Hans-Jürgen Rumpf

Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard

Short screening questionnaires for mental health are useful tools for research and clinical practice, e.g. they could play a major role in detecting patients with psychiatric disorders in primary care. The present study tests the validity of the five-item Mental Health Inventory (MHI-5) screening test using DSM-IV Axis I diagnoses as a gold standard and analyzes its performance in different diagnostic groups. A random sample was drawn from the resident registration office files in northern Germany. Personal interviews with a response rate of 70% were conducted. Of the sample, 4036 respondents filled in the MHI-5. DSM-IV diagnoses were assessed using the Munich Composite International Diagnostic Interview (M-CIDI). The area under the receiver operating characteristics curve (AUC) of 0.72 in identifying any DSM-IV Axis I disorder (except substance use) is not satisfying. The MHI-5 revealed best performance for mood (AUC: 0.88) followed by anxiety disorders (AUC: 0.71). Sensitivity and specificity were poor for somatoform and substance use disorders, especially in cases without comorbid mood or anxiety disorder. The power to detect mood and anxiety disorders of the MHI-5 was better for the 4-week compared with the 12-month diagnoses. The MHI-5 can be recommended to screen for mood disorders. Data have to be confirmed for primary care settings.

An international consensus for assessing internet gaming disorder using the new DSM‐5 approach

AIMS For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces non-substance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5 criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments reflect the divergence of opinions in the field regarding how best to diagnose this condition. METHODS We convened international experts from European, North and South American, Asian and Australasian countries to discuss and achieve consensus about assessing internet gaming disorder as defined within DSM-5. RESULTS We describe the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present a single item that best reflects each criterion, translated into the 10 main languages of countries in which research on this condition has been conducted. CONCLUSIONS Using results from this cross-cultural collaboration, we outline important research directions for understanding and assessing internet gaming disorder. As this field moves forward, it is critical that researchers and clinicians around the world begin to apply a common methodology; this report is the first to achieve an international consensus related to the assessment of internet gaming disorder.

Proactive interventions for smoking cessation in general medical practice: a quasi-randomized controlled trial to examine the efficacy of computer-tailored letters and physician-delivered brief advice*

Aims To test the efficacy of (i) computer-generated tailored letters and (ii) practitioner-delivered brief advice for smoking cessation against an assessment-only condition; and to compare both interventions directly. Design Quasi-randomized controlled trial. Setting A total of 34 randomly selected general practices from a German region (participation rate 87%). Participants A total of 1499 consecutive patients aged 18–70 years with daily cigarette smoking (participation rate 80%). Interventions The tailored letters intervention group received up to three individualized personal letters. Brief advice was delivered during routine consultation by the practitioner after an onsite training session. Both interventions were based on the Transtheoretical Model of behaviour change. Measurements Self-reported point prevalence and prolonged abstinence at 6-, 12-, 18- and 24-month follow-ups. Findings Among participants completing the last follow-up, 6-month prolonged abstinence was 18.3% in the tailored letters intervention group, 14.8% in the brief advice intervention group and 10.5% in the assessment-only control group. Assuming those lost to follow-up to be smokers, the rates were 10.2%, 9.7% and 6.7%, respectively. Analyses including all follow-ups confirmed statistically significant effects of both interventions compared to assessment only. Using complete case analysis, the tailored letters intervention was significantly more effective than brief advice for 24-hour [odds ratio (OR) = 1.4; P = 0.047] but not for 7-day point prevalence abstinence (OR = 1.4; P = 0.068) for prolonged abstinence, or for alternative assumptions about participants lost to follow-up. Conclusions The study demonstrated long-term efficacy of low-cost interventions for smoking cessation in general practice. The interventions are suitable to reach entire populations of general practices and smoking patients. Computer-generated letters are a promising option to overcome barriers to provide smoking cessation counselling routinely.

Occurence of internet addiction in a general population sample: a latent class analysis.

Background: Prevalence studies of Internet addiction in the general population are rare. In addition, a lack of approved criteria hampers estimation of its occurrence. Aims: This study conducted a latent class analysis (LCA) in a large general population sample to estimate prevalence. Methods: A telephone survey was conducted based on a random digit dialling procedure including landline telephone (n = 14,022) and cell phone numbers (n = 1,001) in participants aged 14-64. The Compulsive Internet Use Scale (CIUS) served as the basis for a LCA used to look for subgroups representing participants with Internet addiction or at-risk use. CIUS was given to participants reporting to use the Internet for private purposes at least 1 h on a typical weekday or at least 1 h on a day at the weekend (n = 8,130). Results: A 6-class model showed best model fit and included two groups likely to represent Internet addiction and at-risk Internet use. Both groups showed less social participation and the Internet addiction group less general trust in other people. Proportions of probable Internet addiction were 1.0% (CI 0.9-1.2) among the entire sample, 2.4% (CI 1.9-3.1) in the age group 14-24, and 4.0% (CI 2.7-5.7) in the age group 14-16. No difference in estimated proportions between males and females was found. Unemployment (OR 3.13; CI 1.74-5.65) and migration background (OR 3.04; CI 2.12-4.36) were related to Internet addiction. Conclusions: This LCA-based study differentiated groups likely to have Internet addiction and at-risk use in the general population and provides characteristics to further define this rather new disorder.

