Lee Chien-Hung, Ko Albert Min-Shan, Yang Frances M, Hung Chung-Chieh, Warnakulasuriya Saman, Ibrahim Salah Osman, Zain Rosnah Binti, Ko Ying-Chin
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
JAMA Psychiatry. 2018 Mar 1;75(3):261-269. doi: 10.1001/jamapsychiatry.2017.4307.
Betel-quid (BQ) is the fourth most popular psychoactive agent worldwide. An emerging trend across Asia is the addictive consumption of BQ, which is associated with oral cancer and other health consequences.
To investigate the validity and pattern of DSM-5-defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations.
DESIGN, SETTING, AND PARTICIPANTS: In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016.
Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD.
Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5-defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5-defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P < .001), whereas those with mild BUD showed a 9.6-fold (95% CI, 1.8-56.8) risk (P = .01), those with moderate BUD showed a 35.5-fold (95% CI, 4.3-292.3) risk (P = .001), and those with severe BUD showed a 27.5-fold (95% CI, 1.6-461.4) risk of OPMD (P = .02). Individuals with moderate to severe BUD who used BQ and had the symptom of tolerance had a 153.4-fold (95% CI, 33.4-703.6) higher risk of OPMD than those who did not use BQ, and those with moderate to severe BUD who used BQ and had a larger amount or longer history of BQ use had an 88.9-fold (95% CI, 16.6-476.5) higher risk of OPMD than those who did not use BQ.
This international study gathered data about BQ users across 6 Asian populations, and it demonstrates that DSM-5 symptoms could fulfill a BUD construct. Most current Asian users of BQ already have BUD, which is correlated with risk of OPMD. Among individuals with moderate to severe BUD who used BQ, tolerance and a larger amount or longer history of BQ use are the key symptoms that correlated with enhanced risk of OPMD. These findings play an important role in providing a new indication of an additional psychiatric management plan for users of BQ who have BUD.
槟榔是全球第四大最常用的精神活性物质。在亚洲，槟榔成瘾性消费呈上升趋势，这与口腔癌及其他健康后果相关。
调查亚洲人群中《精神疾病诊断与统计手册》第五版（DSM-5）定义的槟榔使用障碍（BUD）的有效性和模式及其与口腔潜在恶性疾病（OPMD）的关联。
设计、设置和参与者：2009年1月1日至2010年2月28日，对亚洲槟榔研究联盟研究中的8922名非机构化成年人进行了面对面访谈，该研究是对6个槟榔流行人群的亚洲代表性调查。2015年1月1日至2016年12月31日进行了统计分析。
使用DSM-5物质使用障碍标准评估参与者的BUD，并通过临床口腔检查评估OPMD。有0至1种症状的当前槟榔使用者被分类为无BUD，有2至3种症状的为轻度BUD，有4至5种症状的为中度BUD，有6种或更多症状的为重度BUD。
在8922名参与者（4564名女性和4358名男性；平均[标准差]年龄为44.2[0.2]岁）中，DSM-5症状显示出足够的单维性，可作为BUD的有效测量指标。6个研究人群中DSM-5定义的BUD的12个月患病率为18.0%（轻度BUD为3.2%；中度BUD为4.3%；重度BUD为10.5%）。当前槟榔使用者中DSM-5定义的BUD的12个月比例为86.0%（轻度BUD为15.5%；中度BUD为20.6%；重度BUD为50.0%）。性别、年龄、低教育水平、吸烟和饮酒与BUD显著相关。在使用槟榔的个体中，家庭使用、高使用频率和槟榔使用量与中度至重度BUD显著相关。与未使用槟榔的个体相比，使用槟榔且无BUD的个体发生OPMD的风险高22.0倍（95%CI，4.3-112.4）（P<0.001），而轻度BUD个体的风险高9.6倍（95%CI，1.8-56.8）（P=0.01），中度BUD个体的风险高35.5倍（95%CI，4.3-292.3）（P=0.001），重度BUD个体的风险高27.5倍（95%CI，1.6-461.4）（P=0.02）。使用槟榔且有耐受性症状的中度至重度BUD个体发生OPMD的风险比未使用槟榔的个体高153.4倍（95%CI，33.4-703.6），而使用槟榔且槟榔使用量更大或使用时间更长的中度至重度BUD个体发生OPMD的风险比未使用槟榔的个体高88.9倍（95%CI，16.6-476.5）。
这项国际研究收集了6个亚洲人群中槟榔使用者的数据，表明DSM-5症状可满足BUD结构。大多数当前亚洲槟榔使用者已经患有BUD，这与OPMD风险相关。在使用槟榔的中度至重度BUD个体中，耐受性以及更大的槟榔使用量或更长的使用时间是与OPMD风险增加相关的关键症状。这些发现对于为患有BUD的槟榔使用者提供额外精神科管理计划的新指征具有重要作用。
