<\/p>\nAgreementbetweenDSM-IVandDSM-5criteriaforalcoholusedisorderamongoutpatientssufferingfromdepressiveandanxietydisorders.pdf<\/h2>\n
<\/b><\/p>\n
Brief Report: Agreement Between DSM-IV and DSM-5
\nCriteria for Alcohol Use Disorder Among Outpatients
\nSuffering From Depressive and Anxiety Disorders\n<\/p>\n
Francesco Bartoli, MD, PhD,1 Giuseppe Carr\ufffda, MD, MSc, PhD,1,2,3 Enrico Biagi, MD,2\n<\/p>\n
Cristina Crocamo, MSc,2 Antonios Dakanalis, PsyD, MSc, PhD,1 Francesco Di Carlo, MD,1\n<\/p>\n
Francesca Parma, MSc,4 Anna Paola Perin, MD,5 Ester Di Giacomo, MD,1,2\n<\/p>\n
Luigi Zappa, MD,2 Fabio Madeddu, MD,4 Fabrizia Colmegna, MD,2\n<\/p>\n
Massimo Clerici, MD, PhD1,2\n<\/p>\n
1Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
\n2Department of Mental Health, San Gerardo Hospital, Monza, Italy
\n3Division of Psychiatry, University College London, London, UK
\n4Department of Psychology, University of Milano-Bicocca, Milano, Italy
\n5Department of Psychiatry, University of Brescia, Milano, Italy\n<\/p>\n
Background and Objectives: Since significant differences have
\nbeen reported, we estimated agreement betweenDSM-5 andDSM-IV
\ncriteria for alcohol use disorder (AUD).
\nMethods:We assessed 327 outpatients (mean age: 45.2\ufffd 13.4) with
\ndepressive or anxiety disorders.
\nResults: Absolute differences in prevalence rates between DSM-5
\nand DSM-IV AUD ranged from \ufffd1.1% (subjects with anxiety
\ndisorders) to \u00fe1.8% (tobacco smokers). The agreement was
\nexcellent (k\u00bc 0.88), also accounting for specific subgroups (relevant
\nk coefficients >0.80).
\nDiscussion and Conclusions: DSM-5 criteria did not inflate AUD
\nrates.
\nScientific Significance: Our results have epidemiological signifi-
\ncance since, unlike previous reports, we found diagnostic stability
\nbetween new and old AUD criteria in this clinical population. (Am J
\nAddict 2017;26:53\u201356)\n<\/p>\n
INTRODUCTION\n<\/p>\n
Alcohol use disorder (AUD) is a chronic illness associated
\nwith a high burden of disease,1 often comorbid with other
\nmental disorders.2 In 2013, the fifth edition of the Diagnostic
\nand Statistical Manual of Mental Disorders (DSM-5) made
\nseveral changes to diagnostic criteria and classifications of
\nAUD.3 First, abuse\/dependence criteria were merged into a\n<\/p>\n
single diagnostic category requiring that at least two criteria
\nweremet. Second, the alcohol-related legal problems criterion,
\nrepresenting one of the four used for DSM-IV alcohol abuse,
\nwas dropped. Third, the craving criterion, ie, the strong desire
\nor urge to use alcohol, was added. Finally, the new
\nclassification has traced the transition from a categorical to
\na dimensional diagnosis, identifying a severity grade of the
\ndisorder (mild, moderate, severe), according to the number of
\ncriteria met.\n<\/p>\n
All individuals with a diagnosis of DSM-IV alcohol
\ndependence, but only a portion of those with DSM-IV alcohol
\nabuse, thus reach the DSM-5 diagnostic threshold for AUD. On
\nthe other hand, a portion of so-called DSM-IV \u201cdiagnostic
\norphans\u201d, ie, people meeting one or two criteria for alcohol
\ndependence, but none for alcohol abuse, are diagnosed with
\nAUD according to DSM-5 criteria. Therefore, based onDSM-5
\ncriteria, some AUD cases are lost and other gained, implying
\npotential epidemiological variations. Indeed, a previous
\nsystematic overview4 showed that DSM-5 criteria might
\nsignificantly inflate AUD rates in general population. Never-
\ntheless, there is a lack of data exploring this issue in particularly
\nvulnerable populations. For example, AUD is frequently
