Article

The Reliability and Validity of the Alcohol Use Disorders Identification Test (AUDIT) in a German General Practice Population Sample

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Abstract

Our goal was to analyze the retest reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a primary-care setting and recommend a cut-off value for the different alcohol-related diagnoses. Participants recruited from general practices (GPs) in two northern German cities received the AUDIT, which was embedded in a health-risk questionnaire. In total, 10,803 screenings were conducted. The retest reliability was tested on a subsample of 99 patients, with an intertest interval of 30 days. Sensitivity and specificity at a number of different cut-off values were estimated for the sample of alcohol consumers (n=8237). For this study, 1109 screen-positive patients received a diagnostic interview. Individuals who scored less than five points in the AUDIT and also tested negative in a second alcohol-related screen were defined as "negative" (n=6003). This definition was supported by diagnostic interviews of 99 screen-negative patients from which no false negatives could be detected. As the gold standard for detection of an alcohol-use disorder (AUD), we used the Munich-Composite International Diagnostic Interview (MCIDI), which is based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. On the item level, the reliability, measured by the intraclass correlation coefficient (ICC), ranged between .39 (Item 9) and .98 (Item 10). For the total score, the ICC was .95. For cut-off values of eight points and five points, 87.5% and 88.9%, respectively, of the AUDIT-positives, and 98.9% and 95.1%, respectively, of the AUDIT-negatives were identically identified at retest, with kappa = .86 and kappa = .81. At the cut-off value of five points, we determined good combinations of sensitivity and specificity for the following diagnoses: alcohol dependence (sensitivity and specificity of .97 and .88, respectively), AUD (.97 and .92), and AUD and/or at-risk consumption (.97 and .91). Embedded in a health-risk questionnaire in primary-care settings, the AUDIT is a reliable and valid screening instrument to identify at-risk drinkers and patients with an AUD. Our findings strongly suggest a lowering of the recommended cut-off value of eight points.

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... This is especially relevant for the implementation of early interventions (Babor et al., 2001;Senft et al., 1997). Although it is well established that the AUDIT is able to detect at-risk alcohol consumption and screen for alcohol abuse (AA) and alcohol dependence (AD) according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of psychiatric disorders (DSM-IV, American Psychiatric Association, 2000; Rumpf et al., 2002) and despite the frequent use of both the AUDIT and the AUDIT-C in the general population (Dawson et al., 2012;Dybek et al., 2006;Selin, 2003) performance of the AUDIT in regard to the DSM-5 (American Psychiatric Association, 2013) are still scarce. Dawson et al. (2012) provided a preliminary analysis of the performance of the AUDIT-C in screening for DSM-5 alcohol use disorder compared to DSM-IV with a representative sample of US adults. ...
... A score of 8 has been originally proposed as a cut-off to detect potentially hazardous alcohol consumption (Babor and Grant, 1989). However, various studies have proposed different cut-off scores, ranging from 5 to 11 (Babor et al., 2001;Dybek et al., 2006;Reinert and Allen, 2007), with 8 and 5 points as the most frequently used cut-offs. In Germany, a cut-off of ≥ 5 has shown the best sensitivity and specificity in a general population sample for the fullscale AUDIT (Dybek et al., 2006;Rumpf et al., 2002). ...
... However, various studies have proposed different cut-off scores, ranging from 5 to 11 (Babor et al., 2001;Dybek et al., 2006;Reinert and Allen, 2007), with 8 and 5 points as the most frequently used cut-offs. In Germany, a cut-off of ≥ 5 has shown the best sensitivity and specificity in a general population sample for the fullscale AUDIT (Dybek et al., 2006;Rumpf et al., 2002). Furthermore, some results have shown that the use of gender-specific cut-off scores, i.e. lower cut-offs for women, might be advisable (Reinert and Allen, 2007;Rumpf et al., 2002). ...
Article
Objective: The Alcohol Use Disorders Identification Test (AUDIT) is an established screening questionnaire for the detection of at-risk drinking and possible alcohol use disorders (AUD) according to the Diagnostic and Statistical Manual of Mental Disorders - fourth edition (DSM-IV). But there are still no comparable results on the diagnostic performance regarding the new criteria for AUD in the Diagnostic and Statistical Manual of Mental Disorders - fifth edition (DSM-5), especially taking account of possible gender differences. We evaluated the performance of the full AUDIT and the consumption questions (AUDIT-C) in screening for DSM-5 AUD and at-risk drinking. Method: Data from the study Transitions in Alcohol Consumption and Smoking (TACOS) is used to analyze the area under the receiver-operating characteristic curve, sensitivity, and specificity of the AUDIT and the AUDIT-C in the general population of northern Germany. DSM-5 AUD and at-risk drinking were assessed with the Munich-Composite Diagnostic Interview and used as gold standards. Results: The best balance between sensitivity and specificity is achieved at a score of 5 for men and 4 for women. High severity, according to DSM-5, were associated with higher cut-offs. Conclusions: Both AUDIT versions are accurate in the screening for DSM-5 AUD. Since the proposed cut-offs do not differ from the optimal screening cut-offs for DSM-IV disorders, current screening procedures should not face major changes.
... Prior to each session and throughout the follow up assessments, participants completed a variety of questionnaires on Qualtrics, including: Alcohol Use Disorders Identification Test (AUDIT) [30][31][32][33][34][35] and Rutgers Alcohol Problem Index 36,37 ( Table 1). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Alcohol related scales were used to assess problematic and/or excessive drinking and alcohol related consequences. ...
... Prior to each session and throughout the follow up assessments, participants completed a variety of questionnaires on Qualtrics, including: Alcohol Use Disorders Identification Test (AUDIT) [30][31][32][33][34][35] and Rutgers Alcohol Problem Index 36,37 ( Table 1). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Alcohol related scales were used to assess problematic and/or excessive drinking and alcohol related consequences. These variables served as the primary treatment outcome (See Table 1 for detailed measure descriptions). ...
... Participants also completed several measures related to treatment perceptions following each BASICS session, including: Working Alliance Inventory-Short Revised (WAI-SR), [39][40][41] Client Satisfaction Questionnaire (CSQ-8), 42,43 and Temple Presence Inventory (TPI) 44 (See Table 1 for measure descriptions). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] These scales served as a measurement of the participants perception of therapeutic alliance (WAI), treatment satisfaction (CSQ), and how similar telehealth interactions feel compared to face-to-face (TPI; see Table 1 for detailed measure descriptions). ...
