DSM-5特定诊断标准在酒精使用障碍早期发展中的关键作用:RADAR前瞻性队列研究的结果。

IF 3 Q2 SUBSTANCE ABUSE Alcohol (Hanover, York County, Pa.) Pub Date : 2024-06-24 DOI:10.1111/acer.15379
Tim Slade, Siobhan M. O'Dean, Tammy Chung, Louise Mewton, Jim McCambridge, Philip Clare, Raimondo Bruno, Wing See Yuen, Joel Tibbetts, Peter Clay, Alexandra Henderson, Nyanda McBride, Richard Mattick, Veronica Boland, Delyse Hutchinson, Emily Upton, Ashling Isik, Phoebe Johnson, Kypros Kypri
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引用次数: 0

摘要

背景:预防和早期干预酒精使用障碍(AUD)是公共卫生的当务之急,然而,我们对酒精使用障碍是如何出现的、酒精使用障碍的哪些症状最先出现、是否存在可改变的风险因素来预测酒精使用障碍的发展等问题的认识还存在差距。本研究调查了发生 AUD 的潜在预警信号症状:数据来自 RADAR 研究,这是一项针对澳大利亚当代新兴成年人的前瞻性队列研究(n = 565,平均年龄 = 18.9,基线年龄范围 = 18-21,48% 为女性)。参与者在 2.5 年的时间里接受了五次访谈。临床心理学家使用根据 DSM-5 标准修改的 DSM-IV 结构化临床访谈(SCID-IV)对《精神疾病诊断与统计手册》第五版(DSM-5)的 AUD 标准和诊断进行了评估。危害分析模拟了从首次饮酒到出现任何 AUD 标准的时间,并确定了哪些首次出现的 AUD 标准与更快地转变为障碍有关:到最后一个时间点,54.8%的样本至少经历过一次DSM-5 AUD标准,26.1%的样本达到了DSM-5 AUD标准。从首次出现 AUD 标准到被诊断为 AUD 的中位时间为 4 年。饮酒导致的社会问题(危险比 [HR] = 3.24,CI95 = 2.14,4.92,P 95 = 1.58,4.06,P 95 = 1.20,3.46,P = 0.008)是与更快转变为 AUD 相关的首次发病标准:结论:在对 AUD 的时间发展进行前瞻性普通人群队列研究时,与酒精相关的社会问题、主要角色问题以及饮酒量超过预期或时间超过预期是关键的风险因素,可作为早期干预的目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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The key role of specific DSM-5 diagnostic criteria in the early development of alcohol use disorder: Findings from the RADAR prospective cohort study

Background

Prevention and early intervention of alcohol use disorder (AUD) is a public health priority, yet there are gaps in our understanding of how AUD emerges, which symptoms of AUD come first, and whether there are modifiable risk factors that forecast the development of the disorder. This study investigated potential early-warning-sign symptoms for the development of AUD.

Methods

Data were from the RADAR study, a prospective cohort study of contemporary emerging adults across Australia (n = 565, mean age = 18.9, range = 18–21 at baseline, 48% female). Participants were interviewed five times across a 2.5-year period. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) AUD criteria and diagnoses were assessed by clinical psychologists using the Structured Clinical Interview for DSM-IV (SCID-IV), modified to cover DSM-5 criteria. Hazard analyses modeled the time from first alcoholic drink to the emergence of any AUD criteria and determined which first-emergent AUD criteria were associated with a faster transition to disorder.

Results

By the final time point, 54.8% of the sample had experienced at least one DSM-5 AUD criterion and 26.1% met criteria for DSM-5 AUD. The median time from first AUD criterion to a diagnosis of AUD was 4 years. Social problems from drinking (hazard ratio [HR] = 3.24, CI95 = 2.14, 4.92, p < 0.001), major role (HR = 2.53, CI95 = 1.58, 4.06, p < 0.001), and drinking larger amounts/for longer than intended (HR = 2.04, CI95 = 1.20, 3.46, p = 0.008) were first-onset criteria associated with a faster transition to AUD.

Conclusion

In the context of a prospective general population cohort study of the temporal development of AUD, alcohol-related social problems, major role problems, and using more or for longer than intended are key risk factors that may be targeted for early intervention.

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