López Mariana B, Conde Karina, Cremonte Mariana
Interdisciplinary Centre of Mathematical and Experimental Psychology Research "Dr. Horacio J. A. Rimoldi" (CIIPME) (MBL). National Scientific and Technical Research Council (CONICET), Buenos Aires; National University at Mar del Plata (KC), Psychoactive Substance and External Cause Injuries Group; and National University at Mar del Plata (MC), Psychoactive Substance and External Cause Injuries Group, National Scientific and Technical Research Council (CONICET), Mar del Plata, Argentina.
J Addict Med. 2017 Mar/Apr;11(2):106-113. doi: 10.1097/ADM.0000000000000285.
The evidence of important problems related to prenatal alcohol exposure has faced researchers with the problem of understanding and screening alcohol use in this population. Although any alcohol use should be considered risky during pregnancy, identifying alcohol-drinking problems (ADPs) could be especially important because women with ADPs could not benefit from a simple advice of abstinence and because their offsprings are subjected to a higher risk of problems related with prenatal alcohol exposure. In this context, we aim to study the prevalence and characteristics of ADPs in pregnant women, evaluating the performance of different diagnostic systems in this population.
The aims of the study were to describe the prevalence of ADPs obtained with the criteria of the Diagnostic and Statistical Manual of Mental Disorders in its fourth (DSM-IV) and fifth edition (DSM-5), and the International Classification of Diseases (ICD)-10, in Argentinean females aged 13 to 44 years, 12 months before delivery; to evaluate the level of agreement between these classification systems; and to analyze the performance of each diagnosis criterion in this population.
Data were collected through personal interviews of a probability sample of puerperal women (N = 641) in the city of Santa Fe (Argentina), between October 2010 and February 2011. Diagnoses compatible with DSM-IV, DSM-5, and ICD-10 were obtained through the Composite International Diagnostic Interview. Agreement among diagnostic systems was measured through Cohen kappa. Diagnosis criteria performance were analyzed considering their prevalence and discriminating ability (D value).
Total ADP prevalence was 6.4% for DSM-IV (4.2% abuse and 2.2% dependence), 8.1% for DSM-5 (6.4% mild, 0.8% moderate, and 0.9% severe alcohol use disorder), and 14.1% for the ICD-10 (11.9% harmful use and 2.2% dependence). DSM-5 modifications improved agreement between DSM and ICD. The least prevalent and worst discriminating ability diagnostic criterion was "legal problems." The most prevalent and 1 of the best discriminating ability diagnostic criterion was '"health issues."
DSM-IV and ICD-10 dependence prevalence was similar to that of previous studies in pregnant women, whereas abuse prevalence was surprisingly higher. Our results indicate a better performance of the DSM-5 alcohol use disorder category relative to the DSM-IV dual categorization. Nevertheless, the poor diagnostic performance of some DSM-5 criteria in this population could evidence their intercultural variability.
与产前酒精暴露相关的重要问题的证据使研究人员面临理解和筛查该人群酒精使用情况的难题。尽管孕期任何酒精使用都应被视为有风险，但识别饮酒问题（ADPs）可能尤为重要，因为有饮酒问题的女性无法从简单的戒酒建议中获益，且她们的后代面临与产前酒精暴露相关问题的风险更高。在此背景下，我们旨在研究孕妇中饮酒问题的患病率和特征，评估不同诊断系统在该人群中的表现。
本研究的目的是描述根据《精神疾病诊断与统计手册》第四版（DSM-IV）和第五版（DSM-5）以及《国际疾病分类》（ICD）-10标准，在阿根廷13至44岁女性分娩前12个月获得的饮酒问题患病率；评估这些分类系统之间的一致性水平；并分析各诊断标准在该人群中的表现。
2010年10月至2011年2月期间，通过对阿根廷圣菲市产后妇女概率样本（N = 641）进行个人访谈收集数据。通过综合国际诊断访谈获得与DSM-IV、DSM-5和ICD-10相符的诊断。诊断系统之间的一致性通过科恩kappa系数进行测量。考虑诊断标准的患病率和区分能力（D值）分析其表现。
DSM-IV的饮酒问题总患病率为6.4%（滥用为4.2%，依赖为2.2%），DSM-5为8.1%（轻度酒精使用障碍为6.4%，中度为0.8%，重度为0.9%），ICD-10为14.1%（有害使用为11.9%，依赖为2.2%）。DSM-5的修订提高了DSM与ICD之间的一致性。最不常见且区分能力最差的诊断标准是“法律问题”。最常见且区分能力最佳的诊断标准之一是“健康问题”。
DSM-IV和ICD-10的依赖患病率与先前孕妇研究相似，而滥用患病率出人意料地更高。我们的结果表明，相对于DSM-IV的双重分类，DSM-5的酒精使用障碍类别表现更好。然而，DSM-5的一些标准在该人群中诊断表现不佳可能证明了其跨文化变异性。