Article
Background: Problematic alcohol use is a common occurrence among college students. While empirically supported interventions exist, their access is typically limited to those with greater resources. There has been an expansion of services provided via telehealth to increase client access to treatment in the health care field. However, the evidence is mixed regarding the effectiveness of face-to-face versus telehealth interventions and there is a gap in the literature regarding brief alcohol interventions delivered via telehealth. As such, the purpose of this study was to test the effectiveness of a well-validated brief alcohol screening and intervention for college students (BASICS) when conducted face-to-face or through a videoconferencing system. Method: Participants included 51 college students who engaged in heavy episodic drinking (5+ drinks for males and 4+ drinks for females over a two hour period) over the last two weeks. They were randomly assigned to receive the face-to-face or telehealth intervention and completed a variety of questionnaires throughout. Follow up data on the participant’s alcohol use and alcohol-related problems was collected at 1-, 2-, and 3-months. Multilevel modeling in SAS was utilized for analyses, which included the modeling of treatment outcome trajectories and the influence of predictors on the trajectory of change for each outcome. Results: Results indicated that the intervention significantly reduced alcohol consumption and related problems regardless of condition. Both conditions saw an increase in treatment satisfaction and therapeutic alliance between the two sessions. Increased therapeutic alliance resulted in greater decreases in alcohol use and related harm across both conditions. Additionally, those with a mental health diagnosis showed greater improvement related to risk reduction for both treatment modalities. Conclusion: In sum, the results of this study suggest that telehealth services should be further implemented and the BASICS intervention can be effectively delivered via telehealth for college students.
... FA und Alkoholkonsum wurden bislang kaum gleichzeitig vor Adipositaschirurgie erfasst. In den wenigen vorliegenden Studien wurde FA mit der YFAS (Gearhardt et al., 2009b) oder YFAS 2.0 (Gearhardt et al., 2016;Meule et al., 2017) und Alkoholkonsum mit dem Alcohol Use Disorder Identification Test (AUDIT) (Dybek et al., 2006;Saunders, Aasland, Babor, de la Fuente & Grant, 1993) gemessen. Dabei ergaben sich keine Unterschiede im AUDIT zwischen präoperativen Adipositaschirurgiepa-tient_innen mit und ohne FA (Chiappetta et al., 2020;Meule et al., 2014;Müller et al., 2018b). ...
... Das Ausmaß des Alkoholkonsums wurde mit dem AU-DIT-Summenscore (Dybek et al., 2006) gemessen (aktuelle Stichprobe α = .80). Die Prävalenz einer alkoholbezogenen Störung wurde zunächst anhand eines Cut-offs von ≥ 8 geschätzt (Saunders et al., 1993). ...
... Die Prävalenz einer alkoholbezogenen Störung wurde zunächst anhand eines Cut-offs von ≥ 8 geschätzt (Saunders et al., 1993). Da für deutsche Stichproben ein Schwellenwert von ≥ 5 für riskanten Alkoholkonsum empfohlen wird (Dybek et al., 2006;Rumpf, Hapke, Meyer & John, 2002), wurden die Prävalenzschätzungen für aktuellen riskanten Alkoholkonsum basierend auf diesem Cut-off Wert ergänzt. Aufgrund der ungleichen Ge-schlechterverteilung wurde zudem in Anlehnung an die AWMF-S3-Leitlinie "Screening, Diagnose und Behandlung alkoholbezogener Störungen" (AWMF, 2020) ein geschlechtssensibler Cut-off-Wert von 4 bzw. ...
Article
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Zusammenfassung: Zielsetzung: Bei Personen vor Adipositaschirurgie wurden die Prävalenzen von Food Addiction (FA), alkoholbezogener Störung, Angst- und depressiven Störungen geschätzt. Zudem wurde untersucht, ob FA-Symptome mit Alkoholkonsum, Lebensqualität sowie Essstörungs-, Angst- und Depressionssymptomatik assoziiert sind und ob es Unterschiede zwischen Personen mit und ohne FA in diesen Variablen gibt. Methodik: Bei 419 Personen mit Adipositas wurden FA, Alkoholkonsum, gewichtsbezogene Lebensqualität, Essstörungs-, Angst- und Depressionssymptomatik mit validierten Fragebögen erfasst. Unterschiede in den psychopathologischen Variablen zwischen Patient_innen mit und ohne FA wurden mit non-parametrischen Verfahren untersucht. Ergebnisse: Die geschätzten Prävalenzen von riskantem Alkoholkonsum (11 %) und alkoholbezogener Störung (5 %) waren in der aktuellen Stichprobe geringer als in bevölkerungsbasierten Stichproben, die geschätzten Prävalenzen von Food Addiction (38 %), Essstörungen (79 %), Depression (30 %) und Angststörungen (24 %) hingegen deutlich höher. FA-Symptome waren nicht mit Alkoholkonsum und gewichtsbezogener Lebensqualität assoziiert. Hingegen zeigten sich positive Korrelationen von FA-Symptomen mit globaler Essstörungspathologie, Depressions- und Angstsymptomatik. Es zeigten sich keine Unterschiede zwischen Personen mit/ohne FA hinsichtlich der Häufigkeit von früherem oder aktuellem riskanten Alkoholkonsum oder alkoholbezogener Störung. Schlussfolgerungen: Die Ergebnisse bestätigen frühere Befunde eines fehlenden Zusammenhangs von FA mit Alkoholkonsum bei Menschen vor chirurgischer Adipositasbehandlung. Längsschnittstudien mit großen Stichproben und langfristigen Follow-Ups sollten eine etwaige postoperative Symptomverlagerung von FA zu Substanzkonsum untersuchen.
... The AUDIT is a screening questionnaire developed by the World Health Organization (WHO) to assess alcohol-related problems, and available published data indicate that it is a reliable and valid tool used in different cultural backgrounds [25][26][27][28][29][30]. However, the AUDIT questionnaire has not yet been validated among medical students in Europe, both in the paper or electronic form. ...
... Choosing the electronic version of the tool will facilitate contact with medical students in the coming years, also after completing education, and at the same time, will significantly reduce the costs of subjects' recruitment. In general, it can be assumed that the results obtained by us are consistent with previous observations [8,20,21,[24][25][26]28,29,31,32]. ...
Article
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Background: Chronic fatigue, depression, burnout syndrome, and alcohol addiction have been identified as significant mental health problems in young medical doctors. Given the lack of prospective studies in this area in Poland, the POLski LEKarz (POLLEK) cohort study was created. The goal of the POLLEK study is to assess the quality of life and health status (including mental health) of medical students and young physicians. The aim of the presented paper was to assess the reliability and compatibility of paper and electronic versions of the POLLEK questionnaire. Methods: Between 1 October 2019 and 28 February 2020, all medical students (N = 638) of the first year in the Medical University of Silesia were invited to participate in a cross-sectional study. Three hundred and fifty-three students (55.3%) who accomplished both versions were included in the current analysis. Results: Values of Cronbach's alpha >0.7 proved both modes of delivery to have good internal consistency, except for the individual Alcohol Use Disorder Identification Test (AUDIT) domains and the Environmental domain of the WHOQOL-BREF (paper version). Similarly, interclass correlation coefficients equal to or greater than 0.9 denoted an excellent reproducibility. Conclusions: We documented very good accordance and reproducibility of POLLEK questionnaire (both paper and electronic versions). These findings legitimize the use of the questionnaire interchangeably.
... and its psychometric properties have been extensively investigated in many countries. The sensitivity, specificity and diagnostic cut-off points of the AUDIT for hazardous use, harmful use, and alcohol dependence respectively differ in different countries (de Meneses-Gaya, Zuardi, Loureiro, & Crippa, 2009;Dybek et al., 2006;Gache et al., 2005;Leung & Arthur, 2000;Pal, Jena, & Yadav, 2004;Selin, 2003;Tsai, Tsai, Chen, & Liu, 2005;Wu et al., 2008). ...