\nassociated with an unfavorable prognosis among subjects
\nwith depressive and anxiety disorders.5 Thus, it seems
\nimportant to test if there are AUD epidemiological variations,
\ndue to DSM-5 new set of criteria, also among subjects with
\ndepressive and anxiety disorders. To our knowledge, there are
\nno studies exploring this topic so far. In order to overcome
\nlimitations of previous research, we aimed at estimating
\ndifferences in prevalence, as well as agreement, between
\nDSM-5 and DSM-IV criteria for AUD in a sample of\n<\/p>\n
Received July 25, 2016; revised November 18, 2016; accepted
\nDecember 4, 2016.\n<\/p>\n
Address correspondence to Dr. Bartoli, Department of Medicine
\nand Surgery, University of Milano-Bicocca, Via Cadore 48, 20900
\nMonza (MB), Italy. E-mail: [email\u00a0protected]\n<\/p>\n
The American Journal on Addictions, 26: 53\u201356, 2017
\nCopyright \u00a9 2016 American Academy of Addiction Psychiatry
\nISSN: 1055-0496 print \/ 1521-0391 online
\nDOI: 10.1111\/ajad.12482\n<\/p>\n
53<\/p>\n<\/p><\/div>\n
individuals with depressive and anxiety disorders. We
\nhypothesized that DSM-5 diagnostic criteria would increase
\nAUD rates as compared with those based on DSM-IV criteria.\n<\/p>\n
METHODS\n<\/p>\n
This study was drawn up according to \u201cThe Strengthening
\nthe Reporting of Observational Studies in Epidemiology
\n(STROBE) Statement\u201d.6 STROBE Statement developed
\nrecommendations on items that should be included in accurate
\nand complete reports of observational studies.\n<\/p>\n
Setting and Eligibility Criteria
\nWe included individuals older than 18 years of age,\n<\/p>\n
consecutively admitted, in a 12-month period from January to
\nDecember 2015, to San Gerardo Hospital outpatient clinic
\n(\u201cAmbulatorio Vademecum\u201d) and suffering from a depressive
\nor anxiety disorder. The setting, sampling strategies and
\ninclusion\/exclusion criteria are fully described elsewhere.7\n<\/p>\n
San Gerardo University Hospital of Monza covers a
\ncomprehensive range of medical and surgical inpatient and
\noutpatient services, serving a catchment area of 319,000
\ninhabitants.8\n<\/p>\n
Data Collection and Measures
\nStandard socio-demographic and clinical characteristics\n<\/p>\n
were collected for descriptive purposes. The Italian version
\nof the K-6 scale was used to measure individual
\npsychological distress.9 We used the Mini- International
\nNeuropsychiatric Interview (MINI)\u2014alcohol module, to
\nassess current DSM-IV and DSM-5 AUDs. Since DSM-5
\nincludes the additional craving criterion, we implemented
\nthe interview with an item derived from the Composite
\nInternational Diagnostic Interview (CIDI), assessing strong
\ndesire and urge to drink alcohol. Individuals were diagnosed
\nwith a current DSM-IV AUD if, in a 12-month period,
\ncriteria for DSM-IV abuse or dependence were met. On the
\nother hand, subjects were diagnosed with a current DSM-5
\nAUD if, equally in a 12-month period, at least two out of the
\neleven criteria were met. Fully trained consultant psychia-
\ntrists sequentially administered, along with other routine
\nscreening questionnaires, the MINI\/CIDI alcohol module.
\nAll data were recorded anonymously in a dataset not
\nallowing identification of subjects included in this study.
\nThe protocol was submitted to, and approved by, the ethic
\ncommittee of San Gerardo University Hospital.\n<\/p>\n
Data Analysis
\nIn order to estimate variations attributable to DSM-5\n<\/p>\n
criteria as compared with DSM-IV ones, we calculated
\nabsolute differences (increase\/decrease) in prevalence rates.
