Case ascertainment of alcohol dependence in general population surveys: 'gated' versus 'ungated' approaches.
Social role impairment and other forms of maladaptation are referenced explicitly in the case definitions for the drug use disorders within DSM-IV-TR, but there is continuing debate about whether and how to include these manifestations of 'clinical significance' in diagnostic criteria and assessment protocols. When a 'gated' approach (based on impairment or other maladaptation) has been taken during recent large scale psychiatric surveys with coverage of drug dependence (e.g. to reduce participant fatigue or burden), the net effect may include (a) a reduced number of identified cases, and (b) biases in the estimates of association linked to the occurrence of drug dependence. In this report focused on alcohol dependence, we probe these issues, making use of data from the cross-sectional US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey with 44,093 adult participants. NESARC alcohol dependence assessments were 'ungated', but allowed simulation of a 'gated' approach; the end result was a robust decrement in the estimated prevalence of this condition. Nonetheless, patterns of association linking suspected background characteristics to prevalence of alcohol dependence were not appreciably different when the gated and ungated estimates were contrasted. In summary, there are reasons to take the ungated approach in detailed research on alcohol use and dependence. Nevertheless, in panoramic mental health surveys, the inefficiency of an ungated approach must be balanced against the anticipated yield of cases who have experienced alcohol dependence without alcohol related social role impairments or other maladaptation, particularly when the dependence syndromes without these consequences are sometimes thought to lack clinical significance.
Degenhardt
Louisa
L
Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA.
Bohnert
Kipling M
KM
Anthony
James C
JC
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011795:Surveys and Questionnaires
Arch Gen Psychiatry. 1998 Dec;55(12):1145; author reply 1147-8
9862559
Arch Gen Psychiatry. 2004 Aug;61(8):807-16
15289279
Arch Gen Psychiatry. 1977 Sep;34(9):1012-22
901133
Am J Epidemiol. 1998 Dec 15;148(12):1168-74
9867262
Arch Gen Psychiatry. 1998 Feb;55(2):109-15
9477922
Arch Gen Psychiatry. 2004 Dec;61(12):1188-94
15583110
Q J Stud Alcohol. 1946 Jun;7:1-88
20989144
Addiction. 1999 Oct;94(10):1541-50
10790906
Arch Gen Psychiatry. 2000 Mar;57(3):227-8
10711908
Aust N Z J Psychiatry. 2000 Apr;34(2):206-13
10789525
Arch Gen Psychiatry. 1998 Feb;55(2):120
9477924
Br Med J. 1976 May 1;1(6017):1058-61
773501
J Epidemiol Community Health. 2003 Nov;57(11):893-900
14600117
Arch Gen Psychiatry. 1981 Apr;38(4):381-9
6260053
Arch Gen Psychiatry. 1998 Feb;55(2):119
9477923
Aust N Z J Psychiatry. 2006 Oct;40(10):830-4
16959008
Int J Methods Psychiatr Res. 2007;16(2):43-51
17623384
Neuropsychopharmacology. 2002 Apr;26(4):479-88
11927172
Arch Gen Psychiatry. 2004 Dec;61(12):1197-207
15583111
Am J Psychiatry. 1970 Jan;126(7):983-7
5409569
Subst Use Misuse. 2000 May-Jun;35(6-8):1051-73
10847222
Arch Gen Psychiatry. 2002 Feb;59(2):115-23
11825131
Biometrics. 1946 Jun;2(3):47-53
21001024