Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth)
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Population and Procedures
2.2. Sample Size
2.3. Measurement of Self-Reported Alcohol Use and Alcohol Dependence
2.4. Blood Sample Collection, Processing and Laboratory Assay for Phosphatidylethanol (PEth)
2.5. Data Management and Analysis
3. Results
3.1. Characteristics of the Population
Characteristic | Categories | Overall | Female College Students | Male College Students | Casual Labourers |
---|---|---|---|---|---|
Sample (N) | 202 | 41 | 58 | 103 | |
Age (%) | 18–20 years | 36 (17.8) | 4 (9.8) | 2 (3.5) | 30 (29.1) |
21–24 years | 166 (82.2) | 37 (90.2) | 56 (96.6) | 73 (70.9) | |
Religion (%) | Moslem | 36 (17.8) | 8 (19.5) | 5 (8.6) | 23 (22.3) |
Catholic | 102 (50.5) | 20 (48.8) | 32 (55.2) | 50 (48.5) | |
Other Christians | 64 (31.7) | 13 (31.7) | 21 (36.2) | 30 (29.1) | |
Education (%) | Primary and less | 62(30.7) | 0(0.0) | 0(0.0) | 62(60.2) |
Secondary and above | 140 (69.3) | 41 (100.0) | 58 (100.0) | 41 (39.8) | |
Marital status (%) | Single | 64 (31.8) | 9 (22.0) | 19 (33.3) | 36 (35.0) |
In relationship | 137 (68.2) | 32 (78.1) | 38 (66.7) | 67 (65.0) | |
Age at alcohol initiation (%) | Less than 18 years | 116 (58.0) | 22 (53.7) | 34 (59.7) | 60 (58.8) |
18–24 years | 84 (42.0) | 19 (46.3) | 23 (40.4) | 42 (41.2) | |
AUDIT( 10 items) score Median(IQR) | 8.5 (5.0,14.0) | 5.0 (3.0–8.0) | 7.0 (5.0, 13.0) | 10.0 (6.0, 16.0) | |
AUDIT (%) | <8 (Low risk drinking) | 95 (47.0) | 30 (73.2) | 30 (51.7) | 35 (34.0) |
≥8 (Risk drinking) | 107 (53.0) | 11 (26.8) | 28 (48.3) | 68 (66.0) | |
Dependence by AUDIT dependence questions (%) | No | 190 (94.1) | 40 (97.6) | 56 (96.6) | 94 (91.3) |
Yes | 12 (5.9) | 1 (2.4) | 2 (3.5) | 9 (8.7) | |
PEth cut-off for heavy alcohol intake (PEth-16:0/18:1 > 0.30 µmol/L) (%) | Yes | 25 (12.4) | 2 (4.9) | 7 (12.1) | 16 (15.5) |
3.2. Responses to MINI Questions and Characteristics of Respondents
3.3. Sensitivities and Specificities of the Original and Modified Versions of MINI Compared to PEth.
4. Discussion
Variables | Responses | N (%) | Dependent by Original DSM IV Criteria N (%) | PEth-16:0/18:1 ≥0.30 µmol/L N (%) | Median(IQR) AUDIT Score |
---|---|---|---|---|---|
DSM IV—Dependence question 1:Did you need to drink a lot more in order to get the same effect you got when you started first drinking or did you get much less effect with continued use of the same amount? | Yes | 177 (87.6) | 79 (44.6) | 25 (14.1) | 9 (6,15) |
No | 25 (12.4) | 0 (0.0) | 0 (0.0) | 5 (2,6) | |
DSM IV—Dependence question 2: When you cut down on drinking did your hands shake, did you sweat or feel agitated? Did you drink to avoid these symptoms (for example, “the shakes”, sweating or agitation) or to avoid being hungover? | Yes | 17 (8.4) | 17 (100.0) | 5 (29.4) | 13 (7,19) |
No | 185 (91.6) | 62 (33.5) | 20 (10.8) | 8 (5,13) | |
DSM IV—Dependence question 3: During the times when you drank alcohol, did you end up drinking more than you planned when started? | Yes | 121 (59.9) | 73 (60.3) | 22 (18.1) | 11 (7,17) |
No | 81 (40.1) | 6 (7.4) | 5 (3.7) | 5 (3,9) | |
DSM IV—Dependence question 4: Have you tried to reduce or stop drinking alcohol but failed? | Yes | 55 (27.2) | 47 (85.5) | 11 (20.0) | 12 (7,19) |
No | 147 (72.8) | 32 (21.8) | 14 (9.5) | 7 (5,12) | |