\nCohen\u2019s Kappa coefficients (k), with relevant Pr(a) (relative
\nobserved agreement) and Pr(e) (chance agreement), were used
\nto measure the agreement between the different diagnostic
\nsystems. We chose the conventional cut-offs to indicate\n<\/p>\n
poor (\ufffd0.20), fair (0.21\u20130.40), moderate (0.41\u20130.60), sub-
\nstantial (0.61\u20130.80), and excellent (0.81\u20131.00) agreement.4\n<\/p>\n
Relevant subgroup analyses, accounting for age, gender,
\ndiagnosis, psychological distress score, and smoking status,
\nwere tested to verify variability of k coefficients across
\ndifferent characteristics of subjects.\n<\/p>\n
Statistical analyses were performed using Stata for
\nWindows, version 13.1.\n<\/p>\n
RESULTS\n<\/p>\n
Four hundred and twenty-six individuals were consecu-
\ntively admitted to the San Gerardo Hospital outpatient clinic
\nfor depressive and anxiety disorders during the index period.
\nAmong these, 83 subjects were excluded because they did not
\nsuffer from depressive or anxiety disorders, while other 16
\nwere excluded because they refused to be screened (n\u00bc 10) or
\nhad a mental status or physical conditions not allowing the
\nscreening (n\u00bc 6). Thus, 327 subjects (mean age: 45.2\ufffd 13.4;
\nwomen\/men ratio: 1.51) were assessed for DSM-IV\/DSM-5
\nalcohol use disorders using the MINI\/CIDI interview. The
\nmean K-6 psychological distress score was 10.9 (5.6), and
\nmost of subjects suffered from an anxiety disorder (58.3%).\n<\/p>\n
Prevalence rates for DSM-IV and DSM-5 AUDs were
\nidentical, both corresponding to 11.3% (37\/327) in the overall
\nsample, and to 15.3% (37\/242) among alcohol users. The
\nabsolute differences were generally low and homogenous also
\nacross relevant subgroups, ranging from \ufffd1.1% among
\nsubjects suffering from anxiety disorders, to \u00fe1.8% among
\ntobacco smokers. A high level of diagnostic stability was
\nfound since DSM-5 AUD was present in most people with
\nDSM-IV AUD (89.2%) and absent in almost all subjects
\nwithout DSM-IV AUD diagnosis (98.6%). The overall
\nagreement between DSM-IV and DSM-5 criteria was
\nexcellent (k\u00bc 0.88). Excellent values (k> 0.80) were found
\nalso considering the subsample of alcohol users, and
\naccounting for age, gender, diagnosis, psychological distress,
\napart from non-smokers where the k coefficient (0.79) was
\nslightly below the relevant threshold, probably because of the
\nlimited proportion of AUD cases. Detailed findings are
\nsummarized in Table 1.\n<\/p>\n
DISCUSSION\n<\/p>\n
To our knowledge, this is the first empirical study
\naddressing the epidemiological impact of DSM-5 diagnostic
\ncriteria on AUD rates among subjects suffering from
\ndepressive or anxiety disorders. We tested a clinical sample
\nof 327 subjects consecutively admitted to a hospital
\noutpatient service. We found that DSM-5 diagnostic criteria,
\nas compared with DSM-IV ones, did not increase expected
\nAUD prevalence rates. DSM-IV and DSM-5 showed
\ncomparable rates of AUD in our clinical sample. We also
\nfound a high level of diagnostic stability, highlighting that\n<\/p>\n
54 From DSM-IV to DSM-5 Rates of Alcohol Use Disorder January 2017<\/p>\n<\/p><\/div>\n
most of the subjects with DSM-IV, had also DSM-5 AUDs.
\nThis was confirmed by the excellent overall agreement,
\nverified also by subgroup analyses, with k values generally
\nremaining above 0.80 also accounting for alcohol use, age,
\ngender, diagnosis, psychological distress score, and smoking
\nstatus. Thus, despite previous concerns on potential
\nepidemiological impact of DSM-5 criteria,4 DSM-5 does
\nnot seem to produce several AUD new cases (also called
\nDSM-IV \u201cdiagnostic orphans\u201d10) in this clinical population.
\nTherefore, the additional epidemiological burden of dual
\ndiagnosis after DSM-5 could be considered minimal if any,
\nat least among subjects suffering from depressive or anxiety
\ndisorders.\n<\/p>\n
Nevertheless, this study has some potential limitations that
\nshould be taken into account.7 First, the small sample sizemight
\nhave reduced the statistical power of our findings. However, it
\nseems unlikely that the magnitude of overlapping in AUD rates
\nbetween DSM-IV and DSM-5 might be entirely due to the
\nreduced sample size. Second, it should be considered the
\npotential lack of representativeness of our sample. As
\npreviously reported,4 individuals identified in clinical settings
\nmay not necessarily share identical characteristics of the general
\npopulation. Furthermore, we recruited subjects from an
\noutpatient clinic, receiving referrals fromprimary care services.
