Marco Piccinelli

Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study

Abstract Objective: To determine the properties of the alcohol use disorders identification test in screening primary care attenders for alcohol problems. Design: A validity study among consecutive primary care attenders aged 18-65 years. Every third subject completed the alcohol use disorders identification test (a 10 item self report questionnaire on alcohol intake and related problems) and was interviewed by an investigator with the composite international diagnostic interview alcohol use module (a standardised interview for the independent assessment of alcohol intake and related disorders). Setting: 10 primary care clinics in Verona, north eastern Italy. Patients: 500 subjects were approached and 482 (96.4%) completed evaluation. Results: When the alcohol use disorders identification test was used to detect subjects with alcohol problems the area under the receiver operating characteristic curve was 0.95. The cut off score of 5 was associated with a sensitivity of 0.84, a specificity of 0.90, and a positive predictive value of 0.60. The screening ability of the total score derived from summing the responses to the five items minimising the probability of misclassification between subjects with and without alcohol problems provided an area under the receiver operating characteristic curve of 0.93. A score of 5 or more on the five items was associated with a sensitivity of 0.79, a specificity of 0.95, and a positive predictive value of 0.73. Conclusions: The alcohol use disorders identification test performs well in detecting subjects with formal alcohol disorders and those with hazardous alcohol intake. Using five of the 10 items on the questionnaire gives reasonable accuracy, and these are recommended as questions of choice to screen patients for alcohol problems.

Reliability, validity and factor structure of the 12-item General Health Questionnaire among young males in Italy.

The internal consistency, validity and factor structure of the 12‐item General Health Questionnaire (GHQ‐12) were investigated in a homogeneous sample consisting of 18‐year‐old males in Italy. The GHQ‐12 proved to be a reliable instrument, as indicated by a Cronbachs alpha of 0.81. When the screening characteristics of the GHQ‐12 (scored by the Likert method) were evaluated against the psychiatrists ratings, the best balance between sensitivity and specificity was found at the GHQ cut‐off score of 8/9: at this threshold, sensitivity was 0.68 and was paired to a specificity of 0.59 and an overall misclassification rate of 0.40. Validity coefficients based on a single severity score were rather low compared with those reported in other settings. When a principal components analysis with varimax (and oblimin) rotation was performed, two factors were identified: factor A (general dysphoria) was defined by 7 items related to anxiety and depression; factor B (social dysfunction) included 6 items testing the ability to perform daily activities and to cope with everyday problems. The identified factors revealed distinct ability in the discrimination between subjects with and without emotional disturbance according to the psychiatrists ratings and correlated differently with 3 Minnesota Multiphasic Personality Inventory subscales (depression, D; conversion hysteria, Hy; psychasthenia, Pt). Thus, the factor structure of the GHQ‐12 might provide useful information along with that offered by a single severity score, and the detection of cases might be improved by examining an individuals profile of scores on different subscales derived from factor analysis.

Validity and test-retest reliability of the italian version of the 12-item General Health Questionnaire in general practice: A comparison between three scoring methods

Validity coefficients of the 12-item General Health Questionnaire (GHQ-12) were established against the Clinical Interview Schedule (CIS) in a sample of primary care patients. Comparison between the conventional scoring method, Likert scoring, and the revised scoring procedure proposed by Goodchild and Duncan-Jones (C-GHQ) showed very similar screening properties: sensitivity ranged between 71% and 75%, and specificity ranged between 73% and 76%. The test-retest reliability of the GHQ-12, as expressed by Pearsons r and intraclass correlation coefficient, was satisfactory irrespective of the scoring method used, even though mean scores on the second test tended to be significantly lower than the corresponding mean scores on the first test. The C-GHQ by itself did not result in an improvement of the screening capacity of the GHQ; however, the best results were obtained by combining the conventional scoring and C-GHQ case criteria.

Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics

BACKGROUND The authors analyse the prevalence of subthreshold psychiatric disorders in primary care and their association with the patients health perception, disability in daily activities and psychological distress. METHODS Five-hundred and fifty-four primary care patients who completed a two-phase study were administered the Composite International Interview for Primary Health Care (CIDI-PHC) and other self-report measures. Unweighted and weighted prevalence estimates were obtained for ICD-10 formal disorders and subthreshold disorders defined by specific operational criteria. The impact of subthreshold disorders on health perception, disability in daily activities and psychological distress was analysed by using multiple regression models. RESULTS The overall prevalence of subthreshold disorders exceeded that of ICD-10 disorders. Subjects with subthreshold disorders reported levels of psychological distress, disability in daily activities and perceived health comparable to those of patients with full-fledged ICD-10 disorders. When we analysed the associated health characteristics of individual subthreshold disorders, we found that each subthreshold disorder was characterized by poorer health perception, after adjusting for comorbidity with defined disorders and physical illness, age and gender. Disability in daily activities was increased in individuals with subthreshold depression and agoraphobia. LIMITATIONS The number of cases with subthreshold panic and somatization is very small and does not allow one to draw any definite conclusions on their associated characteristics. To reduce non-response bias related to sampling design and refusals, adjusted sampling weights were computed. Since the study design in Bologna and Verona was different and Bologna patients scoring <4 on the General Health Questionnaire were not interviewed, individuals with minimal distress come from the Verona sample alone. CONCLUSIONS Because of the prevalence and associated characteristics of subthreshold disorders, primary care physicians should attach adequate importance to the patients perceived poor health, distress and inability to fulfil daily tasks. The clinical relevance of subthreshold disorders has also potential implications for ongoing revisions of classification systems.