DSM IV—Dependence question 5: On the days that you drank, did you spend substantial time in obtaining alcohol, drinking, or in recovering from the effects of alcohol? | Yes | 33 (16.3) | 33 (100) | 6 (18.2) | 16 (9,19) |
No | 169 (83.7) | 46 (27.2) | 19 (11.2) | 7 (5,12) | |
DSM IV—Dependence question 6: Did you spend less time working, enjoying hobbies or being with others because of your drinking? | Yes | 36 (17.8) | 34 (94.4) | 6 (16.7) | 13 (8,19) |
No | 166 (82.2) | 45 (27.1) | 19 (11.5) | 7 (5,12) | |
DSM IV—Dependence question 7: If your drinking caused you health or mental problems, did you still keep on drinking? | Yes | 13 (6.4) | 10 (76.9) | 4 (30.8) | 12 (11,18) |
No | 189 (93.6) | 69 (36.5) | 21 (11.1) | 8 (5,13) |
Populations | Dependence by DSM IV | PEth-16:0/18:1 ≥0.30 µmol/L | Area under Receiver Operating Characteristics (AUROC) | ||
---|---|---|---|---|---|
Positive | Negative | ||||
Overall (n = 202) | ≥3 dependence questions | Yes | 15 (60.0) 1 | 64 (36.2) | 0.62 (0.52–0.72) |
No | 10 (40.0) | 113 (63.8) 2 | |||
Female college students (n = 41) | ≥3 dependence questions | Yes | 0 (0.0) | 6 (15.4) | 0.42 (0.37–0.48) |
No | 2 (100.0) | 33 (84.6) | |||
Male college students (n = 58) | ≥3 dependence questions | Yes | 4 (57.1) | 16 (31.4) | 0.63 (0.42–0.84) |
No | 3 (42.9) | 35 (68.6) | |||
Male casual labourers (n = 103) | ≥3 dependence questions | Yes | 11 (68.8) | 42 (48.3) | 0.60 (0.47–0.73) |
No | 5 (31.3) | 45 (51.7) | |||
Overall (n = 202) | ≥4 dependence questions | Yes | 10 (40.0) | 29 (16.4) | 0.62 (0.52–0.72) |
No | 15 (60.0) | 148 (83.6) | |||
Female college students (n = 41) | ≥4 dependence questions | Yes | 0 (0.0) | 3 (7.7) | 0.46 (0.42–0.50) |
No | 2 (100.0) | 36 (92.3) | |||
Male college students (n = 58) | ≥4 dependence questions | Yes | 3 (42.9) | 4 (7.8) | 0.68 (0.47–0.88) |
No | 4 (57.1) | 47 (92.2) | |||
Male casual labourers (n = 103) | ≥4 dependence questions | Yes | 7 (43.8) | 22 (25.3) | 0.59 (0.46–0.73) |
No | 9 (56.2) | 65 (74.7) | |||
Overall (n = 202) | ≥5 dependence questions | Yes | 3 (12.0) | 9 (5.1) | 0.54 (0.47–0.60) |
No | 22 (88.0) | 168 (94.9) | |||
Female college students (n = 41) | ≥5 dependence questions | Yes | 0 (0.0) | 1 (2.6) | 0.49 (0.46–0.51) |
No | 2 (100.0) | 38 (97.4) | |||
Male college students (n = 58) | ≥5 dependence questions | Yes | 1 (14.3) | 1 (2.0) | 0.56 (0.42–0.70) |
No | 6 (85.7) | 50 (98.0) | |||
Male casual labourers (n = 103) | ≥5 dependence questions | Yes | 2 (12.5) | 7 (8.0) | 0.52 (0.43–0.61) |
No | 14 (87.5) | 80 (92.0) |
Populations | Dependence by Modified DSM IV | PEth-16:0/18:1 ≥0.30 µmol/L | Area under Receiver Operating Characteristics (AUROC) | ||
---|---|---|---|---|---|
Positive | Negative | ||||
Overall (n = 202) | ≥1 dependence questions | Yes | 16 (64.0) 1 | 76 (42.9) | 0.61 (0.50–0.71) |
No | 9 (36.0) | 101 (57.1) 2 | |||
Female college students (n = 41) | ≥1 dependence questions | Yes | 0 (0.0) | 8 (20.5) | 0.40 (0.33–0.46) |
No | 2 (100.0) | 31 (79.5) | |||
Male college students (n = 58) | ≥1 dependence questions | Yes | 4 (57.1) | 20 (39.2) | 0.59 (0.38–0.80) |
No | 3 (42.9) | 31 (60.8) | |||
Male casual labourers (n = 103) | ≥1 dependence questions | Yes | 12 (75.0) | 48 (55.2) | 0.60 (0.48–0.72) |
No | 4 (25.0) | 39 (44.8) | |||
Overall (n = 202) | ≥2 dependence questions | Yes | 10 (40.0) | 35 (19.8) | 0.60 (0.50–0.70) |
No | 15 (60.0) | 142 (80.2) | |||
Female college students (n = 41) | ≥2 dependence questions | Yes | 0 (0.0) | 3 (7.7) | 0.46 (0.42–0.50) |