\nService users included in our study might be considerably
\ndifferent to those from caseloads of community mental health
\nservices.11 Finally, since we excluded from analyses a
\nsubstantial pool of individuals without depressive and anxiety
\ndisorders, we cannot exclude that our findings are valid only for
\nsubjects with a confirmed clinical diagnosis.\n<\/p>\n
Although some open questions regarding, especially,
\nreliability and validity of diagnostic criteria12,13 still remain,
\nDSM is considered worldwide a key tool for diagnosing
\nmental disorders. Thus, our observational study has
\nimportant implications for AUD assessment and treatment.
\nThere is a large diagnostic stability between new and old\n<\/p>\n
AUD criteria, at least in the specific clinical population we
\nassessed, suggesting it is unlikely that DSM-5 diagnostic
\ncriteria may inflate the size of AUD cases. Nevertheless,
\nfurther research is needed to estimate epidemiological trends
\nalso for illicit substance use disorders whose criteria had
\nsimilar changes in DSM-5.3\n<\/p>\n
Declaration of Interest
\nThe authors report no conflicts of interest. The authors\n<\/p>\n
alone are responsible for the content and writing of this paper.\n<\/p>\n
REFERENCES\n<\/p>\n
1. Rehm J, Mathers C, Popova S, et al. Global burden of disease and injury
\nand economic cost attributable to alcohol use and alcohol-use disorders.
\nLancet. 2009;373:2223\u20132233.\n<\/p>\n
2. Carr\ufffda G, Crocamo C, Borrelli P, et al. Correlates of dependence and
\ntreatment for substance use among people with comorbid severe mental
\nand substance use disorders: Findings from the \u201cPsychiatric andAddictive
\nDual Disorder in Italy (PADDI)\u201d study. Compr Psychiatry. 2015;58:
\n152\u2013159.\n<\/p>\n
3. Hasin DS, O\u2019Brien CP, Auriacombe M, et al. DSM-5 criteria for
\nsubstance use disorders: Recommendations and rationale.Am JPsychiatry.
\n2013;170:834\u2013851.\n<\/p>\n
4. Bartoli F, Carr\ufffdaG, CrocamoC, et al. FromDSM-IV toDSM-5 alcohol use
\ndisorder: An overview of epidemiological data. Addict Behav. 2015;41:
\n46\u201350.\n<\/p>\n
5. Boschloo L, Vogelzangs N, van den BrinkW, et al. Alcohol use disorders
\nand the course of depressive and anxiety disorders. Br J Psychiatry. 2012;
\n200:476\u2013484.\n<\/p>\n
6. von Elm E, Altman DG, EggerM, et al. The strengthening the reporting of
\nobservational studies in epidemiology (STROBE) statement: Guidelines
\nfor reporting observational studies. J Clin Epidemiol. 2008;61:344\u2013349.\n<\/p>\n
7. Bartoli F, Crocamo C, Biagi E, et al. Clinical utility of a single-item test
\nfor DSM-5 alcohol use disorder among outpatients with anxiety and
\ndepressive disorders. Drug Alcohol Depend. 2016;165:283\u2013287.\n<\/p>\n
8. Carr\ufffda G, Bartoli F, Carretta D, et al. The prevalence of metabolic
\nsyndrome in people with severe mental illness: A mediation analysis. Soc
\nPsychiatry Psychiatr Epidemiol. 2014;49:1739\u20131746.\n<\/p>\n
TABLE 1. Agreement between DSM-IV and DSM-5 alcohol use disorders across participant characteristics\n<\/p>\n
DSM-IV AUD DSM-5 AUD\n<\/p>\n
Cases Prevalence (%) Cases Prevalence (%) Absolute difference (%) Pr(a) Pr(e) k\n<\/p>\n
Overall sample (n\u00bc 327) 37 11.3 37 11.3 0.0 0.98 0.80 0.88
\nAlcohol users (n\u00bc 242) 37 15.3 37 15.3 0.0 0.97 0.74 0.87
\nMen (n\u00bc 130) 23 17.7 22 16.9 \ufffd0.8 0.96 0.71 0.87
\nWomen (n\u00bc 196) 14 7.1 15 7.6 +0.5 0.98 0.86 0.89
