The Alcohol Use Disorders Identification Test (AUDIT): a review of recent research

Psychometric properties and factor structure of an Ecuadorian version of the Alcohol Use Disorders Identification Test (AUDIT) in college students

BACKGROUND

The Alcohol Use Disorders Identification Test (AUDIT) is the gold standard in assessing harmful alcohol intake, which is responsible for substantial morbidity and mortality.

OBJECTIVE

The goal of this study is to evaluate the psychometric properties and factor structure of an Ecuadorian adaptation of a Spanish translation of the AUDIT in a large sample of college students in Ecuador.

METHODS

A total of 7905 students, including 46.26% males, and 53.75% females, from 11 universities in Ecuador, were surveyed. The questionnaire was tested for two- and three-factor structures, reliability, and correlations with other health related measures.

RESULTS

The Kaiser-Meyer-Olkin test for sampling adequacy was satisfactory (.0885), and Bartlett´s test for sphericity was significant (p < .001). Although both models showed a good fit to the data, the two-factor model was preferred based on the high correlations between the factors 2 and 3 within the three-factor model (.86 for the total sample, .77 for females, and .91 for males). The reliability for the two-factor model was good, as indicated by Cronbach´s α = .806 (factor I) and .716 (factor II) for the total sample, .808 (factor I) and .667 (factor II) for females, and .787 (factor I) and .728 (factor II) for males. Additionally, the AUDIT scores positively correlated with several health-related measures: stress, psychological inflexibility, loneliness and depression/anxiety symptomatology.

CONCLUSION

The Ecuadorian adaptation of the Spanish version of the AUDIT has good reliability, and internal consistency and correlates with other health related measures, proving to be a reliable tool that can be used by researchers and clinicians to screen hazardous alcohol intake in college students.

Lung Microbiota Is Related to Smoking Status and to Development of Acute Respiratory Distress Syndrome in Critically Ill Trauma Patients

RATIONALE

Cigarette smoking is associated with increased risk of acute respiratory distress syndrome (ARDS) in patients after severe trauma; however, the mechanisms underlying this association are unknown.

OBJECTIVES

To determine whether cigarette smoking contributes to ARDS development after trauma by altering community composition of the lung microbiota.

METHODS

We studied the lung microbiota of mechanically ventilated patients admitted to the ICU after severe blunt trauma. To do so, we used 16S ribosomal RNA gene amplicon sequencing of endotracheal aspirate samples obtained on ICU admission (n = 74) and at 48 hours after admission (n = 30). Cigarette smoke exposure (quantified using plasma cotinine), ARDS development, and other clinical parameters were correlated with lung microbiota composition.

MEASUREMENTS AND MAIN RESULTS

Smoking status was significantly associated with lung bacterial community composition at ICU admission (P = 0.007 by permutational multivariate ANOVA [PERMANOVA]) and at 48 hours (P = 0.03 by PERMANOVA), as well as with significant enrichment of potential pathogens, including Streptococcus, Fusobacterium, Prevotella, Haemophilus, and Treponema. ARDS development was associated with lung community composition at 48 hours (P = 0.04 by PERMANOVA) and was characterized by relative enrichment of Enterobacteriaceae and of specific taxa enriched at baseline in smokers, including Prevotella and Fusobacterium.

CONCLUSIONS

After severe blunt trauma, a history of smoking is related to lung microbiota composition, both at the time of ICU admission and at 48 hours. ARDS development is also correlated with respiratory microbial community structure at 48 hours and with taxa that are relatively enriched in smokers at ICU admission. The data derived from this pilot study suggest that smoking-related changes in the lung microbiota could be related to ARDS development after severe trauma.

Lifetime and 12-month treatment for mental disorders and suicidal thoughts and behaviors among first year college students

OBJECTIVES

Mental disorders and suicidal thoughts and behaviors (STB) are common and burdensome among college students. Although available evidence suggests that only a small proportion of the students with these conditions receive treatment, broad-based data on patterns of treatment are lacking. The aim of this study is to examine the receipt of mental health treatment among college students cross-nationally.

METHODS

Web-based self-report surveys were obtained from 13,984 first year students from 19 colleges in eight countries across the world as part of the World Health Organization's World Mental Health-International College Student Initiative. The survey assessed lifetime and 12-month common mental disorders/STB and treatment of these conditions.

RESULTS

Lifetime and 12-month treatment rates were very low, with estimates of 25.3-36.3% for mental disorders and 29.5-36.1% for STB. Treatment was positively associated with STB severity. However, even among severe cases, lifetime and 12-month treatment rates were never higher than 60.0% and 45.1%, respectively.

CONCLUSIONS

High unmet need for treatment of mental disorders and STB exists among college students. In order to resolve the problem of high unmet need, a reallocation of resources may focus on innovative, low-threshold, inexpensive, and scalable interventions.

Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative

OBJECTIVES

Comorbidity is a common feature of mental disorders. However, needs assessment surveys focus largely on individual disorders rather than on comorbidity even though the latter is more important for predicting suicidal thoughts and behaviors. In the current report, we take a step beyond this conventional approach by presenting data on the prevalence and correlates (sociodemographic factors, college-related factors, and suicidal thoughts and behaviors) of the main multivariate profiles of common comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV disorders among students participating in the first phase of the World Health Organization World Mental Health International College Student initiative.

METHOD

A web-based mental health survey was administered to first year students in 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States; 45.5% pooled response rate) to screen for seven common DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, alcohol use disorder, and drug use disorder. We focus on the 14,348 respondents who provided complete data; 38.4% screened positive for at least one 12-month disorder.

RESULTS

Multivariate disorder profiles were detected using latent class analysis (LCA). The least common class (C1; 1.9% of students) was made up of students with high comorbidity (four or more disorders, the majority including mania/hypomania). The remaining 12-month cases had profiles of internalizing-externalizing comorbidity (C2; 5.8%), internalizing comorbidity (C3; 14.6%), and pure disorders (C4; 16.1%). The 1.9% of students in C1 had much higher prevalence of suicidal thoughts and behaviors than other students. Specifically, 15.4% of students in C1 made a suicide attempt in the 12 months before the survey compared with 1.3-2.6% of students with disorders in C2-4, 0.2% of students with lifetime disorders but no 12-month disorders (C5), and 0.1% of students with no lifetime disorders (C6).

CONCLUSIONS

In line with prior research, comorbid mental disorders were common; however, sociodemographic correlates of LCA profiles were modest. The high level of comorbidity underscores the need to develop and test transdiagnostic approaches for treatment in college students.

Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative

BACKGROUND

The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use.

AIMS

To investigate the effects and moderators of a brief acceptance-facilitating intervention on intention to use mental health services among university students.

METHOD

Within the German site of the World Health Organization's World Mental Health International College Student (WMH-ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n = 664) or a control condition (CC; n = 710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH-ICS surveys. The IC group then additionally received: Internet-based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self-injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored.

RESULTS

There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition (d = 0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime (d = 0.34; 95% CI: -0.08 to 0.7) and 12-month panic-disorder (d = 0.32; 95% CI: -0.10 to 0.74) compared with those without lifetime (d = 0.11; 95% CI: 0.00 to 0.22) or 12-month panic disorder (d = 0.11; 95% CI: 0.00 to 0.22), students with lower (d = 0.37; 95% CI: -0.77 to 1.51) than higher (d = -0.01; 95% CI: -0.36 to 0.34) self-reported physical health, and students with nonheterosexual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: -0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and "are already working actively to change it" (Stage 4 "stages of change").

CONCLUSIONS

A simple acceptance-facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs.

Readiness to change and barriers to treatment seeking in college students with a mental disorder

BACKGROUND

College students have high prevalence of mental disorders and suicidal thoughts and behaviours, and low rates of treatment uptake. This study assesses treatment access, intentions to seek help, and perceived barriers to help-seeking, considering gender and suicidal thoughts or behaviours (STBs) as predictors.

METHODS

Data is from the Ulster University Student Wellbeing study (2015) conducted in Northern Ireland (NI), as part of the WHO World Mental Health Surveys International College Student Project. Participants are 392 new college entrants (162 males (41.3%)/230 females (58.7%)), who all reported some lifetime mental disorder or STBs.