No | 2 (100.0) | 36 (92.3) | |||
Male college students (n = 58) | ≥2 dependence questions | Yes | 3 (42.9) | 6 (11.8) | 0.66 (0.45–0.86) |
No | 4 (57.1) | 45 (88.2) | |||
Male casual labourers (n = 103) | ≥2 dependence questions | Yes | 7 (43.8) | 26 (29.9) | 0.57 (0.44–0.70) |
No | 9 (56.2) | 61 (70.1) | |||
Overall (n = 202) | ≥3 dependence questions | Yes | 3 (12.0) | 9 (5.1) | 0.54 (0.47–0.60) |
No | 22 (88.0) | 168 (94.9) | |||
Female college students (n = 41) | ≥3 dependence questions | Yes | 0 (0.0) | 1 (2.6) | 0.49 (0.46–0.51) |
No | 2 (100.0) | 38 (97.4) | |||
Male college students (n = 58) | ≥3 dependence questions | Yes | 1 (14.3) | 1 (2.0) | 0.56 (0.42–0.70) |
No | 6 (85.7) | 50 (98.0) | |||
Male casual labourers (n = 103) | ≥3 dependence questions | Yes | 2 (12.5) | 7 (8.0) | 0.52 (0.43–0.61) |
No | 14 (87.5) | 80 (92.0) |
5. Conclusions
Acknowledgements
Author Contributions
Conflicts of Interest
Appendix 1: Mini International Neuropsychiatric Interview questionnaire (MINI)
Section I. Alcohol Abuse and Dependence
Section I2. Alcohol Dependence
a | Did you need to drink more in order to get the same effect that you got when you first started drinking? | Yes/No |
b | When you cut down on drinking did your hands shake, did you sweat or feel agitated? Did you drink to avoid these symptoms or to avoid being hungover, for example, "the shakes", sweating or agitation? If Yes to either, CODE Yes. | Yes/No |
c | During the times when you drank alcohol, did you end up drinking more than you planned when you started? | Yes/No |
d | Have you tried to reduce or stop drinking alcohol but failed? | Yes/No |
e | On the days that you drank, did you spend substantial time in obtaining alcohol, drinking, or in recovering from the effects of alcohol? | Yes/No |
f | Did you spend less time working, enjoying hobbies, or being with others because of your drinking? | Yes/No |
g | Have you continued to drink even though you knew that the drinking caused you health or mental problems? | Yes/No |
References
- World Health Organisation. Global Status Report on Alcohol and Health; World Health Organization: Geneva, Switzerland, 2014; pp. 1–43. [Google Scholar]
- Francis, J.M.; Grosskurth, H.; Changalucha, J.; Kapiga, S.H.; Weiss, H.A. Systematic review and meta-analysis: Prevalence of alcohol use among young people in eastern Africa. Trop. Med. Int. Health 2014, 19, 476–488. [Google Scholar] [CrossRef] [PubMed]
- World Health Organisation. International Classification of Diseases and Related Health Problems, 10th Revision; World Health Organization: Geneva, Switzerland, 2007. [Google Scholar]
- American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; APA: Washington, DC, USA, 1994. [Google Scholar]
- Sheehan, D.V.; Lecrubier, Y.; Sheehan, K.H.; Amorim, P.; Janavs, J.; Weiller, E.; Hergueta, T.; Baker, R.; Dunbar, G.C. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiat. 1998, 59 (Suppl. 20), 22–33. [Google Scholar]
- Hasin, D.S.; O’Brien, C.P.; Auriacombe, M.; Borges, G.; Bucholz, K.; Budney, A.; Compton, W.M.; Crowley, T.; Ling, W.; Petry, N.M.; et al. DSM-5 criteria for substance use disorders: Recommendations and rationale. Am. J. Psychiat. 2013, 170, 834–851. [Google Scholar] [CrossRef] [PubMed]
- American Psychiatric Association. Highlights of Changes from DSM-IV-TR to DSM-5; American Psychiatric Publishing: Arlington, VA, USA, 2013. [Google Scholar]
