Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
J Stud Alcohol Drugs. 2010 May;71(3):418-23. doi: 10.15288/jsad.2010.71.418.
This is the first study to examine the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for alcohol-use disorders and heavy episodic (or "binge") drinking in a college sample using item-response theory (IRT) analysis. IRT facilitates assessment of the severity of the criteria, their ability to distinguish between those at greatest and lowest risk, and the value of adding a "binge" drinking criterion.
In a sample of undergraduate drinkers (n = 353), we conducted factor analyses to determine whether the criteria best fit a one- or two-factor structure. We then conducted IRT analyses to obtain item-characteristic curves indicating the probability of endorsing a criterion at increasing levels of alcohol-use-disorder risk. These analyses were first conducted including current (i.e., past-year) DSM-IV alcohol-use-disorder criteria only and then rerun adding weekly "binge" drinking.
A single-factor model of the DSM-IV criteria did not differ significantly from a two-factor model. After including "binge" drinking, two factors fit the data slightly better than one factor but with a dominant single factor. Withdrawal was the most severe criterion, whereas tolerance and "larger/longer" were the least severe. Time spent drinking and a combined social/legal difficulties criterion had the best ability to discriminate those at greatest and lowest risk for an alcohol-use disorder. "Binge" drinking showed both low discrimination and low severity.
To our knowledge, this is the first study to examine DSM-IV criteria in an undergraduate sample using IRT. In this sample, abuse and dependence were intermixed on a continuum of severity, and "binge" drinking was in the least severe region.
这是第一项使用项目反应理论（IRT）分析，在大学生样本中研究《精神障碍诊断与统计手册》第四版（DSM-IV）酒精使用障碍和重度（或“狂饮”）饮酒标准的研究。IRT 有助于评估标准的严重程度、它们区分风险最大和最低人群的能力，以及添加“狂饮”饮酒标准的价值。
在一组大学生饮酒者（n=353）样本中，我们进行了因素分析，以确定标准是否最适合单因素或双因素结构。然后，我们进行了 IRT 分析，以获得表明在不断增加的酒精使用障碍风险水平上赞同标准的可能性的项目特征曲线。这些分析首先仅包括当前（即过去一年）DSM-IV 酒精使用障碍标准进行，然后重新运行，加入每周“狂饮”饮酒标准。
DSM-IV 标准的单因素模型与双因素模型没有显著差异。包括“狂饮”饮酒标准后，双因素模型比单因素模型略好拟合数据，但主要是单因素模型。戒断是最严重的标准，而耐受和“更大/更长”是最不严重的标准。饮酒时间和综合社交/法律困难标准具有最佳的区分风险最大和最低人群的能力。“狂饮”饮酒标准的区分度和严重程度都较低。
据我们所知，这是第一项使用 IRT 在大学生样本中检查 DSM-IV 标准的研究。在这个样本中，滥用和依赖在严重程度的连续体上混合在一起，而“狂饮”饮酒标准处于最不严重的区域。
