DSM-5 latent classes of alcohol users in a population-based sample: results from the São Paulo Megacity Mental Health Survey, Brazil.
BACKGROUND
We aimed to identify different categorical phenotypes based upon the DSM-V criteria of alcohol use disorders (AUD) among alcohol users who had at least one drink per week in the past year (n=948).


METHODS
Data are from the São Paulo Megacity Mental Health Survey collected in 2005-2007, as part of the World Mental Health Survey Initiative. A latent class analysis of the 11 DSM-5-AUD criteria was performed using Mplus, taking into account complex survey design features. Weighted logistic regression models were used to examine demographic correlates of the DSM-5-AUD latent classes.


RESULTS
The best latent-class model was a three-class model. We found a "non-symptomatic class" (69.7%), a "use in larger amounts class" (23.2%), defined by high probability (>70%) of the "use in larger amounts" criterion only, and a "high-moderate symptomatic class" (7.1%), defined by high-moderate probability of all the 11 AUD criteria. Compared to those in the non-symptomatic class, individuals in the "high-moderate symptomatic class" were more likely to have been married, have lower educational attainment and to be unemployed or in non-regular/informal employment. Those on the "use in larger amounts class" were more likely to have been married or never married.


CONCLUSIONS
The two symptomatic classes clearly represented the dimensionality of the new proposed AUD criteria, and could be more specifically targeted by different prevention or treatment strategies. DSM-5-AUD has the advantage of shedding light on risky drinkers included in the "use in larger amounts class", allowing for preventive interventions, which will reach a large number of individuals.
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil; Interdisciplinary Group of Studies on Alcohol and Drugs, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP 05403, Brazil; Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP 09060, Brazil. Electronic address: jmcmaia2@gmail.com.
João Mauricio
JM
Castaldelli-Maia
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil; Interdisciplinary Group of Studies on Alcohol and Drugs, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP 05403, Brazil.
Camila M
CM
Silveira
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil.
Erica R
ER
Siu
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil.
Yuan-Pang
YP
Wang
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil.
Igor A
IA
Milhorança
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil.
Clóvis
C
Alexandrino-Silva
National Institute of Psychiatry and Metropolitan Autonomous University, Mexico City 14370, Mexico.
Guilherme
G
Borges
Department of Social Medicine and Post-Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, ES 29040, Brazil.
Maria C
MC
Viana
Interdisciplinary Group of Studies on Alcohol and Drugs, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP 05403, Brazil; Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP 09060, Brazil.
Arthur G
AG
Andrade
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403, Brazil.
Laura H
LH
Andrade
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
Silvia S
SS
Martins
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology*; D001938:Brazil / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult
Alcohol use disorders (AUD); Brazil; DSM-5 criteria; Latent class analysis; São Paulo