RESULTS

Receipt of treatment was low (37.8%), particularly among males and those with no STBs. Males were less likely to intend to access external professional services and were less likely than females to rate embarrassment (OR = 0.60) or worry about being treated differently (OR = 0.63) as important reasons for not seeking treatment. Those with STBs rated wanting to handle things on their own as a more important barrier those with no STBs (OR = 0.55 for non STBs group) and rated being unsure where to go as a less important barrier than those with no STBs (OR = 1.80 for non STBs group).

LIMITATIONS

Data is correlational and concerns lifetime criteria for mental disorder, with no consideration of current mental status nor disorder type.

CONCLUSIONS

These findings have implications for the active screening and intervention for vulnerable college students, particularly males and those with mental disorders but no STBs.

Suicidal Thoughts and Behaviors: Prevalence and Association with Distal and Proximal Factors in Spanish University Students

OBJECTIVE

We report on the prevalence of suicidal thoughts and behaviors in Spanish university students and their risk and protective factors (distal/proximal; individual/environmental).

METHODS

First-year university students completed an online survey including Self-Injurious Thoughts and Behaviors Interview (SITBI) items, the screening version of the Columbia-Suicide Severity Rating Scale (C-SSRS) along with adversities and positive relationships during childhood/adolescence, recent stressful experiences, and lifetime mental disorders. Nested logistic regression models were estimated and areas under the curve (AUC) compared.

RESULTS

A total of 2,118 students completed the survey (mean age = 18.8 [SD = 1.4] years; 55.4% female). Twelve-month prevalence of suicide ideation (SI) was 9.9%, plans, 5.6%, and attempts, 0.6%. Risk factors of 12-month SI were as follows: parental psychopathology (OR = 1.7, 95% CI 1.2-2.5); sexual assault (OR = 5.6, 95% CI 1.4-22.1); lifetime mood disorder (OR = 5.2, 95% CI 3.5-7.7); and lifetime anxiety disorder (OR = 1.7, 95% CI: 1.1-2.5). Childhood positive relationships protected from SI were as follows: peers/others (OR = 0.6, 95% CI 0.4-0.9 for the second highest tertile) and family (OR = 0.4, 95% CI 0.3-0.7 for the highest tertile). AUC of the final model was 0.82 (SE = 0.015).

CONCLUSION

Our results indicate a high prevalence of SI among Spanish university students and identify protective and risk factors from a comprehensive conceptual model.

The role impairment associated with mental disorder risk profiles in the WHO World Mental Health International College Student Initiative

OBJECTIVE

The objective of this study is to assess the contribution of mental comorbidity to role impairment among college students.

METHODS

Web-based self-report surveys from 14,348 first-year college students (Response Rate [RR] = 45.5%): 19 universities, eight countries of the World Mental Health International College Student Initiative. We assessed impairment (Sheehan Disability Scales and number of days out of role [DOR] in the past 30 days) and seven 12-month DSM-IV disorders. We defined six multivariate mental disorder classes using latent class analysis (LCA). We simulated population attributable risk proportions (PARPs) of impairment.

RESULTS

Highest prevalence of role impairment was highest among the 1.9% of students in the LCA class with very high comorbidity and bipolar disorder (C1): 78.3% of them had severe role impairment (vs. 20.8%, total sample). Impairment was lower in two other comorbid classes (C2 and C3) and successively lower in the rest. A similar monotonic pattern was found for DOR. Both LCA classes and some mental disorders (major depression and panic, in particular) were significant predictors of role impairment. PARP analyses suggest that eliminating all mental disorders might reduce severe role impairment by 64.6% and DOR by 44.3%.

CONCLUSIONS

Comorbid mental disorders account for a substantial part of role impairment in college students.

Barriers of mental health treatment utilization among first-year college students: First cross-national results from the WHO World Mental Health International College Student Initiative

BACKGROUND

Although mental disorders and suicidal thoughts-behaviors (suicidal thoughts and behaviors) are common among university students, the majority of students with these problems remain untreated. It is unclear what the barriers are to these students seeking treatment.

AIMS

The aim of this study is to examine the barriers to future help-seeking and the associations of clinical characteristics with these barriers in a cross-national sample of first-year college students.

METHOD

As part of the World Mental Health International College Student (WMH-ICS) initiative, web-based self-report surveys were obtained from 13,984 first-year students in eight countries across the world. Clinical characteristics examined included screens for common mental disorders and reports about suicidal thoughts and behaviors. Multivariate regression models adjusted for socio-demographic, college-, and treatment-related variables were used to examine correlates of help-seeking intention and barriers to seeking treatment.

RESULTS

Only 24.6% of students reported that they would definitely seek treatment if they had a future emotional problem. The most commonly reported reasons not to seek treatment among students who failed to report that they would definitely seek help were the preference to handle the problem alone (56.4%) and wanting to talk with friends or relatives instead (48.0%). Preference to handle the problem alone and feeling too embarrassed were also associated with significantly reduced odds of having at least some intention to seek help among students who failed to report that they would definitely seek help. Having 12-month major depression, alcohol use disorder, and suicidal thoughts and behaviors were also associated with significantly reduced reported odds of the latter outcome.

CONCLUSIONS

The majority of first-year college students in the WMH-ICS surveys report that they would be hesitant to seek help in case of future emotional problems. Attitudinal barriers and not structural barriers were found to be the most important reported reasons for this hesitation. Experimental research is needed to determine whether intention to seek help and, more importantly, actual help-seeking behavior could be increased with the extent to which intervention strategies need to be tailored to particular student characteristics. Given that the preference to handle problems alone and stigma and appear to be critical, there could be value in determining if internet-based psychological treatments, which can be accessed privately and are often build as self-help approaches, would be more acceptable than other types of treatments to student who report hesitation about seeking treatment.

The World Health Organization World Mental Health International College Student initiative: An overview

OBJECTIVES

The college years are a developmentally crucial period and a peak age for the onset of mental disorders.

METHODS

The World Health Organization World Mental Health International College Student (WMH-ICS) initiative is aimed at developing and implementing a system for improving prevention and early interventions for mental health problems among college students.

RESULTS

The initiative consists of three core elements. The first element is a web-based survey to assess the magnitude and nature of emotional problems, the effects of these problems on students' functioning, and barriers to seeking treatment. All first-year students in participating colleges are invited to participate, and we plan to expand the survey to all students in the future. The second element is an infrastructure to test internet-based interventions aimed at the prevention and early intervention in mental health problems. Participating colleges can develop and test internet-based interventions in randomized trials. The first pilot tests on such interventions now been done. The third element is the dissemination and continuous quality improvement monitoring of the evidence-based interventions developed in WMH-ICS.

CONCLUSIONS

By addressing these three core elements, the WMH-ICS aims to integrate epidemiological and clinical research to offer scalable and effective evidence-based interventions for mental health problems at a critical life course stage.

Alcohol use disorder and associated factors among individuals living with HIV in Hawassa City, Ethiopia: a facility based cross- sectional study

Background

Individuals living with HIV/AIDS with co-occurring harmful alcohol use may require specialized intervention or even multi-disciplinary team follow-up and management. This study was aimed to assess alcohol use disorder and associated factors among people living with HIV/AIDS in Hawassa city, Ethiopia, 2019.

Methods

A facility based cross-sectional study was conducted among 195 people living with HIV/AIDS who had follow-up visit at Hawassa University Comprehensive Specialized hospital. A systematic sampling technique was used to recruit the study participants. Alcohol used disorders identification test (AUDIT) was used to measure alcohol consumption, drinking behaviors, and alcohol-related problems. The binary logistic regression model was used to see the association between alcohol use disorder (AUD) and the independent variables. The strength of association was measured by odds ratios with 95% confidence intervals. Statistical significance declared at P < 0.05.

Results

The mean age of the study participants was 29.88 (±SD = 10.89) years. The magnitude of alcohol use disorder among people living with HIV/AIDS was 31.8%. Being male [AOR = 2.43, (95% CI: 1.76, 5.76)], having poor social support [AOR = 1.34, (95% CI: 1.12, 6.73)], being medication non-adherent [AOR = 1.78, (95% CI: 1.33, 6.79)], current khat chewing [AOR = 1.67, (95% CI: 1.16, 5.45)] and current cigarette smoking [AOR = 3.76, (95% CI: 2.16, 7.54)] had statistically significant association with alcohol use disorder.

