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. 2015 Jul 1:152:123-30.
doi: 10.1016/j.drugalcdep.2015.04.024. Epub 2015 May 9.

Investigating dimensionality and measurement bias of DSM-5 alcohol use disorder in a representative sample of the largest metropolitan area in South America

João Mauricio Castaldelli-Maia  1 , Yuan-Pang Wang  2 , Guilherme Borges  3 , Camila M Silveira  4 , Erica R Siu  2 , Maria C Viana  5 , Arthur G Andrade  6 , Silvia S Martins  7 , Laura H Andrade  2
Affiliations

Investigating dimensionality and measurement bias of DSM-5 alcohol use disorder in a representative sample of the largest metropolitan area in South America

João Mauricio Castaldelli-Maia et al. Drug Alcohol Depend. .

Abstract

Background: Given the recent launch of a new diagnostic classification (DSM-5) for alcohol use disorders (AUD), we aimed to investigate its dimensionality and possible measurement bias in a non-U.S.

Methods: The current analyses were restricted to 948 subjects who endorsed drinking at least one drink per week in the past year from a sample of 5037 individuals. Data came from São Paulo Megacity Project (which is part of World Mental Health Surveys) collected between 2005 and 2007. First, exploratory factor analysis (EFA) was carried out to test for the best dimensional structure for DSM-5-AUD criteria. Then, item response theory (IRT) was used to investigate the severity and discrimination properties of each criterion of DSM-5-AUD. Finally, differential criterion functioning (DCF) were investigated by socio-demographics (income, gender, age, employment status, marital status and education). All analyses were performed in Mplus software taking into account complex survey design features.

Results: The best EFA model was a one-dimensional model. IRT results showed that the criteria "Time Spent" and "Given Up" have the highest discrimination and severity properties, while the criterion "Larger/Longer" had the lowest value of severity, but an average value of discrimination. Only female gender had DCF both at criterion- and factor-level, rendering measurement bias.

Conclusion: This study reinforces the existence of a DSM-5-AUD continuum in the largest metropolitan area of South America, including subgroups that had previously higher rates of alcohol use (lower educational/income levels). Lower DSM-5-AUD scores were found in women.

Keywords: DSM-5; Differential item functioning; Exploratory factor analysis; Item response theory; Latin America; Megacities.

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Conflict of interest statement

Conflict of Interest

Dr. Castaldelli-Maia receives Pfizer Independent Grant for Learning and Change (IGLC) managed by Global Bridges (Healthcare Alliance for Tobacco Dependence Treatment) hosted at Mayo Clinic, to support free smoking cessation treatment training in addiction/mental health care units in Brazil (grant IGLC 13513957), which had no relationship with the present study. Dr. Martins is currently a consultant for Purdue Pharma to conduct secondary data analyses of U.S. data unrelated to this project. Dr. A. G. Andrade and Dr. Silveira are respectively Executive President and Coordinator of Center for Information on Health and Alcohol (CISA), which had no funding relationship with this project. All other authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Item Characteristics Curves (ICC) and Item Information Curves (IIC) of each criterion of DSM-5 Alcohol Use Disorder among alcohol users who had at least 1 drink/week in the past year in São Paulo Metropolitan Area, 2005–2007.
Figure 2
Figure 2
Direct effects of sociodemographic correlates in DSM-5 AUD found in DCF models among alcohol users who had at least 1 drink/week in the past year in São Paulo Metropolitan Area, 2005–2007.
See this image and copyright information in PMC

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