Motivation to change drinking behavior: comparison of alcohol-dependent individuals in a general hospital and a general population sample.

The general hospital would be especially suited to initiate interventions if hospitalized alcohol-dependent individuals were particularly motivated to change their drinking behavior. This study compares the readiness to change of alcohol-dependent persons in the general hospital and the general population. Stages of change according to the model of Prochaska and DiClemente [6] are assessed using the Readiness to Change Questionnaire (RCQ) in two representative samples: 118 alcohol-dependent subjects admitted to a general hospital (sample 1) and 50 alcohol-dependent individuals in the general population (sample 2). In sample 1, alcohol-dependent persons were identified in 1167 consecutive admissions using screening questionnaires and a diagnostic interview (SCAN). In sample 2, alcohol dependence was assessed in 4075 individuals using a German version of CIDI. The distribution of stages of change differed significantly (p < 0.0001) between the groups, revealing a shift towards higher stages in the hospital subjects. Logistic regression analysis revealed that the stages of readiness to change and age contributed in predicting whether subjects belonged to the general hospital or the general population sample. Findings suggest that the general hospital is a suitable site to initiate interventions for alcohol-dependent individuals.

Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients.

AIMS Dependence on or problematic use of prescription drugs (PD) is estimated to be between 1 and 2% in the general population. In contrast, the proportion of substance-specific treatment in PD use disorders at 0.5% is comparatively low. With an estimated prevalence of 4.7%, PD-specific disorders are widespread in general hospitals compared to the general population. Brief intervention delivered in general hospitals might be useful to promote discontinuation or reduction of problematic prescription drug use. DESIGN A randomized, controlled clinical trial. SETTING Internal, surgical and gynaecological wards of a general and a university hospital. PARTICIPANTS One hundred and twenty-six patients fulfilling criteria for either regular use of PD (more than 60 days within the last 3 months) or dependence on or abuse of PD, respectively, were allocated randomly to two conditions. INTERVENTION Subjects received two counselling sessions based on Motivational Interviewing plus an individualized written feedback (intervention group, IG) or a booklet on health behaviour (control group, CG). MEASUREMENTS The outcome was measured as reduction (>25%) and discontinuation of PD intake in terms of defined daily dosages (DDD). FINDINGS After 3 months, more participants in the IG reduced their DDD compared to the participants in the CG (51.8% versus 30%; chi(2) = 6.17; P = 0.017). In the IG 17.9%, in the CG 8.6% discontinued use of PD (chi(2) = 2.42; P = 0.17). Conclusions Brief intervention based on Motivational Interviewing is effective in reducing PD intake in non-treatment-seeking patients.

Excess Mortality of Alcohol-Dependent Individuals After 14 Years and Mortality Predictors Based on Treatment Participation and Severity of Alcohol Dependence

BACKGROUND Little is known about excess mortality and its predictors among alcohol-dependent individuals in the general population. We sought to estimate excess mortality and to determine whether alcohol dependence treatment utilization, alcohol dependence severity, alcohol-related problems, and self-rated health may predict mortality over 14 years. METHODS A random sample of the general population between the ages of 18 and 64 in 1 region in Germany was drawn. Among 4,070 respondents with valid data, 153 alcohol-dependent individuals were identified. For 149 of these 153, vital status information was provided 14 years later. Baseline data from the Composite International Diagnostic Interview (German version M-CIDI) included a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) of the American Psychiatric Association, alcohol dependence treatment utilization, alcohol dependence severity based on the number of DSM-IV alcohol dependence diagnostic criteria fulfilled and a symptom frequency questionnaire, alcohol-related problems, self-rated general health, cigarettes smoked per day, and the number of psychiatric disorders according to the DSM-IV at baseline. RESULTS Annualized death rates were 4.6-fold higher for women and 1.9-fold higher for men compared to the age- and sex-specific general population. Having participated in inpatient specialized alcohol dependence treatment was not related with longer survival than not having taken part in the treatment. Utilization of inpatient detoxification treatment predicted the hazard rate ratio of mortality (unadjusted: 4.2, 90% confidence interval 1.8 to 9.8). The severity of alcohol dependence was associated with the use of detoxification treatment. Alcohol-related problems and poor self-rated health predicted mortality. CONCLUSIONS According to the high excess mortality, a particular focus should be placed on women. Inpatient specialized alcohol dependence treatment did not seem to have a sufficient protective effect against dying prematurely. Having been in detoxification treatment only, the severity of alcohol dependence, alcohol-related problems, and self-rated health may be predictors of time-to-death among this general population sample.

