Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

Zsolt Horváth¹, Léna Nagy², Mónika Koós², Shane W Kraus³, Zsolt Demetrovics⁴, Marc N Potenza⁵, Rafael Ballester-Arnal⁶, Dominik Batthyány⁷, Sophie Bergeron⁸, Joël Billieux⁹, Peer Briken¹⁰, Julius Burkauskas¹¹, Georgina Cárdenas-López¹², Joana Carvalho¹³, Jesús Castro-Calvo¹⁴, Lijun Chen¹⁵, Giacomo Ciocca¹⁶, Ornella Corazza¹⁷, Rita Csako¹⁸, David P Fernandez¹⁹, Hironobu Fujiwara²⁰, Elaine F Fernandez²¹, Johannes Fuss²², Roman Gabrhelík²³, Ateret Gewirtz-Meydan²⁴, Biljana Gjoneska²⁵, Mateusz Gola²⁶, Joshua B Grubbs²⁷, Hashim T Hashim²⁸, Md Saiful Islam²⁹, Mustafa Ismail²⁸, Martha C Jiménez-Martínez³⁰, Tanja Jurin³¹, Ondrej Kalina³², Verena Klein³³, András Költő³⁴, Sang-Kyu Lee³⁵, Karol Lewczuk³⁶, Chung-Ying Lin³⁷, Christine Lochner³⁸, Silvia López-Alvarado³⁹, Kateřina Lukavská⁴⁰, Percy Mayta-Tristán⁴¹, Dan J Miller⁴², Oľga Orosová³², Gábor Orosz⁴³; Sungkyunkwan University’s research team⁴⁴; Fernando P Ponce⁴⁵, Gonzalo R Quintana⁴⁶, Gabriel C Quintero Garzola⁴⁷, Jano Ramos-Diaz⁴⁸, Kévin Rigaud⁴³, Ann Rousseau⁴⁹, Marco De Tubino Scanavino⁵⁰, Marion K Schulmeyer⁵¹, Pratap Sharan⁵², Mami Shibata⁵³, Sheikh Shoib⁵⁴, Vera Sigre-Leirós⁵⁵, Luke Sniewski⁵⁶, Ognen Spasovski⁵⁷, Vesta Steibliene¹¹, Dan J Stein⁵⁸, Julian Strizek⁵⁹, Meng-Che Tsai⁶⁰, Berk C Ünsal², Marie-Pier Vaillancourt-Morel⁶¹, Marie Claire Van Hout⁶², Beáta Bőthe⁸