... Similar to our study, other studies investigating the validity and reliability of the AUDIT have reported a very good to excellent Cronbach's alpha and ICC. For example, in the general population of Sweden (Selin, 2003), German population (Dybek et al., 2006), French (Gache et al., 2005) and in a group of Spanish students (Alvarado et al., 2009), Cronbach's alpha was more than 0.8 and ICC between 0.60-0.98; only in a study of Japanese workers was the Cronbach's alpha was 0.67 (Kawada, Inagaki, & Kuratomi, 2011) and in the German population study, ICC was 0.39 for question 9. ...
Article
Background and aims: It is important to incorporate a screening test for unhealthy alcohol use into primary and other health care settings. The Alcohol Use Disorders Identification Test (AUDIT) is one of the most commonly used of such tests. The objectives of this study were to evaluate the psychometric properties of the Persian version of AUDIT, and to determine the best cut-off points for detection of hazardous drinking and alcohol use disorders. Methods: We translated the AUDIT to Persian and assessed its face and content validity, reliability, and criterion validity against the diagnosis of alcohol use disorders according to the International Classification of Diseases, 10th Revision (ICD-10) diagnostic guidelines, as assessed using the Composite International Diagnostic Interview (CIDI). We determined the best cut-off points for detection of hazardous use, harmful use, and dependence using receiver operating characteristic (ROC) curve analysis. Psychometric properties were assessed in a sample of 400 participants attending medium-term residential drug treatment centers located in Tehran, Iran. Results: The Persian AUDIT had high internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (intraclass correlation coefficient = 0.84). The questionnaire also had excellent face and content validity as well as criterion validity when compared with CIDI. The best cut-off points for alcohol dependence, harmful use, and hazardous use were 11 (sensitivity = 95.6, specificity = 80.4), 7 (sensitivity = 85.5, specificity = 84.2), and 5 (sensitivity = 87.6, specificity = 92.9), respectively. Conclusions: The Persian version of the AUDIT has excellent psychometric properties as a screening tool for alcohol use disorders and hazardous alcohol use in settings in which alcohol use is common. Further research on the AUDIT in the general population and in primary health care settings is warranted.
... The German version of the Alcohol Use Disorder Identification Test (AUDIT) was administered to assess problematic alcohol consumption, whereas a total score ≥8 is indicative for being at risk for disorders due to alcohol use (present sample Cronbach's α: 0.69-0.86) (Dybek et al., 2006;Saunders et al., 1993). Symptoms of gambling disorder were assessed with the German translation of the South Oaks Gambling Screen (SOGS) (Cremer et al., 2001;Lesieur & Blume, 1987). ...
... The prevalence of YFAS food addiction in the entire sample (n = 125) was within the range of reported prevalence rates for preoperative bariatric surgery samples (Chiappetta et al., 2020;Ivezaj et al., 2017;Meule et al., 2017;Sevinçer et al., 2016). Symptom scores of alcohol use determined with the AUDIT (Dybek et al., 2006) were comparable to other studies from Germany (Chiappetta et al., 2020;Meule et al., 2014) but much lower than in some preoperative samples from the United States (e.g., (King et al., 2012) and lower than in the German general population (Atzendorf et al., 2019). ...
Article
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Objective The aim of the present study was to investigate whether the remission of preoperative food addiction is associated with increases or new onset of other addictions within the first year following bariatric surgery. Methods One hundred and twenty-five bariatric surgery patients were assessed before surgery (t1) and at 6 months (t2) and 1 year (t3) follow-ups. The assessments included the Yale Food Addiction Scale 2.0 (YFAS 2.0) and standardized questionnaires to measure symptoms of problematic alcohol use, gambling disorder, internet-use disorder, buying-shopping disorder, hypersexual disorder and exercise dependence. Results Forty-nine (39.2%) patients were assigned to the food addiction (FA⁺) and 76 patients (60.8%) to the non-food addiction group (FA⁻) based on their preoperative YFAS scores. Overall, BMI and symptoms of food addiction decreased significantly from baseline to follow-ups. Preoperative food addiction status was not associated with postoperative increases or new onset of other addictions. Elevated symptoms of buying-shopping disorder, internet-use and hypersexual behaviour at baseline in the FA⁺-group decreased over time and were comparable to the FA⁻-group at follow-ups. Conclusion The ‘addiction transfer’ or ‘cross addiction’ hypothesis was not supportive for alcohol addiction, gambling addiction or other behaviours that may be addictive. Further studies are needed that investigate larger samples and longer observation periods, as well as other substance-use disorders.
... Several studies have tried to establish optimal AUDIT cut-offs for diagnosing AUD in various samples of patients and their differences imply that the use of universal AUDIT-cut offs for diagnosing AUD may be questionable. [11][12][13][14] The major differences in cut-off points for diagnosing AUD were observed between subgroups based on sex, age, 11,15,16 or the presence of another psychiatric diagnosis. 17,18 Moreover, an additional disadvantage of considering AUDIT score as a dichotomous measure has been raised by the inconsistency in the results from studies which examined the factorial structure of AUDIT. ...
Article
Full-text available
The most widely used screening instrument for alcohol use disorders (AUD) is the Alcohol Use Disorders Identification Test (AUDIT) which, although initially developed for use in primary care, is increasingly used in general population studies. Previous studies that have assessed the screening properties and the factorial structure of AUDIT were mostly based on clinical samples and did not take into consideration the possible differences in AUDIT factorial properties between subgroups according to age, sex and mental health status. Aim of the current study was to explore the distribution of AUDIT and AUDIT-Consumption (AUDIT-C) scores and the factorial structure of AUDIT in subgroups of participants according to sex, age and the presence of mental health disorder. Descriptive statistics and Exploratory/Confirmatory Factor Analysis of AUDIT were extracted in a general population representative sample of 4,894 Greek participants. Different cut-offs are suggested in order to screen 10% of the population with the highest severity of AUD into the aforementioned subgroups. Generally, a cut-off between 10-12 at AUDIT score is suggested for screening the 10% with the highest severity of alcohol use problems in subgroups of frequent alcohol consumers (e.g. younger males) and a cut-off between 4-5 would screen the 5% with the highest severity of alcohol use problems in subgroups of low alcohol-consumers (e.g. older women). A cut-off of 3 in AUDIT-C score is suggested for screening 25% of individuals with the heaviest alcohol consumption. The traditional three-factor model does not explain better the factorial structure of AUDIT compared to the 2-factors model. The AUDIT is a reliable instrument for assessing AUD and heavy alcohol consumption in the Greek general population. Age, sex and the presence of mental health disorders should be taken into consideration when selecting cut-offs for screening purposes in non-clinical samples.
... Secondary outcome parameters will be the change in disorder-specific symptoms as measured using the German versions of the major depressive, 46 generalised anxiety, 47 panic and somatoform modules of the PHQ, 48 the SSD-12 49-51 and the AUDIT. 52 We will analyse disorderspecific response (at least 50% symptom reduction at 6 months on the disorder-specific screening instruments) and remission (obtaining a value below the respective clinical cut-off value of the disorder-specific screening instruments at 6 months) for these outcome measures. ...