Alcohol Use Disorders Identification Test (AUDIT)

Adults □ Adolescents Groups for which this instrument might be especially helpful? Populations appropriate for a screening program using the AUDIT include primary care, emergency room, surgery, and psychiatric patients; DWI offenders, criminals in court, jail, and prison; enlisted men in the Armed Forces; workers encountered in employee assistance programs and industrial settings; and college students.

Typologies of anxiety, depression and somatization symptoms among primary care attenders with no formal mental disorder

BACKGROUND Typologies of anxiety, depression and somatization symptoms were investigated in individuals with no formal mental disorders, making no a priori assumptions about symptom distribution and inter-relationship. METHOD The subjects were 1617 adult primary care attenders from the WHO Collaborative Project on Psychological Problems in General Health Care, with at least three symptoms of anxiety, depression and/or somatization, but with no formal ICD-10 disorders. Analyses were based on the grade of membership model, a multivariate statistical procedure exploring indistinct boundaries between disease categories and preserving the heterogeneity of clinical picture within each category. RESULTS Six prototype categories (or pure types) best described the structure of symptoms included in analyses. Pure type I included the full set of somatization symptoms. Pure type II was characterized by most anxiety and depression symptoms. Pure type III resembled generalized anxiety disorder. Pure type IV consisted of individuals reporting sporadic symptoms of anxiety, depression or somatization. Pure type V defined individuals with sleep problems. Finally, pure type VI was characterized by anxiety symptoms, including panic-like symptoms. CONCLUSIONS These findings provide support to the existence of a mixed anxiety-depression category crossing the diagnostic boundaries of current anxiety and depression disorders. Moreover, criteria of anxiety and somatization disorders may be re-examined to assess whether lower diagnostic thresholds can be identified that both preserve the symptom profile and clinical features of current diagnostic categories and allow for a better characterization of individuals with substantial psychopathology though not meeting the high symptom thresholds required for a diagnosis of formal mental disorders.

Lunar cycle and consultations for anxiety and depression in general practice

The influence of the moon on patient consultations for anxiety or depression in general practice was assessed through a retrospective survey based on general practice medical records and on lunar records detailing the dates and times of different phases of the moon. Seven-hundred-eighty-two patients continuously registered in a general practice in Beckenham, South London, between 1971 and 1988 were included in analyses. No statistically significant lunar effect was found by setting the expected surge in consultations one to three days after the full moon and the period of the sine-wave curve to 30 days. Similarly, no statistically significant lunar effect was found, when the period of the sine-wave curve was allowed to vary in order to best fit the data. The moon had little influence on when individuals consulted their general practitioner with anxiety or depression.

Frequency of contact with community-based psychiatric services and the lunar cycle: a 10-year case-register study.

The relationship between the lunar cycle and the frequency of contact with community-based psychiatric services was assessed using the South Verona Psychiatric Case Register data. For each day of the study period (January 1982–December 1991) we recorded the number of contacts made by South Verona residents with psychiatric services and the corresponding day of the lunar cycle. First, the synodic month was divided into four interval phases (usually called new moon, first quarter, full moon and third quarter), and interphase differences in the mean number of contacts were tested using one-way analysis of variance. Second, the null hypothesis of no relationship between the lunar cycle and the frequency of contact with psychiatric services was tested against the alternative hypothesis of a sinusoidal distribution according to the lunar phase. The average number of contacts with psychiatric services on each day of the lunar cycle over the 10-year period was obtained and a sine-wave curve was fitted to the data. Both for total and drop-in contacts, no significant differences in mean number of contacts were found between the four interval phases of the synodic month (new moon, first quarter, full moon and third quarter). Similarly, no significant results were found by setting the expected surge in consultations at 1–3 days after the full moon and the period of the sine-wave curve equal to 30 days. When the period of the sine-wave curve was allowed to vary in order to fit the data best, none of the statistical tests reached the level of significance required to dismiss the possibility of false-positive results. These findings did not support the theory that a relationship exists between the lunar cycle and the frequency of contact with community-based psychiatric services.

Struttura fattoriale della versione a 12 domande del General Health Questionnaire in un campione di giovani maschi adulti

Objectives - a) To investigate the factor structure of the 12-item General Health Questionnaire (GHQ-12) in a sample of 18-year-old males; b) to test the ability of the standardized factor scores in discriminating between subjects who were suffering from emotional disturbance according to the psychiatrists ratings and those who were not. Design - A sample of 363 subjects was selected during the medical examination for military service and invited to fill in the GHQ-12 and to be independently interviewed by a psychiatrist. Completed data were available for 320 subjects (88% of the selected sample). Results - The unrotated factor matrix allowed for the identification of two principal components with eigenvalues greater than 1, jointly accounting for 46.7% of the variance in the data. The first component, on which each item of the questionnaire showed a positive coefficient, was interpreted as measuring the overall severity of psychiatric disorder among respondents. The second component was bipolar with «positive» items having positive coefficients and «negative» items having negative coefficients. These findings suggest that the GHQ can assess both the negative (symptoms) and positive (subjective well-being) aspects of mental health. After Vari- max rotation each item of the questionnaire loaded significantly on one factor only, except for item 12 whose loading was lower than 0.500 on both factors. Factor A contained the «negative» items of the GHQ-12 and was termed as «general dysphoria»; factor B included 5 of the 6 «positive» items and was termed as «well-being/social functioning». The best discrimination between «cases» and «non-cases» was offered by the standardized factor scores on the «general Epidemiologia e Psichiatria Sociale, 2, 3, 1993 dysphoria» factor; no advantage was gained by the combination of the scores on the two factors. Conclusions - A better understanding of the GHQ-12 factor structure might provide useful information along with that offered by a single severity score resulting from the simple adding of positive responses and improve the description of emotional disorders beyond the traditional distinction between «cases» and «non-cases».