McBride Orla, Adamson Gary, Bunting Brendan P, McCann Siobhan
School of Psychology, University of Ulster, Magee Campus, Northland Road, Co. Londonderry, BT48 7JL, Northern Ireland.
Drug Alcohol Depend. 2009 Jan 1;99(1-3):272-9. doi: 10.1016/j.drugalcdep.2008.08.008. Epub 2008 Oct 10.
Interest in subthreshold psychiatric disorders has increased recently. Diagnostic orphans experience one to two criteria of alcohol dependence but do not meet the diagnostic criteria for a DSM-IV alcohol use disorder (AUD). This study investigated the impact of subthreshold alcohol symptoms on three domains: physical illness, drinking patterns, and the occurrence of negative life events.
Current drinkers (n=26,946) in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were divided into five diagnosis groups: no-AUD; one-criterion orphans (reference group), two-criterion orphans, alcohol abuse, and alcohol dependence. Exploratory factor analysis examined the factor structure of items in the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS-IV) relating to each life domains. Factors were related to the diagnosis groups and background covariates using latent variable modeling.
One-criterion orphans did not differ from the other groups with regards to physical illness. One- and two-criterion orphans differed significantly in relation to drinking patterns, with the latter group engaging in hazardous drinking behaviours more frequently. The dependence group were more likely to experience higher estimates of social problems compared to one-criterion orphans. One-criterion orphans were more likely than the abuse group to experience financial problems but less likely than the dependence group to experience family-related legal problems.
Diagnostic orphans were more impaired than those with no-AUD or alcohol abuse in specific life domains; however, diagnostic orphans were significantly less impaired than those with alcohol dependence. Diagnostic orphans may be an important group for early case identification and intervention.
近来，人们对阈下精神障碍的关注度有所提高。诊断孤儿符合一至两条酒精依赖标准，但未达到《精神疾病诊断与统计手册》第四版（DSM-IV）中酒精使用障碍（AUD）的诊断标准。本研究调查了阈下酒精症状对三个方面的影响：身体疾病、饮酒模式以及负面生活事件的发生情况。
《国家酒精及相关疾病流行病学调查》（NESARC）中的当前饮酒者（n = 26,946）被分为五个诊断组：无酒精使用障碍组；单标准孤儿组（参照组）、双标准孤儿组、酒精滥用组和酒精依赖组。探索性因子分析检验了酒精使用障碍及相关残疾访谈表（AUDADIS-IV）中与各生活领域相关项目的因子结构。使用潜在变量模型将各因子与诊断组及背景协变量相关联。
在身体疾病方面，单标准孤儿组与其他组并无差异。单标准和双标准孤儿组在饮酒模式上存在显著差异，后者更频繁地出现危险饮酒行为。与单标准孤儿组相比，酒精依赖组更有可能经历更高程度的社会问题。单标准孤儿组比酒精滥用组更易出现财务问题，但比酒精依赖组出现家庭相关法律问题的可能性更小。
在特定生活领域，诊断孤儿比无酒精使用障碍或酒精滥用者受损更严重；然而，诊断孤儿比酒精依赖者受损程度明显更低。诊断孤儿可能是早期病例识别和干预的重要群体。