Article
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Introduction Mental healthcare is one of the biggest challenges for healthcare systems. Comorbidities between different mental disorders are common, and patients suffer from a high burden of disease. While the effectiveness of collaborative and stepped care models has been shown for single disorders, comorbid mental disorders have rarely been addressed in such care models. The aim of the present study is to evaluate the effectiveness of a collaborative and stepped care model for depressive, anxiety, somatoform and alcohol use disorders within a multiprofessional network compared with treatment as usual. Methods and analysis In a cluster-randomised, prospective, parallel-group superiority trial, n=570 patients will be recruited from primary care practices (n=19 practices per group). The intervention is a newly developed collaborative and stepped care model in which patients will be treated using treatment options of various intensities within an integrated network of outpatient general practitioners, psychiatrists, psychotherapists and inpatient institutions. It will be compared with treatment as usual with regard to effectiveness, cost-effectiveness and feasibility, with the primary outcome being a change in mental health-related quality of life from baseline to 6 months. Patients in both groups will undergo an assessment at baseline, 3, 6 and 12 months after study inclusion. Ethics and dissemination The study has been approved by the ethics committee of the Hamburg Medical Association (No. PV5595) and will be carried out in accordance with the principles of the Declaration of Helsinki. For dissemination, the results will be published in peer-reviewed journals and presented at conferences. Within the superordinate research project Hamburg Network for Health Services Research, the results will be communicated to relevant stakeholders in mental healthcare. Trial registration number NCT03226743 .
... Trinkmengen psychometrischen Eigenschaften gilt der AUDIT als Goldstandard zur Identifikation von riskantem Konsum bzw. von Alkoholkonsumstörungen [11]. Für die zweite Gruppe -Personen mit einer schweren Alkoholkonsumstörung (Missbrauch und Abhängigkeit) -wird eine spezialisierte, stationäre Entzugsbehandlung empfohlen. ...
Article
Background Early detection of risky alcohol use and severe alcohol use disorders (AUDs) is crucial to avoid adverse health consequences. The German “Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders” recommend to routinely screen patients for hazardous alcohol use and to subsequently conduct brief interventions, for example in primary healthcare. For severe AUDs, provision of withdrawal treatment is recommended in inpatient settings if complications are anticipated.Objectives To estimate the proportion of people with hazardous alcohol use or severe AUDs receiving healthcare as stipulated by the guidelines.Materials and methodsThe prevalence of hazardous use (female ≥12 g; male ≥24 g) and severe AUDs (female ≥60 g; male ≥90 g) was estimated using per capita consumption of pure alcohol. Treatment rates were estimated using survey data (for hazardous use) and inpatient admissions (for severe AUDs). All estimates refer to the adult population (15 years or older) of the federal state of Bremen for 2016.ResultsPhysicians screened 2.9% of all people with hazardous alcohol use and conducted brief interventions with 1.4%. Among people with severe AUDs, 7.1% received inpatient treatment. Among people with severe AUDs who required inpatient treatment, 14.1% received withdrawal treatment in inpatient settings. Treatment rates below average were registered among 21- to 39-year-olds.Conclusions In Bremen, provision of guideline-conform healthcare for hazardous alcohol use and severe AUDs is insufficient, especially among 21- to 39-year-olds.
... Studies from high income countries (HICs) have recommended a range of AUDIT cut-off scores for their settings: > 13 for alcohol dependence in France (Gache et al., 2005), > 5 for AUD in Germany (Dybek et al., 2006), > 3 and > 10 for hazardous drinking and AUD respectively in Republic of Korea (Kim et al., 2014), and > 10 and > 17 respectively for harmful use and dependence in Australia (Degenhardt et al., 2001). The AUDIT has been translated into several languages, but only a few of these translations (e.g. ...
Article
Introduction: The World Health Organization's (WHO) Alcohol Use Disorders Identification Test (AUDIT) is used extensively across the world, with cut-off scores recommended by the WHO. We reviewed the use and validity of AUDIT cut-off scores in low- and middle-income countries as cultural contexts are expected to influence the detection of alcohol use disorders. Materials and methods: The systematic review was guided by an a priori defined protocol consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We searched Cochrane library, Medline, EMBASE, PsycINFO, CINAHL, Indmed, LILACS, and AJOL databases using appropriate search terms. We conducted a narrative synthesis of the data. Results: We identified 54 distinct studies that used AUDIT cut-off scores which were not in alignment with those recommended by the WHO. India (n = 10), Nigeria (n = 9), and Brazil (n = 9) produced most of these included studies. Most of the studies (n = 42) did not conduct psychometric evaluations of AUDIT cut-off scores. Of the twelve studies which did report psychometric results, a wide range of cut-off scores performed well. In these studies the cut-off scores to detect hazardous drinking ranged from >3 to >5, for harmful drinking from >5 to >16, and for dependent drinking from >7 to >24. Discussion: AUDIT is being widely used in LMICs and non-recommended cut-off scores are considered to be appropriate in these countries. It is important to systematically evaluate the psychometric properties of those cut-off scores to ensure the internal validity of the studies in which they are used.
... .85) (Dybek et al., 2006). In the current study, the internal consistency was α = .62. ...