Affiliations

¹ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar. Electronic address: horvath.zsolt@ppk.elte.hu.
² Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
³ Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
⁴ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
⁵ Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA.
⁶ Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain.
⁷ Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria.
⁸ Département de psychologie, Université de Montréal, Montréal, Canada.
⁹ Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
¹⁰ Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry; University Medical Centre Hamburg-Eppendorf; Hamburg, Germany.
¹¹ Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
¹² Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico.
¹³ William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.
¹⁴ Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
¹⁵ Department of Psychology, College of Humanity and Social Science, Fuzhou University, China.
¹⁶ Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
¹⁷ Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom; Department of Psychocology and Cognitive Science, University of Trento, Italy.
¹⁸ Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand.
¹⁹ Nottingham Trent University, United Kingdom.
²⁰ Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan; The General Research Division, Osaka University Research Center on Ethical, Legal and Social Issues, Osaka, Japan.
²¹ HELP University, Malaysia.
²² Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
²³ Charles University, First Faculty of Medicine, Department of Addictology, Prague, Czech Republic; General University Hospital in Prague, Department of Addictology, Czech Republic.
²⁴ School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
²⁵ Macedonian Academy of Sciences and Arts, North Macedonia.
²⁶ Institute of Psychology, Polish Academy of Sciences, Poland; Institute for Neural Computations, University of California San Diego, USA.
²⁷ University of New Mexico, Albuquerque, United States; Center for Alcohol, Substance use, And Addiction (CASAA), University of New Mexico, Albuquerque, United States.
²⁸ University of Baghdad, College of Medicine, Iraq.
²⁹ Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
³⁰ Universidad Pedagógca y Tecnológica de Colombia, Colombia; Grupo de Investigación Biomédica y de Patología, Colombia.
³¹ Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia.
³² Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
³³ School of Psychology, University of Southampton, United Kingdom.
³⁴ Health Promotion Research Centre, University of Galway, Ireland.
³⁵ Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea; Chuncheon Addiction Management Center, South Korea.
³⁶ Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
³⁷ Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³⁸ SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa.
³⁹ University of Cuenca, Ecuador.
⁴⁰ Charles University, First Faculty of Medicine, Department of Addictology, Prague, Czech Republic; Charles University, Faculty of Education, Department of Psychology, Prague, Czech Republic.
⁴¹ Facultad de Medicina, Universidad Científica del Sur, Lima, Peru.
⁴² College of Healthcare Sciences, James Cook University, Australia.
⁴³ Artois University, France.
⁴⁴ Department of Psychology, Sungkyunkwan University, South Korea.
⁴⁵ Facultad de Psicología, Universidad de Talca, Chile.
⁴⁶ Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile.
⁴⁷ Florida State University, Republic of Panama; Sistema Nacional de Investigación (SNI), SENACYT, Panama.
⁴⁸ Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru.
⁴⁹ Leuven School For Mass Communication, KU Leuven, Leuven, Belgium.
⁵⁰ Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, St. Joseph's Health Care London and London Health Sciences Centre, London, Canada; Lawson Health Research Institute, London, Canada; Departmento e Instituto de Psiquiatria, Hospital das Clinicas; and Experimental Pathophysiology Post Graduation Program, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁵¹ Universidad Privada de Santa Cruz de la Sierra, Bolivia.
⁵² Department of Psychiatry, All India Institute of Medical Sciences, New Delhi -110029, India.
⁵³ Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁵⁴ Department of Health Services, Srinagar, 190001, India; Sharda University, Greater Noida, India; Psychosis Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
⁵⁵ Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
⁵⁶ Auckland University of Technology, New Zealand.
⁵⁷ Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, North Macedonia; Faculty of Philosophy, University of Ss. Cyril and Methodius in Trnava, Slovakia.
⁵⁸ SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town.
⁵⁹ Austrian Public Health Institute, Austria.
⁶⁰ Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶¹ Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
⁶² Public Health Institute, Faculty of Health, Liverpool John Moores University, United Kingdom.

PMID: 37782987
DOI: 10.1016/j.comppsych.2023.152427

Free article

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

Zsolt Horváth et al. Compr Psychiatry. 2023 Nov.

Free article

. 2023 Nov:127:152427.

doi: 10.1016/j.comppsych.2023.152427. Epub 2023 Sep 23.

