A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey

Tim Slade, Wai Tat Chiu, Meyer Glantz, Ronald C. Kessler, Luise Lago, Nancy Sampson, Ali Al-Hamzawi, Silvia Florescu, Jacek Moskalewicz, Sam Murphy, Fernando Navarro-Mateu, Yolanda Torres de Galvis, Maria Carmen Viana, Miguel Xavier, Louisa Degenhardt

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)

Abstract

Background: The current study sought to examine the diagnostic overlap in DSM-IV and DSM-5 alcohol use disorder (AUD) and determine the clinical correlates of changing diagnostic status across the 2 classification systems. Methods: DSM-IV and DSM-5 definitions of AUD were compared using cross-national community survey data in 9 low-, middle-, and high-income countries. Participants were 31,367 respondents to surveys in the World Health Organization's World Mental Health Survey Initiative. The Composite International Diagnostic Interview, version 3.0, was used to derive DSM-IV and DSM-5 lifetime diagnoses of AUD. Clinical characteristics, also assessed in the surveys, included lifetime DSM-IV anxiety; mood and drug use disorders; lifetime suicidal ideation, plan, and attempt; general functional impairment; and psychological distress. Results: Compared with DSM-IV AUD (12.3%, SE = 0.3%), the DSM-5 definition yielded slightly lower prevalence estimates (10.8%, SE = 0.2%). Almost one-third (n = 802) of all DSM-IV abuse cases switched to subthreshold according to DSM-5 and one-quarter (n = 467) of all DSM-IV diagnostic orphans switched to mild AUD according to DSM-5. New cases of DSM-5 AUD were largely similar to those who maintained their AUD across both classifications. Similarly, new DSM-5 noncases were similar to those who were subthreshold across both classifications. The exception to this was with regard to the prevalence of any lifetime drug use disorder. Conclusions: In this large cross-national community sample, the prevalence of DSM-5 lifetime AUD was only slightly lower than the prevalence of DSM-IV lifetime AUD. Nonetheless, there was considerable diagnostic switching, with a large number of people inconsistently identified across the 2 DSM classifications.

Original languageEnglish
Pages (from-to)1728-1736
Number of pages9
JournalAlcoholism-Clinical And Experimental Research
Volume40
Issue number8
DOIs
Publication statusPublished - Aug 2016

Keywords

  • Alcohol Use Disorder
  • DSM-5
  • DSM-IV
  • Prevalence

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