- Yoshimasu, K.; Mure, K.; Hashimoto, M.; Takemura, S.; Tsuno, K.; Hayashida, M.; Kinoshita, K.; Takeshita, T.; Miyashita, K. Genetic alcohol sensitivity regulated by ALDH2 and ADH1B polymorphisms as indicator of mental disorders in Japanese employees. Alcohol Alcohol. 2015, 50, 39–45. [Google Scholar] [CrossRef] [PubMed]
- Chung, T.; Martin, C.S. What were they thinking? Adolescents’ interpretations of DSM-IV alcohol dependence symptom queries and implications for diagnostic validity. Drug Alcohol Depend. 2005, 80, 191–200. [Google Scholar] [CrossRef] [PubMed]
- Chung, T.; Martin, C.S.; Winters, K.C. Diagnosis, course, and assessment of alcohol abuse and dependence in adolescents. Recent Dev. Alcohol. 2005, 17, 5–27. [Google Scholar] [PubMed]
- Hasin, D.S.; Schuckit, M.A.; Martin, C.S.; Grant, B.F.; Bucholz, K.K.; Helzer, J.E. The validity of DSM-IV alcohol dependence: What do we know and what do we need to know? Alcohol. Clin. Exp. Res. 2003, 27, 244–252. [Google Scholar] [CrossRef] [PubMed]
- Helander, A.; Peter, O.; Zheng, Y. Monitoring of the alcohol biomarkers PEth, CDT and EtG/EtS in an outpatient treatment setting. Alcohol Alcohol. 2012, 47, 552–557. [Google Scholar] [CrossRef] [PubMed]
- Helander, A.; Zheng, Y. Molecular species of the alcohol biomarker phosphatidylethanol in human blood measured by LC-MS. Clin. Chem. 2009, 55, 1395–1405. [Google Scholar] [CrossRef] [PubMed]
- Isaksson, A.; Walther, L.; Hansson, T.; Andersson, A.; Alling, C. Phosphatidylethanol in blood (B-PEth): A marker for alcohol use and abuse. Drug Test. Anal. 2011, 3, 195–200. [Google Scholar] [CrossRef] [PubMed]
- Knight, J.R.; Wechsler, H.; Kuo, M.; Seibring, M.; Weitzman, E.R.; Schuckit, M.A. Alcohol abuse and dependence among U.S. college students. J. Stud. Alcohol 2002, 63, 263–270. [Google Scholar] [CrossRef] [PubMed]
- Viel, G.; Boscolo-Berto, R.; Cecchetto, G.; Fais, P.; Nalesso, A.; Ferrara, S.D. Phosphatidylethanol in blood as a marker of chronic alcohol use: A systematic review and meta-analysis. Int. J. Mol. Sci. 2012, 13, 14788–14812. [Google Scholar] [CrossRef] [PubMed]
- Varga, A.; Hansson, P.; Lundqvist, C.; Alling, C. Phosphatidylethanol in blood as a marker of ethanol consumption in healthy volunteers: Comparison with other markers. Alcohol. Clin. Exp. Res. 1998, 22, 1832–1837. [Google Scholar] [CrossRef] [PubMed]
- Hahn, J.A.; Fatch, R.; Kabami, J.; Mayanja, B.; Emenyonu, N.I.; Martin, J.; Bangsberg, D.R. Self-report of alcohol use increases when specimens for alcohol biomarkers are collected in persons with HIV in Uganda. J. Acq. Immun. Def. Synd. 2012, 61. [Google Scholar] [CrossRef] [PubMed]
- Hahn, J.A.; Dobkin, L.M.; Mayanja, B.; Emenyonu, N.I.; Kigozi, I.M.; Shiboski, S.; Bangsberg, D.R.; Gnann, H.; Weinmann, W.; Wurst, F.M. Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-positive patients in sub-Saharan Africa. Alcohol. Clin. Exp. Res. 2012, 36, 854–862. [Google Scholar] [CrossRef] [PubMed]
- Bajunirwe, F.; Haberer, J.E.; Boum, Y., II; Hunt, P.; Mocello, R.; Martin, J.N.; Bangsberg, D.R.; Hahn, J.A. Comparison of self-reported alcohol consumption to phosphatidylethanol measurement among HIV-infected patients initiating antiretroviral treatment in southwestern Uganda. PLoS ONE 2014, 9. [Google Scholar] [CrossRef] [PubMed]
- Helander, A.; Hansson, T. National harmonization of the alcohol biomarker PEth. Lakartidningen 2013, 110, 1747–1748. [Google Scholar] [PubMed]