Conclusion

In the current study, magnitude of alcohol use disorder among people living with HIV was high and, calls for integrating services provided to HIV patients in HIV care and treatment clinic which enhances timely detection and management of AUD cases. This also alerts the stakeholders in HIV prevention and control programs to invest a greater efforts to retain patients in addiction treatment and rehabilitation centers. Lastly, appropriate screening and health education on consequences of alcohol use disorder is warranted.

Post-9/11 Peripheral Neuropathy Symptoms among World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Peripheral neuropathy can result from numerous conditions including metabolic disorders, inflammatory disease, or exposure to environmental or biological toxins. We analyzed questionnaire data from 9239 Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters and emergency medical service workers (EMS) to evaluate the association between work at the WTC site and subsequent peripheral neuropathy symptoms using the validated Diabetic Neuropathy Symptom (DNS) score. We grouped the population into an "Indicated" group with conditions known to be associated with paresthesia (N = 2059) and a "Non-Indicated" group without conditions known to be associated (N = 7180). The level of WTC exposure was categorized by time of arrival to the WTC. Overall, 25% of workers aged 40 and older reported peripheral neuropathy symptoms: 30.6% in the Indicated and 23.8% in the Non-Indicated groups, respectively. Multivariable logistic models performed on the Non-Indicated group, and on the Non-Indicated in comparison with non-WTC exposed National Health and Nutrition Examination Survey (NHANES), found that the highest level of WTC-exposure was significantly associated with DNS positive outcomes, after controlling for potential confounders. In conclusion, this study suggests that symptoms of peripheral neuropathy and paresthesias are common and are associated with WTC-exposure intensity.

Frustration with feeling: Latent classes of non-suicidal self-injury and emotion regulation difficulties

Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.

Drug- and alcohol-related mortality risk after bariatric surgery: evidence from a 7-year prospective multicenter cohort study

BACKGROUND

It is unclear whether bariatric surgery affects the risk of drug- and alcohol-related mortality.

OBJECTIVES

To compare the observed drug- and alcohol-related mortality rate with age, sex, race, and year-adjusted rates from the general U.S.

POPULATION

SETTING

The Longitudinal Assessment of Bariatric Surgery-2, a prospective cohort study of 2458 adults who underwent bariatric surgery at 10 U.S. hospitals between April 2006 and April 2009.

METHODS

Participants attended presurgery and annual postsurgery assessments for up to 7 years. Drug- and alcohol-related standardized mortality ratios (SMR) comparing the observed post-bariatric surgery mortality rate with the age, sex, race, and year-adjusted expected mortality rate from the general U.S. population, among the entire cohort, and among those who underwent Roux-en-Y gastric bypass (RYGB).

RESULTS

Ten deaths related to drug or alcohol use (6 accidental overdose, 1 intentional overdose, 1 intent unknown overdose, and 2 alcoholic liver disease) occurred across 15,616 person-years of follow-up, all among participants who underwent RYGB (n = 1770). The observed mortality rate was significantly higher than expected for all drug- and alcohol-related causes overall (SMR = 2.10, 95% confidence interval = 1.01-3.86, P = .03) and among participants who underwent RYGB (SMR = 2.90, 95% confidence interval = 1.39-5.33, P = .003). The RYGB SMRs were significant for all overdoses (P = .002) and accidental overdoses (P = .01) and in the same direction but nonsignificant for intentional overdoses, intent unknown overdoses, and alcoholic liver disease (P for all ≥. 05).

CONCLUSIONS

Drug- and alcohol-related mortality is significantly higher than expected in the 7 years after bariatric surgery, specifically after RYGB.

Hazardous alcohol use in a sample of first episode psychosis patients in Singapore

BACKGROUND

Hazardous alcohol use has often been found to be more prevalent amongst psychiatric outpatients than the general population. Additionally, it has also been associated with poorer outcomes. The study aimed to investigate (1) the prevalence and (2) socio-demographic and clinical correlates of hazardous alcohol use, as well as (3) the relationship between hazardous alcohol use and quality of life in an outpatient sample with First Episode Psychosis (FEP) in Singapore.

METHODS

Baseline data (N = 280) was extracted from a longitudinal study investigating smoking and alcohol use amongst outpatients with FEP in a psychiatric hospital. Information on socio-demographics, hazardous alcohol use, and quality of life was collected through a self-report survey. Hazardous alcohol use was ascertained by total scores of 8 or higher on the Alcohol Use Disorders Identification Test (AUDIT). Data was analysed using logistic regression and linear regression analyses.

RESULTS

The prevalence of hazardous alcohol use over the past 12-month period was 12.9%. Those who had never smoked in their lifetime (vs current smokers) and those with a diagnosis of brief psychotic disorder (vs schizophrenia spectrum disorders) were found to have significantly lower odds of hazardous alcohol use. Hazardous alcohol use was also associated with lower negative symptom scores. Lastly, hazardous alcohol use was found to significantly predict lower scores on the physical health, social relationship and environment domains of quality of life.

CONCLUSIONS

The association between hazardous alcohol use and lower negative symptom scores is a surprising finding that needs to be further explored. The significant impact of hazardous alcohol use in reductions in quality of life suggests that early screening and interventions could benefit patients with hazardous alcohol use and comorbid psychosis.

Injury Occurrence and Return to Dance in Professional Ballet: Prospective Analysis of Specific Correlates

Professional ballet is a highly challenging art, but studies have rarely examined factors associated with injury status in ballet professionals. This study aimed to prospectively examine gender-specific correlates of injury occurrence and time-off from injury in professional ballet dancers over a one-year period. The participants were 99 professional ballet dancers (41 males and 58 females). Variables included: (i) predictors: sociodemographic data (age, educational status), ballet-related factors (i.e., experience in ballet, ballet status), cigarette smoking, alcohol drinking, and consumption of illicit drugs; and (ii) outcomes: injury occurrence and time-off from injury. Participants were questioned on predictors at the beginning of the season, while data on outcomes were collected continuously once per month over the study period. Dancers reported total of 196 injuries (1.9 injuries (95% CI: 1.6–2.3) per dancer in average), corresponding to 1.4 injuries per 1000 dance-hours (95% CI: 1.1–1.7). In females, cigarette smoking was a predictor of injury occurrence in females (OR: 4.33, 95% CI: 1.05–17.85). Alcohol drinking was a risk factor for absence from dance in females (OR: 1.29, 95% CI: 1.01–4.21) and males (OR: 1.21, 95% CI: 1.05–3.41). Less experienced dancers were more absent from dance as a result of injury than their more experienced peers (Mann-Whitney Z: 2.02, p < 0.04). Ballet dancers and their managers should be aware of the findings of this study to make informed decisions on their behavior (dancers) or to initiate specific programs aimed at the prevention of substance use and misuse in this profession (managers).

Mental Health Differences Between Older and Younger Lesbian, Gay, Bisexual, and Transgender Veterans: Evidence of Resilience

OBJECTIVE

To examine health and identity differences between older (50+) and younger (< 50) lesbian, gay, bisexual, and transgender (LGBT) veterans.

METHODS

Participants (N = 254) completed an internet survey assessing depression, anxiety, alcohol use, identity, minority stress, and outness. T tests and logistic regression were used to analyze results.

RESULTS

Older LGBT veterans reported less alcohol use (p < .01) than younger counterparts. No age differences in depression or anxiety were reported. Older participants reported LGBT identity as more central to their overall identity (p < .01) and having less minority stress (p < .05), than younger participants.

CONCLUSIONS

Compared to younger LGBT veterans, older LGBT veterans appeared more resilient over stressors that can impact mental health. Overall older LGBT veterans experienced less alcohol use and reported less minority stress than younger veterans. LGBT identity was more central to older veterans' overall identity than younger Veterans.

CLINICAL IMPLICATIONS

LGBT veterans may experience stressors that can impact mental health, although older LGBT veterans show remarkable resilience. Clinicians should assess sexual orientation and gender identity, as well as veteran status, of patients in order to best evaluate their health risks and strengths.