Thesis
Mental health problems are common in the general population and are associated with high individual and economic burden. To reduce this burden, psychotherapy research and practice have been increasingly professionalized since the latter half of the 20th century and evidence-based psychotherapeutic treatments have been made widely available. Despite the costly efforts to provide evidence-based psychotherapy on a large scale, a significant number of patients remain untreated or do not respond to available interventions. With the integration of computers into everyday life in the 1990s, research has increasingly focused on computer-based interventions (CBIs) to improve both the provision and the quality of evidence-based treatments for all patients. In the last two decades, numerous studies have demonstrated the effectiveness of CBIs for the treatment of mental health problems. In the 21st century, technology is rapidly progressing, and smartphones have gradually taken the place of personal computers in the general population. As a result, smartphone-based interventions (SBIs) are widely discussed as possible aids for the treatment of mental health problems, and there already exists a plethora of SBIs for various patient groups. However, the majority of available SBIs lack empirical evidence as they have not been evaluated in experimental studies. Hence, there exists considerable uncertainty regarding the benefits and possible treatment effects of SBIs. Moreover, most SBIs lack quality in terms of their interventional content, their use of the smartphone’s technological facilities, and their utilization of strategies that engage the patient to use the SBI regularly. Therefore, this dissertation addresses the development and evaluation of an SBI approach that uses evidence-based strategies, seizes upon the smartphones’ technological features, and applies gamification elements to increase patient engagement. Based on the promising findings for blended interventions that combine traditional face-to-face cognitive-behavioral therapy (CBT) with computerized approach-avoidance modification training (AAMT) in the treatment of alcohol use disorders and depression, the SBI approach introduced in this dissertation makes use of intervention techniques from both CBT and smartphone-based AAMT. In six studies, problem-specific SBIs that apply this combined approach are evaluated for their usability and possible effects in the treatment of various mental health problems. Study 7 presents emotion regulation (ER) as a possible common factor in psychopathology that can be targeted by a single SBI addressing patients suffering from various mental health problems. Study 1 examines the feasibility and explores possible effects of an intervention that combines a brief individual counseling session with two weeks of smartphone-based AAMT. This approach is evaluated in a sample of college students meeting criteria for problematic alcohol use. Findings on both usability and treatment effects provide preliminary evidence that the intervention can significantly reduce dysfunctional beliefs about alcohol, craving of alcohol, and alcohol consumption. Study 2 is a multi-center study that assesses the effect of smartphone-based AAMT combined with a brief individual counseling session for participants with elevated levels of body dissatisfaction. Results show that the intervention significantly reduces body dissatisfaction and symptoms of eating disorders. Study 3 evaluates a blended intervention for the reduction of procrastination. Results from this study provide preliminary evidence that a blended intervention that combines two group counseling sessions with 14 days of smartphone-based AAMT can significantly reduce both general and academic procrastination. In Study 4, the blended intervention is comprised of a brief individual psychoeducation session and smartphone-based AAMT for the training of inter- and intraindividual emotion recognition skills in alexithymic individuals. Results show that the intervention improved computer-assessed emotion recognition skills and demonstrated additional effects over a psychoeducation-only control condition. Studies 5 and 6 evaluate SBIs in samples of individuals reporting heightened levels of depression. While results from Study 5 provide preliminary efficacy for an intervention that combines 14-days of smartphone-based AAMT in combination with a psychoeducation group session, Study 6 examines the effectiveness of a stand-alone SBI targeting depressive symptoms using an automated approach that includes an increased degree of gamification. Results of Study 6 demonstrate that 14 days of training with this stand-alone SBI could significantly reduce depressive symptoms. Study 7 comprises two studies that focus on the cross-sectional assessment of deficits in ER skills with the aim to identify common factors that may be targeted by a single, transdiagnostic SBI. Comparisons between two clinical samples and a sample from the general population indicated that participants that met diagnostic criteria for a mental disorder reported lower ER skills than participants from the general population and that ER skills differed across the clinical subgroups. In conclusion, the present dissertation provides evidence that: (1) the AAMT paradigm can be successfully transferred from computers to smartphone devices as indicated by high acceptance scores, high usability ratings, and the frequent use of the SBIs by participants included in the pilot studies; (2) problem-specific SBIs that incorporate face-to-face CBT techniques with AAMT principles may be efficacious for the reduction of symptoms in the targeted mental health problems; (3) a standalone SBI that applies automated CBT techniques and technologically enriched AAMT variants may effectively reduce symptoms of depression; and that (4) ER skills are promising transdiagnostic processes that may be successfully trained in a single SBI that targets a broad range of mental health problems. Further research using larger, more heterogeneous samples including participants that meet diagnostic criteria for mental disorders is necessary to confirm the findings from this dissertation.
... Inclusion criteria were right-handedness, normal or corrected-to-normal vision, absence of color blindness, no acute or chronic somatic psychological, or neurological illnesses, and no intake of medication affecting kidney or liver function, or the central nervous system. Participants' drinking habits were assessed during a telephone screening using the alcohol use disorders identification test (AUDIT) [31,32]. An AUDIT score below 16 specifies low-to-moderate risk of alcohol use disorder (AUD) [31]. ...
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Elevated distractibility is one of the major contributors to alcohol hangover-induced behavioral deficits. Yet, the basic mechanisms driving increased distractibility during hangover are still not very well understood. Besides attention and psychomotor functions, changes in stimulus-response bindings may cause increased responding to distracting information, as suggested by the theory of event coding (TEC), but this has never been investigated in the context of alcohol hangover. Therefore, we investigated whether alcohol hangover has different effects on target-response bindings and distractor-response bindings using a task that allows to differentiate these two phenomena. N = 35 healthy males aged 19 to 28 were tested once sober and once hungover after being intoxicated in a standardized experimental drinking setting the night before (2.64 gr of alcohol per estimated liter of body water). We found that alcohol hangover reduced distractor-response bindings, while no such impairment was found for target-response bindings, which appeared to be unaffected. Our findings imply that the processing of distracting information is most likely not increased, but in fact decreased by hangover. This means that increased distractibility during alcohol hangover is most likely not caused by modulations in distractor-response bindings.
... The AUDIT is a well-documented, easy to administer screening tool using simple closed-ended response options for assessing the level of alcohol consumption and the degree of problematic drinking (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001). The AUDIT has demonstrated consistently high validity and reliability in use across countries and a variety of cultural settings (e.g., Daeppen, Yersin, Landry, Pécoud, & Decrey, 2000;Dybek et al., 2006;Osaki et al., 2014;Zavar, Jarahi, Alimoradi, & Khosravi, 2015). Moreover, the AUDIT has been shown to demonstrate reasonable psychometric properties among college students (Kokotailo et al., 2004), along with the AUDIT-C (composed of the first three questions of the AUDIT), which has been shown to be particularly effective in determining at-risk drinking behaviors among females (Demartini & Carey, 2012), who represent a significant proportion of occupational therapy students. ...
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The purpose of the present study was to examine alcohol use behaviors among a national sample of occupational therapy students. Survey instruments, including the AUDIT and a checklist of risky and unprofessional behaviors related to alcohol abuse, were mailed to 1,000 occupational therapy students randomly selected from membership in the American Occupational Therapy Association. Surveys were returned by 309 student members; however, 24 indicated they were not currently occupational therapy students. Of the 285 participants, 97% reported drinking alcohol at some point over the previous year, with 1 in 5 drinking two or more times a week, often consuming four or more drinks per occasion. Predominant risky and unprofessional behaviors included binge drinking, saying something very inappropriate, combining alcohol and energy drinks, and attending class with a hangover. In general, these students tended to drink alcohol in a socially responsible and acceptable manner. Nevertheless, based on AUDIT guidelines, almost two-thirds of the students did consume alcohol on some singular or more frequent occurrence in the previous year at harmful or hazardous levels. As a consequence, the need to address the topic of alcohol abuse at both the university and the professional levels is warranted, along with the provision of counseling and occupationbased treatment services for those experiencing physiological and psychological problems stemming from alcohol abuse and/or addiction.
... Alcohol use was assessed at enrollment and annually using the Alcohol Use Disorders Identification Test (AUDIT), an internationally validated 10-item tool used to screen for alcohol use disorders [47][48][49][50]. Such disorders include hazardous alcohol use, described as a pattern of drinking that increases risk of future harm, and harmful use, or excessive drinking that impairs physical and/or mental health [50]. ...
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This prospective study of HIV-positive Kenyan women in serodiscordant couples examined relationships between psychosocial factors, viral suppression, and condomless sex. Participants were screened for alcohol use disorders and intimate partner violence (IPV) annually and depressive symptoms every 6 months. Prostate specific antigen (PSA) detection was used as a marker for condomless sex. A total of 151 participants contributed 349 person-years of follow-up. Hazardous/harmful alcohol use was associated with increased risk of detecting PSA in vaginal secretions (aRR 1.99, 95%CI 1.08–3.66, χ2 = 4.85 (1)), while IPV and depression were not. Events representing HIV transmission potential, where there was biological evidence of condomless sex at a visit with a detectable plasma viral load, were observed at 2% of visits. The high prevalence of IPV and association between alcohol use and sexual risk suggest the need for monitoring and support for these conditions as part of comprehensive HIV care for women.
