Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules: Substance abusers and others in the general population

Highlights

• Procedural validity of DSM-5 AUDADIS-5 mood and anxiety diagnoses was examined.

• Sample: current regular substance abusers and others in the general population.

• Validation procedure: blinded clinician-administered PRISM-5 interviews.

• AUDADIS-5 validity: fair-substantial in substance abusers and others.

• AUDADIS-5 measures are useful in regular substance abusers and others.

Abstract

Background

Little is known about the procedural validity of lay-administered, fully-structured assessments of depressive, anxiety and post-traumatic stress (PTSD) disorders in the general population as determined by comparison with clinical re-appraisal, and whether this differs between current regular substance abusers and others. We evaluated the procedural validity of the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5) assessment of these disorders through clinician re-interviews.

Methods

Test−retest design among respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III): (264 current regular substance abusers, 447 others). Clinicians blinded to AUDADIS-5 results administered the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). AUDADIS-5/PRISM-5 concordance was indicated by kappa (κ) for diagnoses and intraclass correlation coefficients (ICC) for dimensional measures (DSM-5 symptom or criterion counts). Results were compared between current regular substance abusers and others.

Results

AUDADIS-5 and PRISM-5 concordance for DSM-5 depressive disorders, anxiety disorders and PTSD was generally fair to moderate (κ = 0.24−0.59), with concordance on dimensional scales much better (ICC = 0.53−0.81). Concordance differed little between regular substance abusers and others.

Conclusions

AUDADIS-5/PRISM-5 concordance indicated procedural validity for the AUDADIS-5 among substance abusers and others, suggesting that AUDADIS-5 diagnoses of DSM-5 depressive, anxiety and PTSD diagnoses are informative measures in both groups in epidemiological studies. The stronger concordance on dimensional measures supports the current movement toward dimensional psychopathology measures, suggesting that such measures provide important information for research in the NESARC-III and other datasets, and possibly for clinical purposes as well.

Introduction

To diagnose depressive, anxiety and post-traumatic stress disorders in national surveys, trained lay interviewers administer structured diagnostic interviews. Little is known about the validity of these diagnoses in general population samples. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS; Grant et al., 2001) is one such interview. AUDADIS-IV (DSM-IV criteria; American Psychiatric Association, 1994) was used in the U.S. National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991–1992) and National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Compton et al., 2004, Grant et al., 2004a, Grant et al., 2009, Grant et al., 2004b). In 2012−2013, NIAAA-fielded NESARC-III (Grant, 2014), a survey of 36,309 new respondents, using AUDADIS-5 (Grant et al., 2011) to assess DSM-5 diagnoses (American Psychiatric Association, 2013). All these studies required valid measurement in regular substance abusers and others.

In the U.S. general population, AUDADIS test−retest reliability studies with blinded re-interviews conducted by a second, different interviewer maximized independence of the test and retest interviews, and therefore the rigor of the comparison. Using this methodology, AUDADIS-IV depressive and anxiety diagnoses had moderate-to-substantial reliability (κ = 0.40−0.65; Grant et al., 2003). Dimensional measures of these disorders (criteria or symptom counts) had higher reliability than binary diagnoses (Grant et al., 2003). AUDADIS-5 mood and anxiety disorders were recently shown to have comparable test−retest reliability (Grant et al., 2015).

Scientific utility requires replicable, reliable results across independent interviewers. However, reliability does not guarantee validity. An important strategy to determine validity of a lay-administered diagnostic procedure is comparison with a clinician-administered procedure, often termed procedural validity.

Few procedural validity studies of depressive, anxiety or trauma-related disorders have been conducted, in general, population samples, and none compared regular substance abusers to others, important because substance abuse can complicate mood and anxiety diagnoses (Hasin et al., 2006, Hasin et al., 1996, Torrens et al., 2004). Diagnostic Interview Schedule (DIS) diagnoses were compared with structured psychiatrist re-interviews of Epidemiologic Catchment Area participants (n = 370), with psychiatrists blinded to initial DIS interviews. Lay/psychiatrist concordance ranged considerably (κ = 0.10−0.50; Helzer et al., 1985). In studies comparing Composite International Diagnostic Interview (CIDI) to clinician-administered Structured Clinical Interview for DSM (SCID) re-interviews, SCID interviewers were informed of responses to CIDI gateway questions for each module, and reminded participants of these responses, procedures that could increase CIDI/SCID concordance. For example, in National Comorbidity Study participants, CIDI/SCID concordance on Generalized Anxiety Disorder (GAD) was κ = 0.33−0.47 (n = 30; Wittchen et al., 1995), and κ = 0.45−0.63 (n = 40) for phobic disorders (Wittchen et al., 1996). In other national survey participants, CIDI/SCID concordance for depressive and anxiety disorders was κ = 0.42−0.56 (n = 143; Europe), and κ = 0.33−0.61 (n = 325; U.S.; Haro et al., 2006). We know of no CIDI procedural validity studies utilizing fully blinded re-evaluations.

Determining the procedural validity of AUDADIS-5 mood and anxiety disorder diagnoses, in general, population substance abusers and others is important to aid in interpreting NESARC-III (Grant, 2014.) findings. A subset of NESARC-III participants underwent independent clinical re-appraisals using the DSM-5 Psychiatric Research Interview for Substance and Mental Disorders (PRISM-5; Hasin et al., 2011), a semi-structured interview designed to address assessment issues in substance abusers (Hasin et al., 2006). AUDADIS-5 substance disorders showed moderate-to-substantial procedural validity (κ = 0.40−0.72; Hasin et al., 2015). We now examine the procedural validity of AUDADIS-5 depressive, anxiety and post-traumatic stress disorders and dimensional disorder measures in the full sample, and in regular substance abusers and others. Procedural validity was also explored by days between AUDADIS-5 and PRISM-5 interviews, since longer intervals could decrease agreement.