Post-Traumatic Stress, Quality of Life and Alcohol Use Problems among Out-of-School Youth

OBJECTIVE

Post-traumatic stress symptoms (PTSS) in out-of-school youths (OSYs) may be influenced by alcohol use, but there is a lack of evidence explaining how PTSS affect alcohol use problems in OSYs. The present study aimed to investigate the relationships among PTSS, quality of life, and alcohol use in OSYs.

METHODS

In total, 125 OSYs (46.4% male) in South Korea completed the Korean Version of the Child Report of Post-Traumatic Symptoms (CROPS), the KIDSCREEN-27 Quality of Life Measure for Children and Adolescents, and the Alcohol Use Disorders Identification Test-Consumption.

RESULTS

Mean CROPS score was 18.7 (SD=11.6); 37.6% were problem drinkers. Quality of life in the domain of parent relations and autonomy significantly mediated the relationship between PTSS and alcohol use problems. OSYs with high parental satisfaction and autonomy were less likely to have alcohol use problems even with PTSS.

CONCLUSION

Family assessments and therapeutic approaches are needed for OSYs with both PTSS and alcohol use problems.

Deficits in emotion regulation strategies among problematic and pathological gamblers in a sample of vocational school students

BACKGROUND AND AIMS

Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample.

METHODS

A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses.

RESULTS

The analyses showed a significant negative correlation between the subscales "Adjusting" and "Tolerating" and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies "Adjusting" [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91-0.99] and "Tolerating" [COR = 0.95, CI = 0.92-99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only "Tolerating" turned out to be significant [COR = 0.96, CI = 0.93-0.99].

DISCUSSION AND CONCLUSIONS

For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptance-focused strategies, should be considered in prevention and psychotherapy.

Patterns of childhood maltreatment and intimate partner violence, emotion dysregulation, and mental health symptoms among lesbian, gay, and bisexual emerging adults: A three-step latent class approach

BACKGROUND

Childhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals.

OBJECTIVE

Using latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted class-membership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use.

PARTICIPANTS

Participants were 288 LGB adults between 18-29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk.

METHODS AND RESULTS

The 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use.

CONCLUSION

Findings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges.

Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT

BACKGROUND

There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW's alcohol intake, wellbeing, and engagement with alcohol treatment.

METHODS

A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic 'thank you' message, and a nested qualitative study to further explore the intervention's feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index - Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability.

DISCUSSION

This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability.

TRIAL REGISTRATION

This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392 ).

Traumatic brain injury and hazardous/harmful drinking: Concurrent and single associations with poor mental health and roadway aggression

This study describes the association among lifetime traumatic brain injury (TBI) and past year hazardous/harmful drinking, as well as their unique and synergistic effects, on mental health problems and roadway aggression among Canadian adults. A cross-sectional sample of 6074 Ontario adults aged 18 years or older were surveyed between 2011 and 2013. TBI was defined as trauma to the head resulting in loss of consciousness or overnight hospitalization. Past year hazardous/harmful drinking was assessed using the Alcohol Use Disorders Identification Test. An estimated 13.1% (95%CI:12.0,14.2) adults reported a prior TBI (no hazardous/harmful drinking), 2.7% (95%CI:2.2,3.3) reported a prior TBI while concurrently screening positive for past year hazardous/harmful drinking and 9.8% (95%CI:8.9,10.9) screened positive for hazardous/harmful drinking (no TBI). Men had significantly higher odds of exhibiting all three conditions compared to women, especially for the concurrent class. Younger adults had significantly greater odds of hazardous/harmful drinking, or the concurrent class compared to adults 55 years and older. Adults in any of the three conditions had greater odds for mental health problems and roadway aggression. Concordance of both conditions corresponded to a greater than additive effect and greater odds of mild roadway aggression, than either condition alone. Results show that singly and jointly, these conditions are associated with adverse health and behavioral impediments.

Characteristics of Cognitively Normal Mexican-Americans with Cognitive Complaints

BACKGROUND

Subjective cognitive complaints in cognitively normal adults have been linked to later cognitive decline and dementia. Research on the characteristics of this group has been conducted on a variety of clinical and community-based populations. The current study focuses on the rapidly expanding population of Mexican-American elders.

OBJECTIVE

The objective of the study is the determination of characteristics of cognitively normal Mexican-Americans with cognitive complaints.

METHODS

Data on 319 cognitively normal participants in a large-scale community-based study of elderly Mexican-Americans (HABLE) were analyzed comparing those with cognitive complaints with those without on clinical characteristics, affective status, neuropsychological functioning, and proteomic markers.

RESULTS

Those expressing concern about cognitive decline scored lower on the MMSE, were more likely to have significantly more affective symptoms, higher levels of diabetic markers, poorer performance on attention and executive functioning, and a different pattern of inflammatory markers.

CONCLUSION

Although longitudinal research is needed to determine the impact of these differences on later cognition, possible targets for early intervention with Mexican-Americans were identified.

Causal Effects of Alcohol Intoxication on Sexual Risk Intentions and Condom Negotiation Skills Among High-Risk Men Who Have Sex with Men (MSM)

Alcohol use is a key risk factor for HIV infection among MSM, in part because intoxication may interfere with the use of prevention methods like condoms. However, few studies have examined whether this is due to alcohol's pharmacological or expectancy effects or explored the specific aspects of sexual decision-making that may be affected. In this study, high-risk, heavy drinking MSM (N = 121) were randomly assigned to receive either (1) alcohol beverages, (2) placebo beverages, or (3) control beverages, before navigating a video-based sexual risk scenario that assessed several aspects of sexual decision-making. Results showed that condom use intentions and negotiation behaviors were lower among alcohol and placebo participants compared with controls, but that few significant differences emerged between the alcohol and placebo groups. These findings contrast with similar past studies, and suggest that alcohol's expectancy effects may play a role in sexual decision-making.

Trends in Subjective Quality of Life Among Patients With First Episode Psychosis-A 1 Year Longitudinal Study

Quality of life (QoL) is often used as an outcome assessment in programs treating patients with first-episode psychosis (FEP). The aim of this study was to examine the longitudinal trend of subjective QoL among patients with FEP and identify the potential influence of patients' social-demographic/lifestyle factors on the trend of QoL. Two hundred and eighty subjects participated in the study. Patient's demographics and subjective QoL were collected at baseline, 6 months and 1 year follow-up. Data were analyzed with a fixed-effect general linear regression model. Subjective QoL demonstrated significant trends of improvement in all four subdomains (physical health, psychological health, social relationships, and environment). Compared with unemployed participants, employed participants were significantly associated with better social relationships (p = 0.005) and environment (p = 0.029) after adjusting for age and gender. Moderation analysis demonstrated a significant improvement of physical health, social relationships, and environment for participants with a higher level of educational achievement, but not for participants with a lower level of educational achievement. Our results indicate that patients with FEP experienced significant improvement in subjective QoL over a 1 year period. Being employed was associated with overall better social relationships and environment among patients with FEP and higher educational achievement was associated with improvement of physical health, social relationship, and environment. Hence, educational achievement and employment could be considered for future optimization of early psychosis intervention programs.

Approaches for creating comparable measures of alcohol use symptoms: Harmonization with eight studies of criminal justice populations

BACKGROUND

With increasing data archives comprised of studies with similar measurement, optimal methods for data harmonization and measurement scoring are a pressing need. We compare three methods for harmonizing and scoring the AUDIT as administered with minimal variation across 11 samples from eight study sites within the STTR (Seek-Test-Treat-Retain) Research Harmonization Initiative. Descriptive statistics and predictive validity results for cut-scores, sum scores, and Moderated Nonlinear Factor Analysis scores (MNLFA; a psychometric harmonization method) are presented.

METHODS

Across the eight study sites, sample sizes ranged from 50 to 2405 and target populations varied based on sampling frame, location, and inclusion/exclusion criteria. The pooled sample included 4667 participants (82% male, 52% Black, 24% White, 13% Hispanic, and 8% Asian/ Pacific Islander; mean age of 38.9 years). Participants completed the AUDIT at baseline in all studies.

RESULTS

After logical harmonization of items, we scored the AUDIT using three methods: published cut-scores, sum scores, and MNLFA. We found greater variation, fewer floor effects, and the ability to directly address missing data in MNLFA scores as compared to cut-scores and sum scores. MNLFA scores showed stronger associations with binge drinking and clearer study differences than did other scores.