... Each question is scored from 0 to 4 yielding a total maximum score of 40. AUDIT has been proven to be a reliable and valid screening instrument [23][24][25][26][27][28][29]. ...
Article
Objectives: Drunk driving is related to accidents and poorer health, as well as causes a considerable economic cost. In this study, we intended to determine which sociodemographic factors can reduce health-related quality of life (QoL). Methods: We recruited 552 drunken driver recidivists and measured their alcohol use history and sociodemographic factors. We used the Alcohol Use Disorders Identification Test (AUDIT) and the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to evaluate severity of alcohol disorder. Psychological distress was measured using Beck Depression Inventory-II (BDI-II) and the status of well-being using the Short Form 12-Health Survey Questionnaire. We classified into several categories and analyzed with one-way analysis of variance or the Welch's test. Significant factors were further divided into subcategories for comparisons. Results: Alcohol use disorder according to DSM-5 criteria was found to be 34.2% mild, 16.7% moderate, and 44.7% severe in severity. The Depression Index according to BDI-II showed 70.5% in minimal, 13.2% mild, 10.5% moderate, and 5.8% severe depressed participants. In comparing subcategories according to the physical component summary (PCS), men who were older (p < 0.05), had fewer than 6 years of education (p < 0.001), unemployed (p < 0.05), homeless (p < 0.05), had monthly incomes below 15 thousand New Taiwan dollars (p < 0.05), and AUDIT scores ≥ 20 for severe depression (p < 0.001) had significantly lower QoL in PCS. In comparing subcategories according to the mental component summary (MCS), men who were unemployed (p < 0.05), homeless (p < 0.01), and AUDIT ≥ 20 for severe depression (p < 0.001) also had significantly lower QoL on MCS. Conclusion: Unemployment, homelessness, AUDIT scores ≥ 20, and higher BDI-II scores showed a reduction not only in PCS scores but also in MCS scores. Those findings could be used to determine the drunk drivers' behaviors and the well-being among those recidivists. Instead of incarceration or fining for drunk drivers, we need identification and referring them to treatment in those population, especially individuals with poor socioeconomic status, depression, and severe alcohol use disorder.
... 63 The AUDIT has demonstrated strong psychometric properties with evidence of convergent validity, strong test-retest reliability (r = 0.84-0.95), and good internal consistency (a = 0.81). [64][65][66][67] In the present study, the AUDIT demonstrated good internal consistency (a = 0.81). ...
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Background: To reduce women's risk for intimate partner violence (IPV), it is critical to elucidate malleable psychiatric and behavioral health risk factors. We aimed to identify if alcohol use problems moderate the associations between posttraumatic stress disorder (PTSD) symptoms and past-year IPV victimization experiences among female veterans, a population at high risk for IPV. Methods: Female veterans (N = 198) completed mail surveys assessing PTSD symptoms, alcohol use, and IPV at two time points between 2012 and 2013. Regression analyses were used to examine the associations between PTSD symptoms and alcohol use at Time 1 with past-year IPV at Time 2. Results: More than a third of women (36.9%) reported past-year IPV. Alcohol use severity significantly moderated the association between PTSD symptoms and past-year physical IPV. Specifically, there was a significant positive association between PTSD symptoms and past-year IPV at high levels of alcohol use severity, but not at low or average levels of alcohol use. Although both PTSD symptoms and alcohol use were independent risk factors for past-year sexual and psychological IPV, no moderating effect was found for these IPV types. Conclusions: Findings can inform tailored IPV, psychiatric, and behavioral health screening and counseling. Such practices may reduce psychiatric distress and IPV risk.
... Validation of the AUDIT in a German general practice sample showed high retest reliability (ICC = .95) and adequate validity [102]. In the present study, the German Münster Version of the AUDIT following S3 guideline was applied (http://auditscreen.org/cmsb/uploads/audit-german-m-nster.pdf). ...
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Background: People in green professions are exposed to a variety of risk factors, which could possibly enhance the development of depression. Amongst possible prevention approaches, internet- and mobile-based interventions (IMIs) have been shown to be effective and scalable. However, little is known about the effectiveness in green professions. The aim of the present study is to examine the (cost-)effectiveness of a tailored IMI program for reducing depressive symptoms and preventing the onset of clinical depression compared to enhanced treatment as usual (TAU+). Methods: A pragmatic randomized controlled trial (RCT) will be conducted to evaluate a tailored and therapeutically guided preventive IMI program in comparison to TAU+ with follow-ups at post-treatment (9 weeks), 6-, 12-, 24-, and 36-months. Entrepreneurs in green professions, collaborating spouses, family members and pensioners (N = 360) with sufficient insurance status and at least subthreshold depression (PHQ-9 ≥ 5) are eligible for inclusion. Primary outcome is depressive symptom severity (QIDS-SR16). Secondary outcomes include incidence of depression (QIDS-SR16), quality of life (AQoL-8D) and negative treatment effects (INEP). A health-economic evaluation will be conducted from a societal perspective. The IMI program is provided by psychologists of an external service company and consists of six guided IMIs (6-8 modules, duration: 6-8 weeks) targeting different symptoms (depressive mood, depressive mood with comorbid diabetes, perceived stress, insomnia, panic and agoraphobic symptoms or harmful alcohol use). Intervention choice depends on a screening of participants' symptoms and individual preferences. The intervention phase is followed by a 12-months consolidating phase with monthly contact to the e-coach. Discussion: This is the first pragmatic RCT investigating long-term effectiveness of a tailored guided IMI program for depression prevention in green professions. The present trial builds on a large-scale strategy for depression prevention in green professions. The intended implementation of the IMI program with a nationwide rollout has the potential to reduce overall depression burden and associated health care costs in case of given effectiveness. Trial registration: German Clinical Trial Registration: DRKS00014000 . Registered on 09 April 2018.
... Frequency and quantity of alcohol consumption were assessed with the following two questions: "In the past 12 months, on average, how often did you have a drink containing alcohol, e.g. a glass of wine, beer, mixed drink or liqueur?" and "In the past 12 months, on average, how often did you have five or more drinks containing alcohol on one occasion?". The content of the two questions was inspired by the Alcohol Use Disorders Identification Test (Dybek et al., 2006). Participants rated their consumption ranged from "never within the past 12 months" to "daily". ...
Article
Background. This was the first study aiming to develop a theory-based model to analyze the relation between conscientiousness and impaired physical health as well as between conscientiousness and subjective health-related well-being within a large clinical sample with depressive symptomatology. In addition, a mediating effect of health risk behaviors regarding the association between conscientiousness and objectively impaired physical health as well as subjective health-related well-being were exploratory examined. Methods. Individuals with depressive symptoms (n = 943) with a mean age of 52 years (ranging between 20 and 78 years) undergoing intensive psychiatric rehabilitation treatment were investigated with the Big Five Inventory-10 as well as several self-report health questionnaires (Three-Factor Eating Questionnaire, Food-Craving Inventory and lifestyle questions assessing physical inactivity and alcohol consumption). Health-related well-being was measured using the World Health Organisation Quality of Life Assessment and the construct of impaired physical health comprised anthropometric measurements (Body Mass Index, Waist-to-Height-Ratio), blood lipids, and impaired physical performance capacity on the bicycle-ergometric test. Results. Structural path analyses revealed that unhealthy eating habits and physical inactivity partially mediated the negative relation between conscientiousness and impaired physical health as well as the positive relation between conscientiousness and health-related well-being. Limitations. Possible limitations include cross-sectional study design, missing data, assessment of conscientiousness on a global level and self-report assessment of health risk behaviors. Conclusions. The findings highlight the importance concerning the extended inclusion of personality aspects in the treatment of depression in order to improve health.
