Falise Alyssa M, Li Ziying, Huggins-Manley Anne Corinne, Lopez-Quintero Catalina, Cottler Linda B, Striley Catherine W
From the Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL (AMF, CL-Q, LBC, CWS); and School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL (ZL, CH-M).
J Addict Med. 2024;18(6):675-682. doi: 10.1097/ADM.0000000000001343. Epub 2024 Jul 23.
Age-related psychometric differences in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ( DSM-5 ) opioid use disorder (OUD) diagnostic criteria have been hypothesized, but not been tested. This study investigated DSM-5 OUD diagnostic criteria for age-related measurement noninvariance among younger adults (YAs) and middle/older adults (MOAs) with past 12-month nonmedical use of prescription opioids.
People who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III and reported past 12-month nonmedical use of prescription opioids were included. YAs were 18-49 years old, and MOAs were 50+ years old. Item response theory, differential item functioning (DIF), and differential test functioning were used to assess for age-related measurement noninvariance.
One in 5 people met the DSM-5 OUD diagnostic criteria for OUD within the past 12 months, with the most endorsed criteria being tolerance (17.96%). DIF was identified for 3 criteria, including (1) taking opioids for longer or in larger doses than intended, (2) long periods spent obtaining/using/recovering from use, and (3) withdrawal. DIF was associated with the latent OUD severity needed to correctly endorse the criteria, with criteria being correctly endorsed at less severe levels of latent OUD for MOAs when compared with YAs. Differential test functioning analyses showed collectively the criteria had improved detection in MOAs when compared with YAs ( P < 0.01).
These findings suggest that there may be age-related variations in the DSM-5 OUD diagnostic criteria's ability to detect latent OUD. Future research should identify contributing factors and the influence it has on the accuracy of age-specific surveillance estimations.
关于《精神疾病诊断与统计手册》第5版（DSM-5）阿片类物质使用障碍（OUD）诊断标准中与年龄相关的心理测量差异已有假设，但尚未得到验证。本研究调查了DSM-5中OUD诊断标准在过去12个月有非医疗使用处方阿片类物质情况的年轻成年人（YAs）和中老年成年人（MOAs）中与年龄相关的测量非不变性。
纳入参加2012 - 2013年全国酒精及相关状况流行病学调查III且报告过去12个月有非医疗使用处方阿片类物质情况的人群。YAs年龄在18 - 49岁，MOAs年龄在50岁及以上。采用项目反应理论、项目功能差异（DIF）和测验功能差异来评估与年龄相关的测量非不变性。
在过去12个月内，五分之一的人符合DSM-5中OUD的诊断标准，其中被认可最多的标准是耐受性（17.96%）。确定有3项标准存在DIF，包括：（1）服用阿片类物质的时间比预期长或剂量比预期大；（2）花费长时间获取/使用/从使用中恢复；（3）戒断反应。DIF与正确认可该标准所需的潜在OUD严重程度相关，与YAs相比，MOAs在潜在OUD严重程度较低时就能正确认可这些标准。测验功能差异分析总体显示，与YAs相比，这些标准在MOAs中对OUD的检测能力有所提高（P < 0.01）。
这些发现表明，DSM-5中OUD诊断标准检测潜在OUD的能力可能存在与年龄相关的差异。未来的研究应确定促成因素及其对特定年龄监测估计准确性的影响。