CONCLUSIONS

MNLFA scores are a promising tool for data harmonization and scoring in pooled data analysis. Model complexity with large multi-study applications, however, may require new statistical advances to fully realize the benefits of this approach.

Self-efficacy and emotionally dysregulated behaviour: An exploratory test of the role of emotion regulatory and behaviour-specific beliefs

We examined the relationship between self-efficacy and three behaviours that can serve similar affect-regulatory functions (self-injury, risky alcohol use, disordered eating). We proposed that general self-efficacy would be indirectly related to each outcome, operating via emotion regulatory self-efficacy and behaviour-specific self-efficacy. A path analysis confirmed this proposal in a sample of 490 university students, who completed questionnaires assessing the constructs of interest. Emotion regulatory self-efficacy was a salient predictor of self-injury and disordered eating, evidencing both direct and indirect relationships. Self-efficacy to resist each of the behaviours was uniquely related to its target behaviour. We discuss these findings, outlining the implications for a theoretical understanding of emotion-regulatory behaviours, and offer suggestions for prevention and early intervention initiatives.

Educational and sport factors as predictors of harmful alcohol drinking in adolescence: a prospective study in Bosnia and Herzegovina

OBJECTIVES

The cause-effect relationship between educational and sport factors, and alcohol drinking in adolescents is rarely prospectively investigated. This study aimed to establish the possible influence of sport, scholastic and socio-demographic factors on harmful alcohol drinking (HD) and the initiation of HD in adolescents from Bosnia-Herzegovina.

METHODS

Study included 881 adolescents (49% females) and consisted of (1) baseline tests (16 years of age) and (2) follow-up testing (18 years of age). The independent variables were scholastic and sport-related factors. Alcohol Use Disorders Identification Test was used, with the following dependent variables: (1) HD at baseline, (2) HD at follow-up, and (3) HD initiation. Logistic regressions were applied to define the relationships.

RESULTS

Higher likelihood of HD was evidenced in children who performed poorly in school. Sport factors were positively correlated with HD at study baseline. Higher odds for HD initiation were found for adolescents who reported a lower GPA, a lower behavioral grade, more frequent school absences, and more unexcused school absences.

CONCLUSIONS

The results showed scholastic failure as the predictor of HD initiation. The potential influence of sport factors on HD initiation should be studied at an earlier age.

Socio-demographic, mental health and childhood adversity risk factors for self-harm and suicidal behaviour in College students in Northern Ireland

BACKGROUND

Prevalence estimates of suicidal behaviour in the college student population are consistently higher than rates for the general adult population. This study examines mental health disorders and childhood adversities as predictors of self-harm and suicidal behaviours.

METHODS

The Ulster University Student Wellbeing study commenced in September 2015 as part of the WHO World Mental Health Surveys International College Student Project. In Northern Ireland (NI) 739 students participated (462 female, 274 male and 3 other specified), with the WMH-CIDI used to examine psychopathology. Mean age was 21 years old.

RESULTS

Thirty-one percent endorsed suicidal ideation (24.3% of males and 36.9% of females) with almost 1 in 5 students having made a plan for suicide in the 12 months prior to the survey. Latent profile analysis revealed three profiles of childhood adversity (high, moderate, and low risk). Logistic regression analyses showed that there was an increased likelihood of all queried self-harm and suicidal behaviours in those who were not heterosexual orientation, and among those with either moderate or high levels of childhood adversities. Probable alcohol dependence was associated with a significantly increased likelihood of suicide attempt or self-harm with either a suicide plan or a suicide attempt.

LIMITATIONS

Influences of self-report measures and the generalizability of the sample are discussed.

CONCLUSIONS

Policies and strategies for early identification of those with mental illnesses or adversities that increase their risk, should be prioritised. It would also be useful to identify individuals at risk in secondary schools to allow for additional support to be offered to them during the key time of transitioning into higher education.

Problem drinking among at-risk college students: The examination of Greek involvement, freshman status, and history of mental health problems

OBJECTIVE

Scarce research has examined the combined effect of mental health difficulties and demographic risk factors such as freshman status and Greek affiliation in understanding college problem drinking. The current study is interested in looking at the interaction among freshman status, Greek affiliation, and mental health difficulties.

PARTICIPANTS AND METHODS

Undergraduate students (N = 413) from a private and public Midwestern university completed a large online survey battery between January 2009 and April 2013. Data from both schools were aggregated for the analyses.

RESULTS

After accounting for gender, age, and school type, the three-way interaction indicated that the highest drinking levels were reported in freshman students who reported a history of mental health problems although were not involved in Greek life.

CONCLUSIONS

Findings are discussed in the context of perceived social norms, as well as alcohol-related screenings and intervention opportunities on college campuses.

PNPLA3 rs139051 is associated with phospholipid metabolite profile and hepatic inflammation in nonalcoholic fatty liver disease

AIM

To investigate the effect of PNPLA3 polymorphisms on serum lipidomics and pathological characteristics in nonalcoholic fatty liver disease (NAFLD).

METHODS

Thirty-four biopsy-proven NAFLD patients from Northern, Central, and Southern China were subjected to stratification by genotyping their single nucleotide polymorphisms (SNPs) in PNPLA3. Ultra performance liquid chromatographytandem mass spectrometry was then employed to characterize the effects of PNPLA3 SNPs on serum lipidomics. In succession, correlation analysis revealed the association of PNPLA3-related lipid profile and hepatic pathological characteristics on a basis of steatosis, activity, and fibrosis assessment. The variant-based scoring of hepatocyte steatosis, ballooning, lobular inflammation, and liver fibrosis was finally performed so as to uncover the actions of lipidomics-affecting PNPLA3 SNPs in NAFLD-specific pathological alterations.

RESULTS

PNPLA3 SNPs (rs139051, rs738408, rs738409, rs 2072906, rs2294918, rs2294919, and rs4823173) demonstrated extensive association with the serum lipidomics, especially phospholipid metabolites [lysophosphatidylcholine (LPC), lysophosphatidylcholine plasmalogen (LPCO), lysophosphatdylethanolamine (LPE), phosphatidylcholine (PC), choline plasmalogen (PCO), phosphatidylethanolamine (PE), ethanolamine plasmalogen (PEO)], of NAFLD patients. PNPLA3 rs139051 (A/A genotype) and rs2294918 (G/G genotype) dominated the up-regulatory effect on phospholipids of LPCs (LPC 17:0, LPC 18:0, LPC 20:0, LPC 20:1, LPC 20:2) and LPCOs (LPC O-16:1, LPC O-18:1). Moreover, subjects with high-level LPCs/LPCOs were predisposed to low-grade lobular inflammation of NAFLD (rho: -0.407 to -0.585, P < 0.05-0.001). The significant correlation of PNPLA3 rs139051 and inflammation grading [A/A vs A/G + G/G: 0.50 (0.00, 1.75) vs 1.50 (1.00, 2.00), P < 0.05] further demonstrated its pathological role based on the modulation of phospholipid metabolite profile.

CONCLUSION

The A/A genotype at PNPLA3 rs139051 exerts an up-regulatory effect on serum phospholipids of LPCs and LPCOs, which are associated with low-grade lobular inflammation of NAFLD.

Problematic alcohol use associates with sodium channel and clathrin linker 1 (SCLT1) in trauma-exposed populations

Excessive alcohol use is extremely prevalent in the United States, particularly among trauma-exposed individuals. While several studies have examined genetic influences on alcohol use and related problems, this has not been studied in the context of trauma-exposed populations. We report results from a genome-wide association study of alcohol consumption and associated problems as measured by the alcohol use disorders identification test (AUDIT) in a trauma-exposed cohort. Results indicate a genome-wide significant association between total AUDIT score and rs1433375 [N = 1036, P = 2.61 × 10^-8 (dominant model), P = 7.76 × 10^-8 (additive model)], an intergenic single-nucleotide polymorphism located 323 kb upstream of the sodium channel and clathrin linker 1 (SCLT1) at 4q28. rs1433375 was also significant in a meta-analysis of two similar, but independent, cohorts (N = 1394, P = 0.0004), the Marine Resiliency Study and Systems Biology PTSD Biomarkers Consortium. Functional analysis indicated that rs1433375 was associated with SCLT1 gene expression and cortical-cerebellar functional connectivity measured via resting state functional magnetic resonance imaging. Together, findings suggest a role for sodium channel regulation and cerebellar functioning in alcohol use behavior. Identifying mechanisms underlying risk for problematic alcohol use in trauma-exposed populations is critical for future treatment and prevention efforts.

Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project

BACKGROUND

College entrance is a stressful period with a high prevalence of mental disorders.

AIMS

To assess the role impairment associated with 12-month mental disorders among incoming first-year college students within a large cross-national sample.

METHODS

Web-based self-report surveys assessing the prevalence of DSM-IV mental disorders and health-related role impairment (Sheehan Disability Scale) were obtained and analyzed from 13,984 incoming first-year college students (Response = 45.5%), across 19 universities in eight countries. Impairment was assessed in the following domains: home management, work (e.g., college-related problems), close personal relationships, and social life.

RESULTS

Mean age of the sample was 19.3 (SD = 0.59) and 54.4% were female. Findings showed that 20.4% of students reported any severe role impairment (10% of those without a mental disorder vs. 42.9% of those with at least one disorder, P < 0.01). In bivariate analyses, panic disorder, and mania were associated most frequently with severe impairment (60.6% and 57.5%, respectively). Students reporting three or more mental disorders had almost fivefold more frequently severe impairment relative to those without mental disorders. Multiple logistic regression showed that major depression (OR = 4.0; 95%CI = 3.3, 4.8), generalized anxiety (OR = 3.9; 95%CI = 3.1, 4.8), and panic disorder (OR = 2.9; 95%CI 2.4, 4.2) were associated with the highest odds of severe impairment. Only minimal deviations from these overall associations were found across countries.

CONCLUSION

Mental disorders among first-year college students are associated with substantial role impairment. Providing preventative interventions targeting mental disorders and associated impairments is a critical need for institutions to address.

Attempts to reduce alcohol intake and treatment needs among people with probable alcohol dependence in England: a general population survey

AIMS

To compare the proportion of people in England with probable alcohol dependence [Alcohol Use Disorders Identification Test (AUDIT) score ≥ 20] with those with other drinking patterns (categorized by AUDIT scores) in terms of motivation to reduce drinking and use of alcohol support resources.

DESIGN

A combination of random probability and simple quota sampling to conduct monthly cross-sectional household computer-assisted interviews between March 2014 and August 2017.

SETTING

The general population in all nine regions of England.

PARTICIPANTS

Participants in the Alcohol Toolkit Study (ATS), a monthly household survey of alcohol consumption among people aged 16 years and over in England (n = 69 826). The mean age was 47 years [standard deviation (SD) = 18.78; 95% confidence interval (CI) = 46.8-47] and 51% (n = 35 560) were female.

MEASUREMENTS

χ2 tests were used to investigate associations with demographic variables, motivation to quit drinking, attempts to quit drinking, general practitioner (GP) engagement and types of support accessed in the last 12 months across AUDIT risk zones.

FINDINGS

A total of 0.6% were classified as people with probable alcohol dependence (95% CI = 0.5-0.7). Motivation to quit (χ2  = 1692.27, P < 0.001), current attempts (χ2  = 473.94, P < 0.001) and past-year attempts (χ2  = 593.67, P < 0.001) differed by AUDIT risk zone. People with probable dependence were more likely than other ATS participants to have a past-year attempt to cut down or quit (51.8%) and have received a specialist referral from their GP about drinking (13.7%), and less likely to report no motivation to reduce their drinking (26.2%). Those with probable dependence had higher use of self-help books and mobile applications (apps) than other ATS participants; however, 27.7% did not access any resources during their most recent attempt to cut down.

CONCLUSIONS

Adults in England with probable alcohol dependence, measured through the Alcohol Use Disorders Identification Test, demonstrate higher motivation to quit drinking and greater use of both specialist treatment and self-driven support compared with those in other Alcohol Use Disorders Identification Test zones, but most do not access treatment resources to support their attempts.

The Effect of Intimate Partner Violence on the Psychosocial Development of Toddlers

This study used data from the National Survey of Child and Adolescent Well-Being II to examine the effects of intimate partner violence (IPV) on child-welfare-involved toddlers' psychosocial development. The sample was limited to toddlers aged 12 to 18 months with mothers who did ( n = 102) and did not ( n = 163) report IPV physical victimization. Multiple linear regression analyses showed, when compared with mothers who did not report IPV physical victimization, mothers who reported IPV physical victimization were more likely to have toddlers with higher levels of socioemotional and behavioral problems ( B = 5.06, p < .001). Conversely, delayed social competence was not associated with IPV ( B = -1.33, p > .05). Further analyses examining only toddlers with mothers who reported IPV physical victimization revealed, when compared with IPV-exposed toddlers who had a child welfare report of physical abuse as the primary maltreatment type, those with IPV as the primary maltreatment type were at lower risk of having socioemotional and behavioral problems ( B = -12.90, p < .05) and delayed social competence ( B = 3.27, p < .05). These findings indicate a significant concern regarding toddler psychosocial development when a mother has experienced IPV. This concern is even greater among IPV-exposed toddlers who experience physical abuse. We recommend child welfare workers assess for IPV. Once identified, early prevention and intervention services should be offered and tailored to the specific needs of IPV-affected families.

AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents

BACKGROUND

The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents.

METHODS

621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs.

RESULTS

Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%.

CONCLUSIONS

Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C.

Exploring Demographics and Health as Predictors of Risk-Taking in UK Help-Seeking Veterans

Risk-taking amongst veterans has severe consequences, yet few studies have examined factors that may predict risk-taking in help-seeking veteran populations. This paper presents a cross-sectional study involving a random sample of 667 UK help-seeking veterans, investigating the role of demographics, mental health and physical health presentations on the propensity for risk-taking. Out of 403 (73.4%) veterans, 350 (86.8%) reported risk-taking in the past month. We found that younger age, being in a relationship, probable PTSD, common mental health difficulties and traumatic brain injury were significantly associated with risk-taking. Additionally, a direct association was found between increased risk-taking and PTSD symptom clusters, including higher hyperarousal, elevated negative alterations in mood and cognition. Our findings provide initial evidence for demographic and mental health presentations as predictors of risk-taking in help-seeking veterans. Further research and longitudinal studies are needed to facilitate valid risk assessments, and early intervention for veteran services.

Alcohol and Opioid Use in Chronic Pain: A Cross-Sectional Examination of Differences in Functioning Based on Misuse Status

Opioid misuse is regularly associated with disrupted functioning in those with chronic pain. Less work has examined whether alcohol misuse may also interfere with functioning. This study examined frequency of opioid and alcohol misuse in 131 individuals (61.1% female) prescribed opioids for the treatment of chronic pain. Participants completed an anonymous survey online, consisting of measures of pain, functioning, and opioid and alcohol misuse. Cut scores were used to categorize individuals according to substance misuse status. Individuals were categorized as follows: 35.9% (n = 47) were not misusing either opioids or alcohol, 22.9% (n = 30) were misusing both opioids and alcohol, 38.2% (n = 50) were misusing opioids alone, and only 3.0% (n = 4) were misusing alcohol alone. A multivariate analysis of variance was performed to examine differences in pain and functioning between groups (after excluding individuals in the alcohol misuse group due to the small sample size). Group comparisons indicated that individuals who were not misusing either substance were less disabled and distressed in comparison to those who were misusing opioids alone or both opioids and alcohol. No differences were indicated between the latter 2 groups. Overall, the observed frequency of opioid misuse was somewhat higher in comparison to previous work (approximately 1 out of every 3 participants), and misuse of both alcohol and opioids was common (approximately 1 out of every 5 participants). While these data are preliminary, they do suggest that issues of substance misuse in those with chronic pain extends beyond opioids alone.

PERSPECTIVE

Opioid and alcohol misuse was examined in 131 individuals prescribed opioids for chronic pain. In total, 35.9% were not misusing either, 22.9% were misusing both, 38.2% were misusing opioids, and 3.1% were misusing alcohol. Individuals not misusing either were generally less disabled and distressed compared to those misusing opioids or both.

