in a standard twin design with the sources of variance divided between additive (A), common (C), and individual-specific (E) environmental factors. By definition, the “common” environmental components are perfectly correlated in all twins, whereas the “individual-specific” environment is uncorrelated. Additive genetic factors are perfectly correlated in monozygotic twins and correlated 0.50 in dizygotic twins. The paths λa, λc, and λe, denote the paths from these factors. The paths illustrate standardized regression coefficients, so that the proportion of variance in the dependent variables accounted for by the independent variables is equal to the square of the connecting path. For example, heritability of reliably diagnosed LTH-AD equals λa2. (B) Parameter estimates with 95% confidence intervals from the best-fitting model (Model 4, Table 3). No evidence was found for different reliability in the diagnoses of LTH-AD at time 1 and time 2. No significant effect of common environmental influences on liability to LTH-AD was found. Heritability of reliable liability to LTH-AD = 0.842 = 71%. Conversely, the individual-specific environmentality of reliable liability to LTH-AD = 0.542 = 29%.
Heritability of life-time history of alcohol dependence as a function of diagnostic confidence. p < 0.01. The regression line depicts this relationship. In all the models, only additive genetic and individual-specific factors were needed.
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