- Francis, J.M.; Weiss, H.A.; Mshana, G.; Baisley, K.; Grosskurth, H.; Kapiga, S.H. The epidemiology of alcohol use and alcohol use disorders among young people in northern Tanzania. PLoS ONE 2015, 10. [Google Scholar] [CrossRef] [PubMed]
- Saunders, J.B.; Aasland, O.G.; Babor, T.F.; de la Fuente, J.R.; Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction 1993, 88, 791–804. [Google Scholar] [CrossRef] [PubMed]
- Aradottir, S.; Seidl, S.; Wurst, F.M.; Jonsson, B.A.; Alling, C. Phosphatidylethanol in human organs and blood: A study on autopsy material and influences by storage conditions. Alcohol. Clin. Exp. Res. 2004, 28, 1718–1723. [Google Scholar] [CrossRef] [PubMed]
- Zheng, Y.; Beck, O.; Helander, A. Method development for routine liquid chromatography-mass spectrometry measurement of the alcohol biomarker phosphatidylethanol (PEth) in blood. Clin. Chim. Acta. 2011, 412, 1428–1435. [Google Scholar] [CrossRef] [PubMed]
- Gnann, H.; Weinmann, W.; Thierauf, A. Formation of phosphatidylethanol and its subsequent elimination during an extensive drinking experiment over 5 days. Alcohol. Clin. Exp. Res. 2012, 36, 1507–1511. [Google Scholar] [CrossRef] [PubMed]
- Babor, T.F.; John, C.H.B.; Saunders, J.B.; Monteiro, M.G. The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care, 2nd ed.; World Health Organization: Geneva, Switzerland, 2001. [Google Scholar]
- Francis, J.M.; Weiss, H.A.; Helander, A.; Kapiga, S.H.; Changalucha, J.; Grosskurth, H. Comparison of self-reported alcohol use with the alcohol biomarker phosphatidylethanol among young people in northern Tanzania. Drug Alcohol Depend. 2015. [Google Scholar] [CrossRef] [PubMed]
- Winters, K.C.; Martin, C.S.; Chung, T. Substance use disorders in DSM-V when applied to adolescents. Addiction 2011, 106, 882–884. [Google Scholar] [CrossRef] [PubMed]
- Neumann, T.; Neuner, B.; Gentilello, L.M.; Weiss-Gerlach, E.; Mentz, H.; Rettig, J.S.; Schroder, T.; Wauer, H.; Muller, C.; Schutz, M.; et al. Gender differences in the performance of a computerized version of the alcohol use disorders identification test in subcritically injured patients who are admitted to the emergency department. Alcohol Clin. Exp. Res. 2004, 28, 1693–1701. [Google Scholar] [CrossRef] [PubMed]
- Sheehan, D.V.; Janavs, J.; Sheehan, K.H.; Sheehan, M.; Gray, C.; Lecrubier, Y.; Weiller, E.; Hergueta, T.; Allgulander, C.; Kadri, N.; et al. MINI International Neuropsychiatric Interview. Avialiable online: http://cache.trustedpartner.com/docs/library/MentalHealthPBC2009/MINI.pdf (accessed on 12 January 2014).
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Francis, J.M.; Helander, A.; Kapiga, S.H.; Weiss, H.A.; Grosskurth, H. Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth). Int. J. Environ. Res. Public Health 2015, 12, 14021-14033. https://doi.org/10.3390/ijerph121114021
Francis JM, Helander A, Kapiga SH, Weiss HA, Grosskurth H. Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth). International Journal of Environmental Research and Public Health. 2015; 12(11):14021-14033. https://doi.org/10.3390/ijerph121114021
Chicago/Turabian StyleFrancis, Joel M., Anders Helander, Saidi H. Kapiga, Helen A. Weiss, and Heiner Grosskurth. 2015. "Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth)" International Journal of Environmental Research and Public Health 12, no. 11: 14021-14033. https://doi.org/10.3390/ijerph121114021