Increased risk of attempted suicide in Australian veterans is associated with total and permanent incapacitation, unemployment and posttraumatic stress disorder severity

BACKGROUND

Military veterans have higher rates of suicidality and completed suicides compared to the general population. Previous research has demonstrated suicidal behaviour is higher in US combat veterans who are younger, suffer from posttraumatic stress disorder, depression and anxiety and score lower on measures of health. However, research on predictors of suicide for Australian veterans is limited. The aim of this study was to identify significant demographic and psychological differences between veterans with posttraumatic stress disorder who had attempted suicide and those with posttraumatic stress disorder who had not, as well as determine predictors of suicide attempts within an Australian cohort.

METHODS

A retrospective analysis was conducted on 229 ex-service personnel diagnosed with posttraumatic stress disorder who had attended a Military Service Trauma Recovery Day Program as outpatients at Toowong Private Hospital from 2007 to 2014. Patients completed a battery of mental health self-report questionnaires assessing symptoms of posttraumatic stress disorder, alcohol use, anger, depression, anxiety and quality of life. Demographic information and self-reported history of suicide attempts were also recorded.

RESULTS

Results indicated the average age was significantly lower, and the rates of posttraumatic stress disorder, anger, anxiety and depression symptoms were significantly higher in those veterans with history of a suicide attempt. Multivariate logistic regression analyses indicated posttraumatic stress disorder symptom severity, unemployment or total and permanent incapacity pension status significantly predicted suicide attempt history.

CONCLUSION

Among a cohort of Australian veterans with posttraumatic stress disorder, psychopathology severity, unemployment and total and permanent incapacity status are significantly associated with suicidality. This study highlights the importance of early identification of posttraumatic stress disorder and psychopathology, therapeutic and social engagement, and prioritisation of tangible employment options or meaningful and goal-directed activities for veterans deemed unable to work.

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV

Introduction

The standard clinical approach to non-occupational HIV post-exposure prophylaxis (nPEP) focuses on biomedical aspects of the intervention, but may overlook co-occurring or ‘syndemic’ psychosocial problems that reinforce future vulnerability to HIV. We therefore sought to determine the prevalence of syndemic health problems in a cohort of Ontario nPEP patients, and explored the relationship between syndemic burden and HIV risk.

Methods

Between 07/2013-08/2016, we distributed a self-administered questionnaire to patients presenting to three clinics in Toronto and Ottawa seeking nPEP for sexual HIV exposures. We used validated screening tools to estimate the prevalence of depression (CES-D score ≥16), harmful alcohol use (AUDIT ≥8), problematic drug use (DUDIT ≥6 men/≥2 women), and sexual compulsivity (SCS ≥24) among men who have sex with men (MSM) respondents. In exploratory analyses, we examined the relationships between syndemic conditions using univariable logistic regression models, and the relationship between syndemic count (total number of syndemic conditions per participant) and HIV risk, as estimated by the HIRI-MSM score, using linear regression models.

Results

The 186 MSM included in the analysis had median age 31 (IQR = 26–36), including 87.6% having a college/undergraduate degree or higher. Overall, 53.8% screened positive for depression, 34.4% for harmful alcohol use, 30.1% for problematic drug use, and 16.1% for sexual compulsivity. Most participants (74.2%) had at least one syndemic condition and 46.8% had more than one. Exploratory analyses suggested positive associations between depression and harmful alcohol use (OR = 2.11, 95%CI = 1.13, 3.94) and between harmful alcohol use and problematic drug use (OR = 1.22, 95%CI = 0.65, 2.29). Syndemic count was associated with increased HIRI-MSM risk scores in univariable (2.2, 95%CI = 1.0, 3.3 per syndemic condition) and multivariable (2.1, 95%CI = 0.6, 3.6) linear regression models.

Conclusions

The prevalence of syndemic conditions in MSM seeking nPEP for sexual exposure is alarmingly high, and is associated with underlying HIV risk. Routine screening for these conditions may identify opportunities for intervention and could alleviate future vulnerability to HIV.

Evidencing Protective and Risk Factors for Harmful Alcohol Drinking in Adolescence: A Prospective Analysis of Sport-Participation and Scholastic-Achievement in Older Adolescents from Croatia

Background: The prevalence of alcohol drinking (AD) in Croatian adolescents is alarming, but there is an evident lack of prospective analyses of the protective/risk factors of AD. This study aimed to prospectively investigate the relationships between scholastic and sport factors and harmful alcohol drinking (HD) in older adolescents. Methods: The participants (n = 644, 53.7% females) were 16 years of age at study baseline and were tested at baseline and again 20 months later (follow-up). The predictors included four variables of scholastic achievement and four factors evidencing involvement in sport. Criterion was AD observed on the Alcohol Use Disorders Identification Test (AUDIT), and results were later categorized into harmful drinking (HD) and non-harmful drinking (NHD). The HD at baseline, HD at follow-up and HD initiation during the study course were observed as criteria in logistic regression analyses, which were additionally controlled for confounders (age, gender, socioeconomic status, and conflict with parents). Results: With 22% and 29% adolescents who reported HD at baseline and follow-up, respectively, the prevalence of HD remains among the highest in Europe. Scholastic failure was systematically related to HD at baseline and follow-up, but scholastic variables did not predict HD initiation during the course of the study. The higher odds for HD at baseline were evidenced for current and former team sport athletes. Those who quit individual sport were more likely to engage in HD at follow-up. Longer involvement in sport (OR: 2.10, 95% CI: 1.18–3.72), higher sport result (OR: 3.15, 95% CI: 1.19–8.34), and quitting individual sport (OR: 13.13, 95% CI: 2.67–64.62) were predictive of HD initiation. Conclusions: The results indicated specific associations between sport factors with HD initiation, which is understandable knowing the high stress placed on young athletes in this period of life, mainly because of the forthcoming selection between junior (amateur) and senior (professional) level. The results did not allow interpretation of the cause-effect relationship between scholastic failure and HD in the studied period.

Associations between high-risk alcohol consumption and sarcopenia among postmenopausal women

OBJECTIVE

Sarcopenia is an age-related process, leading to cardio-metabolic diseases and disabilities. High-risk drinking is also closely related to diabetes, hypertension, and dyslipidemia, which are modifiable risk factors for sarcopenia. In the present study, we aimed to investigate the association between alcohol-drinking patterns and sarcopenia in Korean postmenopausal women.

METHODS

Data from 2,373 postmenopausal women were analyzed from the 2008 to 2011 Korean National Health and Nutrition Examination Survey. We defined sarcopenia as two standard deviations below the sex-specific means of the appendicular skeletal muscle/weight (percentage) values of a young reference group. Participants were categorized into three groups according to alcohol-drinking patterns, as assessed by the Alcohol Use Disorders Identification Test questionnaire. The odds ratios and 95% confidence intervals for sarcopenia were calculated using multiple logistic regression analyses.

RESULTS

In total, 8.2% of Korean postmenopausal women met criteria for sarcopenia. The prevalence of sarcopenia increased from low-risk to high-risk alcohol-drinking groups as follows: 7.6, 11.0, and 22.7%, respectively. Compared with the low-risk group, the odds ratio (95% confidence interval) for the high-risk group was 4.29 (1.87-9.82) after adjusting for age, body mass index, systolic blood pressure, total cholesterol, fasting blood glucose, household income, education level, daily calorie intake, current smoking and regular exercise, and household food security status CONCLUSIONS:: High-risk alcohol drinking was associated with a higher risk of sarcopenia in postmenopausal Korean women.