... Alcohol use disorder is measured by the AUDIT (ten items; score range: 0-40; cutoff for alcohol dependency disorder > 8; Saunders et al., 1993), which has excellent reliability in German adults (α = .95; Dybek et al., 2006) and also satisfactory reliability in German sample of healthy students (α = .77; Rumpf, Wohlert, Freyer-Adam, Grothues, & Bischof, 2013). ...
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Introduction: Although evidence-based treatments for posttraumatic stress disorder (PTSD) in adolescents and young adults exist, affected youth do not have sufficient access to these treatments due to structural and attitudinal barriers. Internet- and mobile-based interventions (IMIs) can help fill this healthcare gap, but such programmes have not yet been sufficiently evaluated in youth with PTSD. Aim: This study aims to investigate the feasibility of an IMI for youth with PTSD in a one-arm, non-randomised, prospective proof-of-concept feasibility study. Methods: We aim to recruit 32 youth between 15 and 21 years old with clinically relevant posttraumatic stress symptoms (CATS ≥ 21), who will receive access to the IMI. The IMI consists of nine sessions involving psychoeducation, emotion regulation and coping skills, written-based imaginal exposure, cognitive restructuring and relapse prevention. Participants will be guided by an eCoach, who provides weekly semi-standardised written feedback on completed sessions and adherence reminders. We will use a formal feasibility framework to assess different dimensions of feasibility: (1) recruitment capability and resulting sample characteristics, (2) data collection procedures and outcome measures, (3) acceptability of the IMI and study procedures, (4) resources and ability to manage and implement the study and IMI and (5) participants' responses to the IMI in terms of symptom severity and satisfaction. Additionally, potential negative effects related to the intervention will be assessed. Assessments take place pre-, mid- and post-intervention and at follow-up, including semi-structured clinical telephone interviews for PTSD diagnostics at pre- and post-intervention assessment. Qualitative interviews will be conducted to investigate the youth perspectives on the IMI. Discussion: This study aims to determine the feasibility of a guided IMI for youth with PTSD to adapt the IMI as closely as possible to youth needs and to inform the design, procedure and safety management of a large-scale efficacy RCT. Trial registration: German Clinical Trials Register identifier: DRKS00023341. Highlights: Evidence-based care for adolescents after trauma is not widely available.• This study evaluates the feasibility of a guided trauma-focused Internet intervention as a time- and location-independent low-threshold treatment option for adolescents and young adults with posttraumatic stress disorder.
... It addresses drinking amount, frequency, and negative consequences with high test-retest reliability (r ϭ .95; Dybek et al., 2006). ...
Article
Objective: Alcohol-dependent patients show attentional and approach biases for alcohol-related stimuli. Computerized cognitive bias modification (CBM) programs aim to retrain these biases and reduce relapse rates as add-ons to treatment. Retraining of alcohol-approach tendencies has already yielded significant reductions of relapse rates in previous studies, and retraining of biased attention toward alcohol is promising approach. The current large-scale randomized controlled trial compared the clinical effects of these training methods-separately and in combination-to those of sham training methods and a no-training control, as an add-on to regular treatment. Methods: Participants were 1,405 alcohol-dependent patients of an inpatient rehabilitation clinic. In addition to regular treatment, patients were randomized to receive 6 sessions of approach-bias retraining, 6 sessions of attention-bias retraining, 3 sessions of each of these CBM training varieties, 6 sessions of variants of sham training, or no training. Effects of the training methods were evaluated by measuring treatment success at 1-year follow-up. Results: Primary outcome: The 3 active training conditions yielded higher success rates at 1-year follow-up than sham training or no training (8.4%, on average). Secondary results (available for half of the sample): Both varieties of CBM had only small effects on the targeted biases (significant only for the combined training). Moreover, neither significant mediation of the clinical effect by the change in trained bias nor significant moderation of the clinical effect was found. Conclusions: Both alcohol-avoidance training and alcohol-attention training increased success rates effectively, as did the combination of both methods. Future studies should test ways to increase training effectiveness further. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
... Die Anzahl der angegebenen Erkrankungen kann als Indikator für die Gesamtmorbidität genutzt werden(Hasselhorn und Freude 2007).sche Kennwerte auf(Dybek et al. 2006). Der Summenwert über die 10 Items erlaubt eine geschlechtsdifferenzielle Kategorisierung in unproblematisches vs. riskantes bzw. ...
Article
Zusammenfassung Die hohe Relevanz früher Beziehungserfahrungen für die psychosoziale Entwicklung des Säuglings bzw. Kindes ist von der Bindungstheorie elaboriert und von der Bindungsforschung eindrucksvoll empirisch belegt worden. Auch die körperliche Reifung und Ausdifferenzierung biologischer Systeme werden von Beziehungserfahrungen geprägt. Gleichwohl ist der Zusammenhang zwischen Bindung und körperlicher Gesundheit bisher nur unzureichend untersucht, insbesondere nicht bei stationären Psychotherapiepatientinnen und Patienten. In dieser naturalistischen Beobachtungsstudie wurden Daten aus der Routinediagnostik von 6003 Patienten in stationärer Psychotherapie analysiert. Die partnerschaftsbezogenen Bindungsstrategien wurden mit der deutschsprachigen Kurzform des Experiences in Close Relationships Questionnaire (ECR-RD12) und verschiedene körperliche Erkrankungen mit dem Work Ability Index (WAI) erhoben. Unter Kontrolle soziodemografischer und kardiovaskulärer Risikofaktoren war Bindungsangst mit 8 von 11 der erfassten Erkrankungen assoziiert, Bindungsvermeidung hingegen lediglich mit neurologischen Krankheiten. Zudem bestand ein Zusammenhang zwischen Bindungsunsicherheit und genereller somatischer Krankheitslast, der maßgeblich von Bindungsangst bestimmt wurde. In Übereinstimmung mit anderen Studien legen die Befunde den Schluss nahe, dass Assoziationen zwischen einer Vielzahl körperlicher Erkrankungen und Bindungsunsicherheit im Allgemeinen sowie Bindungsangst im Besonderen existieren.
... Scores on the items are summed, with higher scores indicative of elevated levels of hazardous drinking behaviors. Standard interpretation dictates that scores 8 and above are indicative of hazardous alcohol use (Babor, 2001); however, lower cutoffs have been suggested to be more sensitive for assessing problematic alcohol use in college populations (Dybek et al., 2006). The measure has been shown to assess for hazardous drinking-especially in a college and adolescent sample-with an above average internal consistency (Cronbach's alpha = 0.81; Kokotailo et al., 2004). ...
