Bartoli Francesco, Crocamo Cristina, Biagi Enrico, Di Carlo Francesco, Parma Francesca, Madeddu Fabio, Capuzzi Enrico, Colmegna Fabrizia, Clerici Massimo, Carrà Giuseppe
Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.
Department of Mental Health, San Gerardo Hospital, Monza, Italy.
Drug Alcohol Depend. 2016 Aug 1;165:283-7. doi: 10.1016/j.drugalcdep.2016.06.003. Epub 2016 Jun 11.
There is a lack of studies testing accuracy of fast screening methods for alcohol use disorder in mental health settings. We aimed at estimating clinical utility of a standard single-item test for case finding and screening of DSM-5 alcohol use disorder among individuals suffering from anxiety and mood disorders.
We recruited adults consecutively referred, in a 12-month period, to an outpatient clinic for anxiety and depressive disorders. We assessed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) single-item test, using the Mini- International Neuropsychiatric Interview (MINI), plus an additional item of Composite International Diagnostic Interview (CIDI) for craving, as reference standard to diagnose a current DSM-5 alcohol use disorder. We estimated sensitivity and specificity of the single-item test, as well as positive and negative Clinical Utility Indexes (CUIs).
242 subjects with anxiety and mood disorders were included. The NIAAA single-item test showed high sensitivity (91.9%) and specificity (91.2%) for DSM-5 alcohol use disorder. The positive CUI was 0.601, whereas the negative one was 0.898, with excellent values also accounting for main individual characteristics (age, gender, diagnosis, psychological distress levels, smoking status).
Testing for relevant indexes, we found an excellent clinical utility of the NIAAA single-item test for screening true negative cases. Our findings support a routine use of reliable methods for rapid screening in similar mental health settings.
在精神卫生环境中，缺乏对酒精使用障碍快速筛查方法准确性的研究。我们旨在评估一项标准单项测试在患有焦虑症和情绪障碍的个体中用于发现和筛查DSM-5酒精使用障碍的临床效用。
我们连续招募了在12个月期间被转诊至焦虑和抑郁症门诊的成年人。我们使用迷你国际神经精神访谈（MINI）评估美国国立酒精滥用与酒精中毒研究所（NIAAA）单项测试，并将综合国际诊断访谈（CIDI）中关于渴望的另一项作为诊断当前DSM-5酒精使用障碍的参考标准。我们估计了单项测试的敏感性和特异性，以及阳性和阴性临床效用指数（CUI）。
纳入了242名患有焦虑症和情绪障碍的受试者。NIAAA单项测试对DSM-5酒精使用障碍显示出高敏感性（91.9%）和特异性（91.2%）。阳性CUI为0.601，而阴性CUI为0.898，其优异值也考虑了主要个体特征（年龄、性别、诊断、心理困扰水平、吸烟状况）。
通过对相关指标的测试，我们发现NIAAA单项测试在筛查真阴性病例方面具有出色的临床效用。我们的研究结果支持在类似的精神卫生环境中常规使用可靠的快速筛查方法。