Attention deficit hyperactivity disorder and arrest history: Differential association of clinical characteristics by sex

Attention deficit hyperactivity disorder (ADHD) is often cited as a risk factor for criminality. However, many studies do not take other criminogenic variables into account when reporting on this relationship. It is even less clear whether models that include ADHD as a potential risk factor for criminality consider the importance of sex differences. To answer this question, we collected data from a telephone population survey sampling adults over the age of 18 years in the province of Ontario, Canada (final sample size = 5196). Respondents were screened for ADHD using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four extra items. Problematic drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT), while cannabis misuse was evaluated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview provided a measure of previous conduct disorder symptoms and the 12-item General Health Questionnaire screening procedure was used to gauge general distress. History of arrest was self-reported. Three separate logistic regression analyses (entire sample, male only, and female only) were applied to estimate the association of the foregoing variables with arrest history. In the combined sample, conduct disorder symptoms, problem alcohol use, and problem cannabis use all predicted history of arrest. With regard to the male sample, conduct disorder symptoms, elevated AUDIT and ASSIST scores, and general distress were associated with an arrest history. For the female subsample, only conduct disorder symptoms and problematic cannabis use showed a relationship with criminality. To summarize, ADHD did not predict history of arrest for either subsample or the combined sample. When comparing males and females, conduct disorder symptoms and cannabis misuse exerted stronger effects on history of arrest for females than males. These results suggest that the relative importance and type of clinical risk factors for arrest may differ according to sex. Such information could be useful for crime prevention policies and correctional programs that take into account differences in experience by sex.

Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies

BACKGROUND

There is a recent and growing research literature on alcohol use and related harms among transgender and other gender minority populations; however, current definitions and measures of hazardous drinking do not consider the complexity of physiological sex characteristics and socially constructed gender, raising doubts regarding their validity, applicability, and use with these populations. To address this, we reviewed current research on alcohol-related outcomes in transgender populations and critically summarized key issues for consideration in future research.

METHODS

We conducted a systematic review of transgender alcohol research in English language, peer-reviewed journals, published 1990-2017, and extracted key details (e.g., sample composition, alcohol measures, results).

RESULTS

Forty-four studies met all inclusion criteria for the review, the majority of which were conducted in the United States. The prevalence of hazardous drinking was high; however, estimates varied widely across studies. We noted frequent methodological weaknesses, including few attempts to differentiate sex and gender, poor attention to appropriate definitions of hazardous drinking, and reliance on cross-sectional study designs and non-probability sampling methods.

CONCLUSION

Given findings that suggest high need for ongoing public health attention, we offer recommendations to improve future alcohol studies with transgender and other gender minority populations, such as being explicit as to whether and how sex and/or gender are operationalized and relevant for the research question, expanding the repertoire of alcohol measures to include those not contingent on sex or gender, testing the psychometric performance of established screening instruments with transgender populations, and shifting from descriptive to analytic study designs.

Specific mental disorder screening compilation may detect general mental disorders

Objective: To evaluate whether a short compilation of screening tools for specific disorders could identify Mental or Emotional Disorders (MEDs) in the general population. Methods: We selected validated screening tools for the most prevalent MEDs. In order to be selected, these tools should maintain the psychometric properties of the complete instrument with a reduced number of items. These instruments were: Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2), item 3 of the Alcohol Use Disorders Identification Test (AUDIT), and three items on the Adolescent Psychotic-Like Symptom Screener (APSS-3). We called this compilation of screening tools Mini Screening for Mental Disorders (Mini-SMD). The study was divided in two phases. Firstly, 545 subjects were interviewed with the Mini-SMD and COOP/WONCA-Feelings at their residences. Subsequently, subjects who had agreed to participate (230) were reinterviewed with Mini-SMD, COOP/WONCA-Feelings and MINI interview. Test-retest reliability was calculated by Intraclass Correlation Coefficient (ICC). Receiver operating characteristic (ROC) curves were generated for the analysis of discriminative validity. Concurrent validity was calculated by analyzing the correlation between Mini-SMD and COOP/WONCA-Feelings. Results: The joint administration of screening tools for specific disorders showed sensitivities that ranged from 0.76 to 0.88 and specificities from 0.67 to 0.85. The ICC value for the total score of Mini-SMD was 0.78. The area under the curve was 0.84, with a sensitivity of 0.74 and specificity of 0.76 (for a cutoff ≥ 4). Conclusion: This study showed that a short compilation of screening tools for specific disorders can detect MEDs in general population.

Health Risk Behavior Patterns in a National Adult Population Survey

Background: The aim of this paper is to analyze the co-occurrence of health risk behaviors (HRBs), namely, tobacco smoking, alcohol risk drinking, overeating, and physical inactivity, as well as their 16 combinations (patterns), which are stratified by age and gender. Methods: The data of 19,294 study participants, from a telephone survey among the adult general population of Germany that was conducted in 2012, were analyzed. Results: In adults, two or more of the four HBRs were found among 51.5% of females and 61.9% of males. The single most prevalent HRB pattern among all of the female (20.7, 19.6–21.8%) and male participants (18.2, 17.1–19.3%) was being overweight combined with a lack of physical activity, and its prevalence increased by 4% with each year of life. A multinomial regression analysis revealed that education was inversely associated with 11 of the 15 HRB patterns. The risk of having four, compared to zero, HRBs was 3.3 (2.5–4.4) for males relative to females. Conclusion: Similar to the findings from other western countries, the majority of the participants in this adult national sample from Germany had two or more HRBs. The most common of all possible HRB patterns was overweight and inactivity. The data confirm inverse relations between education and most HRB patterns.

Altered Heart Rate Variability During Gaming in Internet Gaming Disorder

Internet gaming disorder (IGD) is characterized by addiction to online gaming and reduced executive control, particularly when individuals are exposed to gaming-related cues. Executive control can be measured as vagally mediated heart rate variability (HRV), which corresponds to variability in the time interval between heart beats. In this study, we investigated whether individuals with IGD have altered HRV while playing online games. We hypothesized that while gaming, individuals with IGD would exhibit phasic suppression of vagally mediated HRV, which would reflect executive control dysfunction during game play. To test this, we measured the changes of HRV when young males with IGD were engaged in real-time online gaming. The changes of HRV were associated with the severity of IGD assessed by self-reports and prefrontal gray matter volume (GMV) calculated by voxel-based morphometry. We included 23 IGD subjects and 18 controls in our analyses. Changes in HRV were not statistically different between IGD subjects and controls. Within the IGD group, however, subjects showed significant decreases in high-frequency (HF) HRV during gaming. Furthermore, the degree of decrease correlated with IGD severity and prefrontal GMV. Importantly, this phasic suppression of HF-HRV in response to gaming did not occur in control subjects. In conclusion, young males with IGD showed an altered HRV response while playing an online game, reflecting their difficulties in executive control over gaming. The dynamics between executive control and reward seeking may be out of balance during game play in IGD.

Alcohol use disorder and associated factors among human immunodeficiency virus infected patients attending antiretroviral therapy clinic at Bishoftu General Hospital, Oromiya region, Ethiopia

Background

Alcohol consumption among patients with HIV/AIDS increases the burden of the disease. HIV/AIDS is an epidemic among Sub-Saharan African countries. Excessive use of alcohol causes a large degree of health problems, social and economic burden in societies. However, the prevalence and associated factors of alcohol use disorder among this group of people has not been studied very well. Therefore, this study sought to assess the magnitude and associated factors of alcohol use disorder among HIV patients attending the antiretroviral (ART) clinic.

Methods

A hospital based cross sectional study design was conducted at Bishoftu General Hospital from May to June 2015. Systematic random sampling technique was used to select the study participants. Data was collected by face to face interview and chart review. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol use disorder. Bivariate and multivariate logistic regression analysis was carried out to identify associated factors and P-value < 0.05 was taken as statistically significant.

Results

A total of 527 participants were enrolled in the study with a response rate of 100%. The prevalence of alcohol use disorder (AUD) was 14.2%. Factors associated with alcohol use disorder were educational status AOR = 8.5 (95%CI: 1.70, 42.99), social support AOR = 0.5(95%CI: 0.26, 0.95), cigarette smoking AOR = 3.49(95%CI: 1.01, 12.13), khat chewing AOR = 5.11 (95% CI: 1.60, 16.33), family history of alcohol use AOR = 3.58 (95% CI: 1.52, 8.47), and missing ART drugs AOR 3.05 (95% CI: 1.302, 7.131).

Conclusion

The prevalence of alcohol use disorder was high as compared to similar epidemiological studies. Educational status, social support, cigarette smoking, khat chewing, and family history of alcohol use were independent predictors. Providing health education about alcohol use and proper screening of alcohol use disorder among patients with HIV/AIDS is crucial. Strengthening the referral linkage with the psychiatric unit will decrease the burdens of the problem.