Authors

Affiliations

¹ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar. Electronic address: horvath.zsolt@ppk.elte.hu.
² Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
³ Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
⁴ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
⁵ Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA.
⁶ Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain.
⁷ Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria.
⁸ Département de psychologie, Université de Montréal, Montréal, Canada.
⁹ Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
¹⁰ Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry; University Medical Centre Hamburg-Eppendorf; Hamburg, Germany.
¹¹ Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
¹² Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico.
¹³ William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.
¹⁴ Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
¹⁵ Department of Psychology, College of Humanity and Social Science, Fuzhou University, China.
¹⁶ Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
¹⁷ Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom; Department of Psychocology and Cognitive Science, University of Trento, Italy.
¹⁸ Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand.
¹⁹ Nottingham Trent University, United Kingdom.
²⁰ Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan; The General Research Division, Osaka University Research Center on Ethical, Legal and Social Issues, Osaka, Japan.
²¹ HELP University, Malaysia.
²² Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
²³ Charles University, First Faculty of Medicine, Department of Addictology, Prague, Czech Republic; General University Hospital in Prague, Department of Addictology, Czech Republic.
²⁴ School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
²⁵ Macedonian Academy of Sciences and Arts, North Macedonia.
²⁶ Institute of Psychology, Polish Academy of Sciences, Poland; Institute for Neural Computations, University of California San Diego, USA.
²⁷ University of New Mexico, Albuquerque, United States; Center for Alcohol, Substance use, And Addiction (CASAA), University of New Mexico, Albuquerque, United States.
²⁸ University of Baghdad, College of Medicine, Iraq.
²⁹ Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
³⁰ Universidad Pedagógca y Tecnológica de Colombia, Colombia; Grupo de Investigación Biomédica y de Patología, Colombia.
³¹ Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia.
³² Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
³³ School of Psychology, University of Southampton, United Kingdom.
³⁴ Health Promotion Research Centre, University of Galway, Ireland.
³⁵ Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea; Chuncheon Addiction Management Center, South Korea.
³⁶ Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
³⁷ Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³⁸ SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa.
³⁹ University of Cuenca, Ecuador.
⁴⁰ Charles University, First Faculty of Medicine, Department of Addictology, Prague, Czech Republic; Charles University, Faculty of Education, Department of Psychology, Prague, Czech Republic.
⁴¹ Facultad de Medicina, Universidad Científica del Sur, Lima, Peru.
⁴² College of Healthcare Sciences, James Cook University, Australia.
⁴³ Artois University, France.
⁴⁴ Department of Psychology, Sungkyunkwan University, South Korea.
⁴⁵ Facultad de Psicología, Universidad de Talca, Chile.
⁴⁶ Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile.
⁴⁷ Florida State University, Republic of Panama; Sistema Nacional de Investigación (SNI), SENACYT, Panama.
⁴⁸ Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru.
⁴⁹ Leuven School For Mass Communication, KU Leuven, Leuven, Belgium.
⁵⁰ Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, St. Joseph's Health Care London and London Health Sciences Centre, London, Canada; Lawson Health Research Institute, London, Canada; Departmento e Instituto de Psiquiatria, Hospital das Clinicas; and Experimental Pathophysiology Post Graduation Program, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁵¹ Universidad Privada de Santa Cruz de la Sierra, Bolivia.
⁵² Department of Psychiatry, All India Institute of Medical Sciences, New Delhi -110029, India.
⁵³ Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁵⁴ Department of Health Services, Srinagar, 190001, India; Sharda University, Greater Noida, India; Psychosis Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
⁵⁵ Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
⁵⁶ Auckland University of Technology, New Zealand.
⁵⁷ Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, North Macedonia; Faculty of Philosophy, University of Ss. Cyril and Methodius in Trnava, Slovakia.
⁵⁸ SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town.
⁵⁹ Austrian Public Health Institute, Austria.
⁶⁰ Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶¹ Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
⁶² Public Health Institute, Faculty of Health, Liverpool John Moores University, United Kingdom.

PMID: 37782987
DOI: 10.1016/j.comppsych.2023.152427

Abstract

Introduction: Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations.

Aims: The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation.

Methods: Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; M_age: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses.

Results: A two-factor model with factors describing 'alcohol use' (items 1-3) and 'alcohol problems' (items 4-10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached.

Conclusions: In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations.

Keywords: Addictive behaviors; Alcohol Use Disorders Identification Test (AUDIT); Cross-cultural comparison; Gender; LGBTQ; Measurement invariance; Sexual orientation.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflict of interest with the content of this manuscript. SWK discloses that he has received funding from the International Center for Responsible Gaming, MGM Resorts International, Center for the Application of Substance Abuse Technologies, Taylor Francis, Springer Nature, The Nevada Problem Gambling Project, Sports Betting Alliance, and Kindbridge Research Institute. Dr. Potenza discloses that he has consulted for and advised Game Day Data, Addiction Policy Forum, AXA, Idorsia, Baria-Tek, and Opiant Therapeutics; been involved in a patent application involving Novartis and Yale; received research support from the Mohegan Sun Casino and the Connecticut Council on Problem Gambling; consulted for or advised legal and gambling entities on issues related to impulse control and addictive behaviors; provided clinical care related to impulse-control and addictive behaviors; performed grant reviews; edited journals/journal sections; given academic lectures in grand rounds, CME events and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. The University of Gibraltar receives funding from the Gibraltar Gambling Care Foundation, an independent, notfor-profit charity. ELTE Eötvös Loránd University receives funding from Szerencsejáték Ltd. (the gambling operator of the Hungarian government) to maintain a telephone helpline service for problematic gambling. RG is the shareholder of Adiquit Ltd. which is currently developing apps for addictions recovery. VS discloses that she received funding from Lithuanian Health Promotion Fund for providing educational materials and lectures on Problematic Internet use. Julius Burkauskas works as consultant at Cronos.

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Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

Affiliations

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

Authors

Affiliations

Abstract

Conflict of interest statement

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