The dimensionality of DSM-IV alcohol use disorders among adolescent and adult drinkers and symptom patterns by age, gender, and race/ethnicity.
- Authors
- Harford, Thomas C; Yi, Hsiao-ye; Faden, Vivian B; Chen, Chiung M
- Year
- 2009
- Journal
- Alcoholism, clinical and experimental research
- PMID
- 19320629
- DOI
- 10.1111/j.1530-0277.2009.00910.x
- PMCID
- PMC4664203
BACKGROUND: There is limited information on the validity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorders (AUD) symptom criteria among adolescents in the general population. The purpose of this study is to assess the DSM-IV AUD symptom criteria as reported by adolescent and adult drinkers in a single representative sample of the U.S. population aged 12 years and older. This design avoids potential confounding due to differences in survey methodology when comparing adolescents and adults from different surveys. METHODS: A total of 133,231 current drinkers (had at least 1 drink in the past year) aged 12 years and older were drawn from respondents to the 2002 to 2005 National Surveys on Drug Use and Health. DSM-IV AUD criteria were assessed by questions related to specific symptoms occurring during the past 12 months. Factor analytic and item response theory models were applied to the 11 AUD symptom criteria to assess the probabilities of symptom item endorsements across different values of the underlying trait. RESULTS: A 1-factor model provided an adequate and parsimonious interpretation for the 11 AUD criteria for the total sample and for each of the gender-age groups. The MIMIC model exhibited significant indication for item bias among some criteria by gender, age, and race/ethnicity. Symptom criteria for "tolerance,""time spent," and "hazardous use" had lower item thresholds (i.e., lower severity) and low item discrimination, and they were well separated from the other symptoms, especially in the 2 younger age groups (12 to 17 and 18 to 25). "Larger amounts,""cut down,""withdrawal," and "legal problems" had higher item thresholds but generally lower item discrimination, and they tend to exhibit greater dispersion at higher AUD severity, particularly in the youngest age group (12 to 17). CONCLUSIONS: Findings from the present study do not provide support for the 2 separate DSM-IV diagnoses of alcohol abuse and dependence among either adolescents or adults. Variations in criteria severity for both abuse and dependence offer support for a dimensional approach to diagnosis which should be considered in the ongoing development of DSM-V.
Prevalence of DSM-IV AUD Symptom Criteria Among Current Drinkers, by Gender and Age Group.
LLM interpretation
This figure consists of two line graphs showing the prevalence of DSM-IV AUD symptom criteria for males (top) and females (bottom), categorized by three age groups (12–17, 18–25, and 26+). The x-axis lists specific AUD criteria (T, W, A, C, G, ‡, P, R, H, L, S), and the y-axis measures the prevalence of criterion endorsement. In both genders, the 18–25 age group generally shows the highest prevalence, with the most prominent peaks occurring for "Tolerance" (T) and "Time spent" (‡).
Item Response Curves for DSM-IV AUD Symptom Criteria, by Gender and Age Group
LLM interpretation
This figure consists of six item response curves (sigmoidal plots) organized by gender (Males, Females) and age group (12-17, 18-25, and 26+ years). The x-axis represents the "Latent Trait of AUD Severity" and the y-axis represents the "Probability of AD Criterion Endorsement." Each curve, labeled with a letter corresponding to a specific DSM-IV AUD symptom, shows the probability of endorsing that symptom as the latent severity of the disorder increases.
Test Information Curves for DSM-IV AUD Symptom Criteria, by Gender and Age Group
LLM interpretation
This line graph displays Test Information Curves for DSM-IV AUD symptom criteria, plotted as Test Information (y-axis) against the Latent Trait of AUD Severity (x-axis). The data is categorized by gender (males represented by dashed lines, females by solid lines) and three age groups (12–17, 18–25, and 26+). All groups show a peak in test information at higher levels of AUD severity, with the "Females, 26+" and "Males, 26+" groups exhibiting the highest peaks of information around a latent trait value of 2 to 2.5.
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