Screening questionnaires for problem drinking in adolescents: performance of AUDIT, AUDIT-C, CRAFFT and POSIT.

Background/Aims: Only rather few data on the validity of screening questionnaires to detect problem drinking in adolescents exist. The aim of this study was to compare the performance of the Alcohol Use Disorders Identification Test (AUDIT), its short form AUDIT-C, the Substance Module of the Problem Oriented Screening Instrument for Teenagers (POSIT), and CRAFFT (acronym for car, relax, alone, forget, family, and friends). Methods: The questionnaires were filled in by 9th and 10th graders from two comprehensive schools. All students received an interview using the alcohol section of the Composite International Diagnostic Interview. Alcohol abuse and alcohol dependence according to DSM-IV as well as episodic heavy drinking served as criteria to validate the screening instruments. Results: All 9th and 10th graders (n = 225) of both schools participated. No significant differences were found for areas under the receiver operating characteristic curves ranging from 0.810 to 0.872. Cronbach’s alpha was satisfactory (0.77–0.80) but poor for CRAFFT (0.64). Different cut-offs are discussed. Conclusions: Considering validity as well as reliability, AUDIT, AUDIT-C and POSIT performed well; however, the POSIT is quite lengthy. AUDIT-C showed good psychometric properties and has clear advantages because of its brevity.

Impact of psychiatric disorders in the general population: satisfaction with life and the influence of comorbidity and disorder duration.

Psychiatric disorders as defined by DSM-IV are found to be highly prevalent in the general population. However, little is known about aspects defining the burden caused by different disorders. The aim of this study was to evaluate the impact of different psychiatric disorders in the community with respect to life satisfaction taking into account the effects of comorbidity and disorder duration. Psychiatric 12-month disorders and life satisfaction were assessed in a random sample of 4075 adults from the general population using the Composite International Diagnostic Interview and the Satisfaction With Life Scale (SWLS). Separate analyses were performed for comorbid and pure disorders. Disorder duration was defined by the time since disorder onset for participants fulfilling diagnostic criteria within the last year. SWLS scores were significantly lower for all diagnostic subgroups except for bipolar disorders, compared to subjects with no 12-month diagnosis. Effect sizes were medium to large. Comorbidity was significantly associated with lower satisfaction with life. Pure disorders are associated with less but still significantly reduced SWLS scores, except alcohol abuse, major depression and specific phobia. Mean duration of disorder was lowest for dysthymia (5.9 years) and highest for specific phobia (24.5 years). The only significant correlation between disorder duration and SWLS was found for major depression (r = –0.26) and no trend for the direction of the relation could be identified across disorders. The impact of mental disorders in the community was confirmed by using the subjective measure of life satisfaction. Comorbidity is a key factor in determining the extent of reduction in satisfaction with life. Measures of disorder persistence should be examined by refined research strategies. Comprehensive analyses of mental disorders—exceeding the prevalence or a single measure of burden—have to be considered to define the most urgent needs in the community.

A Self-Administered Version of a Brief Measure of Suffering: First Aspects of Validity

Background: Measuring the impact of illness is important for several reasons. Recently, a new instrument was introduced using a pictorial approach in measuring the perception of suffering caused by illness: the Pictorial Representation of Illness Measure (PRISM). The aim of the present study was to introduce a self-administered version of PRISM and to provide some first data on its validity. Method: A postal survey was conducted in subjects with the chronic depigmentation disorder vitiligo. Participants were members of the German vitiligo association. The response rate was 60.6%. Data of 333 respondents completing the PRISM were used for analysis. Besides illness-related measures, psychological variables were assessed with the following instruments: Satisfaction with Life Scale (SWLS), five-item version of the Mental Health Inventory, adaptation of the Skindex-29, a quality-of-life measure for skin diseases. Results: Only 2.9% did not fill in the PRISM. Self-illness separation correlated as predicted with some illness-related variables. The distance was significantly larger in subjects whose depigmentation was no longer spreading. Significant correlations were also found with mental health (0.50), satisfaction with life (–0.28), perceived impairment of outward appearance (–0.65), and the Skindex subscales ‘emotions’ (–0.66) and ‘functioning’ (–0.67). Conclusion: Data suggest that PRISM can be self-administered. Measures of convergent validity confirm the usefulness of the new measure.