\nAge <30 years (n\u00bc 58) 13 22.4 13 22.4 0.0 1.00 0.65 1.00
\nAge >30 years (n\u00bc 269) 24 8.9 24 8.9 0.0 0.97 0.84 0.82
\nDepressive disorder (n\u00bc 133) 16 12.0 18 13.5 +1.5 0.97 0.78 0.87
\nAnxiety disorder (n\u00bc 186) 20 10.8 18 9.7 \ufffd1.1 0.98 0.82 0.88
\nK6< 7 (n\u00bc 89) 5 5.6 5 5.6 0.0 1.00 0.89 1.00
\nK6> 7 (n\u00bc 238) 32 13.4 32 13.4 0.0 0.97 0.77 0.86
\nTobacco smoker (n\u00bc 112) 26 23.2 28 25.0 +1.8 0.96 0.63 0.90
\nNon-tobacco smoker (n\u00bc 214) 11 5.1 9 4.2 \ufffd0.9 0.98 0.91 0.79\n<\/p>\n
AUD, alcohol use disorder; Pr(a), relative observed agreement; Pr(e), chance agreement; k, Cohen\u2019s kappa coefficient.\n<\/p>\n
Bartoli et al. January 2017 55<\/p>\n<\/p><\/div>\n
9. Carr\ufffda G, Sciarini P, Segagni-Lusignani G, et al. Do they actually work
\nacross borders? Evaluation of two measures of psychological distress as
\nscreening instruments in a non Anglo-Saxon country. Eur Psychiatry.
\n2011;26:122\u2013127.\n<\/p>\n
10. McBride O, Adamson G, Bunting BP, et al. Characteristics of DSM-IV
\nalcohol diagnostic orphans: Drinking patterns, physical illness, and
\nnegative life events. Drug Alcohol Depend. 2009;99:272\u2013279.\n<\/p>\n
11. Carr\ufffda G, Clerici M. Dual diagnosis-policy and practice in Italy. Am J
\nAddict. 2006;15:125\u2013130.\n<\/p>\n
12. Hasin D. DSM-5 SUD diagnoses: Changes, reactions, remaining open
\nquestions. Drug Alcohol Depend. 2015;148:226\u2013229.\n<\/p>\n
13. Luciano M, Sampogna G, Del Vecchio V, et al. Critical evaluation of
\ncurrent diagnostic classification systems in psychiatry: The case of
\nDSM-5. Riv Psichiatr. 2016;51:116\u2013121.\n<\/p>\n
56 From DSM-IV to DSM-5 Rates of Alcohol Use Disorder January 2017<\/p>\n<\/p><\/div>\n
Copyright of American Journal on Addictions is the property of Wiley-Blackwell and its
\ncontent may not be copied or emailed to multiple sites or posted to a listserv without the
\ncopyright holder’s express written permission. However, users may print, download, or email
\narticles for individual use.<\/p>\n<\/p><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
AgreementbetweenDSM-IVandDSM-5criteriaforalcoholusedisorderamongoutpatientssufferingfromdepressiveandanxietydisorders.pdf Brief Report: Agreement Between DSM-IV and DSM-5 Criteria for Alcohol Use Disorder Among Outpatients Suffering From Depressive and Anxiety Disorders Francesco Bartoli, MD, PhD,1 Giuseppe Carr\ufffda, MD, MSc, PhD,1,2,3 Enrico Biagi, MD,2 Cristina Crocamo, MSc,2 Antonios Dakanalis, PsyD, MSc, PhD,1 Francesco Di Carlo, MD,1 Francesca Parma, MSc,4 Anna Paola Perin, MD,5 Ester Di Giacomo, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16],"tags":[],"class_list":["post-132699","post","type-post","status-publish","format-standard","hentry","category-education"],"_links":{"self":[{"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/posts\/132699","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/comments?post=132699"}],"version-history":[{"count":0,"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/posts\/132699\/revisions"}],"wp:attachment":[{"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/media?parent=132699"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/categories?post=132699"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/assignmenttutors.net\/blog\/wp-json\/wp\/v2\/tags?post=132699"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}