Comparing self-report and parental report of psychopathologies in adolescents with substance use disorders

Both internalizing and externalizing psychopathologies interfere with the treatment of substance use disorders (SUD) in adolescents. Self-reports of psychopathologies are likely biased and may be validated with parental reports. We compared N = 70 standardized self-reports of adolescents entering outpatient SUD treatment (13.2-18.6 years old, 43% female) to parental reports on the same psychopathologies, and explored biases due to gender, age, SUD diagnoses and SUD severity. Bivariate bootstrapped Pearson correlation coefficients revealed several small to moderate correlations between both reporting sources (r = 0.29-0.49, all p_corrected ≤ 0.039). A repeated measures MANOVA revealed moderately stronger parental reports of adolescent psychopathologies compared to adolescent self-reports for most externalizing problems (dissocial and aggressive behaviors, p ≤ 0.016, η²_part = 0.09-0.12) and social/attention problems (p ≤ 0.012, η²_part = 0.10), but no differences for most internalizing problems (p ≥ 0.073, η²_part = 0.02-0.05). Differences were not associated with other patient or parental characteristics including age, gender, number of co-occurring diagnoses or presence/absence of a certain SUD (all p_uncorrected ≥ 0.088). We concluded that treatment-seeking German adolescents with SUD present with a multitude of extensive psychopathologies. The relevant deviation between self- and parental reports indicate that the combination of both reports might help to counteract dissimulation and other reporting biases. The generalizability of results to inpatients, psychiatry patients in general, or adolescents without SUD, as well as the validity of self- and parental reports in comparison to clinical judgements remain unknown.

Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) and prevalence of drug use among SA site-based construction workers

Construction workers in South Africa are an at-risk group for HIV/AIDS. Substance misuse, other than alcohol, is associated with poor decision-making, risky lifestyle behaviour, and non-use of condoms. Substance misuse is also associated with harmful and hazardous alcohol consumption and depression. The Drug Use Disorders Identification Test (DUDIT) is a widely used screening tool to detect drug abuse. The present study examines both the psychometric properties of the DUDIT and the prevalence of drug abuse among construction workers. A field study involving 496 male workers at 18 construction sites of seven construction companies in the Western Cape province of South Africa, was undertaken. Descriptive statistics, reliability, and exploratory and confirmatory factor analyses were used to determine the prevalence of substance use, and the dimensionality, reliability and construct validity of the DUDIT. Approximately 10% of participants reported some form of substance use. Four hundred and sixty-seven employees (94.2%) were determined not to have drug-related problems (DUDIT score < 6). Of the at-risk employees (score >5), 5.0% (n = 25) were classified as 'possibly having a drug-related problem' (score 6-24) and 0.8% (n = 4) as 'possibly highly dependent on drugs' (score 25 or more). Of the 47 employees who reported drug use, 29 (61.7%) were classified as having a medium to high risk in relation to drug use. The internal consistency of the DUDIT was very good. The DUDIT reported a one-factor factorial structure, and the model fit indices indicated good model fit to the data. All factor loadings were significant, but there was some evidence of collinearity. Concurrent validity was demonstrated. DUDIT items 1 and 10 require further investigation due to their poor performance compared to the other items. The contribution of these two items needs to be investigated using item response theory (IRT).

The association between sleep quality and attenuated psychotic symptoms

AIM

To determine if poor sleep makes a unique contribution in predicting the likelihood of experiencing six or more attenuated psychotic symptoms and associated distress, after examining and controlling for sociodemographic factors, depression and drug/alcohol use.

METHOD

An online survey was conducted using Amazon's online crowdsourcing service Mechanical Turk (MTurk). The sample was 1013 adults (18 to 36 years) from the general population in the United States. The survey consisted of the Prodromal Questionnaire 16 (PQ-16), the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire 9, the Drug Abuse Screening Test 10 and the Alcohol Use Disorders Identification Test. Regression analyses were performed with the PQ-16 as the dependent variable, and sleep quality as the predictor variable, holding constant sociodemographic variables, depression, and alcohol/drug abuse.

RESULTS

37% of the sample endorsed six or more PQ-16 items, which may be suggestive of an at-risk mental state, with sleep disturbance significantly increasing the likelihood (Odds ratio 2.09 < .001) of endorsing six or more PQ-16 items. After controlling for sociodemographic variables, depression and drug/alcohol abuse, poor sleep quality made a unique contribution of 5.8% of the variance accounted for in level of distress experienced by attenuated psychotic symptoms.

CONCLUSION

Effective treatment of sleep disturbance may reduce the likelihood ofexperiencing attenuated psychotic symptoms and associated distress.

Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients

Background

A common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients.

Methods

N = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated.

Results

A two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70).

Conclusion

This is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.

The Psychometric Properties of the Drug Use Disorders Identification Test (DUDIT): A Review of Recent Research

This article reviews the reliability (internal consistency, interrater reliability), factor structure, and validity (i.e., sensitivity and specificity) of the 11-item Drug Use Disorders Identification Test (DUDIT). An extensive literature review was conducted using the Medline, Psychinfo and PubMed databases from January 2005 to October 2014. Search terms were "Drug Use Disorders Identification Test" and "DUDIT". All articles that addressed reliability, factor structure, sensitivity and specificity of the DUDIT were examined. Publications in which the DUDIT was used as a screening tool and/or studies that used the DUDIT to compare use and abuse/dependence of drugs in participants at baseline and at follow-up but had no data on its psychometric properties, were not included. In total, 18 usable publications were identified and included in the review. In general, the DUDIT yields satisfactory measures of reliability and validity for use as a clinical or research tool. Internal consistency reliability estimates (Cronbach's α) are generally >.90. Most studies also revealed favorable sensitivity (ranging from .85 to 1.00) and specificity (ranging from .75 to .92) in a variety of populations. Results on the factor structure, however, are somewhat equivocal. Future directions for research on the DUDIT are suggested.