Article
Alcohol use and sleep disruption are highly prevalent amongst college students, yet their combined effects on cognitive functioning and subsequent classroom performance have not been fully examined. Alcohol use has been shown to negatively impact cognitive functioning, especially in college students without fully matured brain regions. This has led to decreases in academic functioning and increases in college dropout. Disruptions in sleep functioning can lead to both lapses in attention and an overall decrease in attention, which can negatively impact learning in a classroom environment. Participants were 96 undergraduate students who were invited to participate based on responses from a screening measure regarding drinking behaviors. Participants were selected to binge drinker/non-binge drinker and sleep problem/no sleep problem groups based on their responses to administered measures. Participants also completed a ~30-minute cognitive assessment via an iPad evaluating multiple cognitive domains (e.g., attention, memory), as well as complete a 7-day diary of sleeping and alcohol use behaviors prior to their assessment. One-way and univariate ANOVAs were conducted to determine main and interactive cognitive differences between the alcohol use and sleep problems groups, as well as Multilevel Modeling to evaluate daily patterns and predictors of sleeping and alcohol use behaviors. Results indicated non-significant main effects for subtests in both the binge drinking and sleep problems groups, and there were also non-significant interactive effects between the conditions. Per self-report, results also exhibited that participants tended to drink more alcoholic drinks, go to bed later, and get less sleep towards the weekends. Although the current study was unable to identify the synergistic effects of alcohol use and sleep problems on cognitive performance, it was able to detect independent effects and illuminate the daily relationship between alcohol use and sleep behaviors in college students. Several limitations were identified, and further research with larger sample sizes may be needed to clarify the complex relationship between alcohol use, sleep problems, and cognitive performance. Advisor: Dennis E. McChargue
... Each item is scored between 0 and 4. The sum score ranges between 0 and 40 points, with scores above the cut-off of 15 reflecting hazardous alcohol consumption (Conigrave et al., 1995). We used the German version of the AUDIT showing good psychometric properties in a German general practice population sample (Dybek et al., 2006). The internal consistency was adequate, α = 0.68, in the present sample. ...
Article
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Background and Aims: It is assumed that a relevant subgroup of individuals experiences an addiction-like eating behaviour (Food Addiction), characterized by an impaired control over eating behaviour, emotional eating and food craving. Individuals experiencing Food Addiction partially share common symptomatology with Binge-Eating-Disorder and Bulimia Nervosa. The aim of this study was to investigate the prevalence of Food Addiction, general psychopathology, and associations with weight- and addiction-related constructs in individuals with overweight and obesity, who did not suffer from Binge-Eating-Disorder or Bulimia Nervosa. Methods: N =213 (67.1% female; M BMI =33.35kg/m ² , SD BMI =3.79kg/m ² ) participants who were included in a weight loss program (I-GENDO project) reported BMI and completed questionnaires before the start of the treatment. Food Addiction severity, depressive symptoms, alcohol use disorder, internet use disorder, psychological distress, impulsivity personality trait, impulsive and emotional eating behaviour, food related inhibitory control, weight bias internalization, and self-efficacy were assessed. Results: The prevalence of Food Addiction was 15% with higher, although not statistically significant, prevalence in female (18.2%) compared to male (8.6%) participants. Food Addiction was associated with higher BMI at baseline assessment, low self-esteem, impulsive and emotional eating behaviour, weight bias internalization, and deficits in food-related inhibitory control. In addition, correlations were found between Food Addiction and severity of depressive symptoms, internet use disorder, and psychological distress. Conclusion: A relevant subgroup of participants experiences Food Addiction even when controlling for Binge-Eating-Disorder and Bulimia Nervosa. Future studies are warranted that investigate whether Food Addiction affects treatment success.
... -abhängigkeit hinweist, da Alkohol abhängig von Metabolismus und Körpergewicht unterschiedlich wirkt. [1,3,7]. In dieser Studie werden die Cutoffs von 5 Punkten für Frauen und 6 Punkten für Männer verwendet. ...
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Zusammenfassung Hintergrund In der Literatur lassen sich Hinweise darauf finden, dass bei Medizinstudierenden häufig risikohafter Alkoholkonsum vorliegt. Ziel der Arbeit Das Ziel dieser Arbeit ist, den Alkoholkonsum Medizinstudierender im Zeitverlauf zu untersuchen. Material und Methoden Von 2011 bis 2017 wurden Dresdner Medizinstudierende des zweiten Semesters mit dem „Alcohol Use Disorders Identification Test“ (AUDIT) befragt. Mögliche beeinflussende Faktoren des Alkoholkonsums wie Alter, Geschlecht, psychische Belastung („Brief-Symptom Inventory-18“ [BSI-18]), Jahrgang und Abiturnote der Medizinstudierenden wurden in einer Regressionsanalyse geprüft. Ergebnisse Auffällige Scores im AUDIT wiesen 47 % der Studierenden auf. Die männlichen Studierenden zeigten verglichen mit ihren Kommilitoninnen signifikant höhere Scores (6,73 vs. 4,64; p < 0,001). Aus der Regressionsanalyse gingen das Geschlecht (p = 0,000) sowie die psychische Belastung (p = 0,041; Frauen: p = 0,000) als beeinflussende Faktoren des Alkoholkonsums hervor. Schlussfolgerung Die Medizinstudierenden des zweiten Semesters zeigen häufig problematischen Alkoholkonsum, wobei dies v. a. für die männlichen Studierenden gilt. Der Alkoholkonsum von Medizinstudierenden scheint sich von 2011 bis 2017 nicht zu verändern. Die psychische Belastung stand überwiegend bei den weiblichen Medizinstudierenden mit dem Alkoholkonsum in Zusammenhang.
... The questionnaire consists of 10 items and has high test-retest reliability (r = .95; Dybek et al., 2006). ...
Article
Objective: Approach bias modification (ApBM) is a promising new add-on training intervention for patients with alcohol use disorder (AUD). Given that comorbid anxiety and major depressive disorders are very common in AUD, and that such comorbidity affects psychological treatments negatively, the primary aim of the present study was investigating whether ApBM training is moderated by anxiety/major depressive disorder comorbidity. The secondary aim was to examine whether ApBM's relapse-preventive effect can be replicated. Method: We conducted a large-scale randomized controlled trial (RCT) in a clinical sample of AUD inpatients (n = 729) with a follow-up assessment after 1 year. All patients received 12 weeks of inpatient treatment as usual (TAU). On top of that, patients were randomized to a 12-session ApBM (TAU + ApBM), and a no-training control condition (TAU-only). Treatment success was defined as either no relapse or a single lapse shorter than 3 days in duration, ended by the patient and followed by at least 4 weeks of abstinence. Failure was defined as relapse, passed away, no contact, or refusal to provide information. Results: We found that TAU + ApBM had significantly higher success rates than TAU-only at 1-year follow-up. Importantly, anxiety/depressive comorbidity moderated ApBM's effects: Adding ApBM to TAU increased success rates more for patients with a comorbid anxiety and/or depressive disorder than for patients without such comorbidity. Conclusions: Our data suggest that adding ApBM to TAU works better in patients with a comorbid anxiety and/or depressive disorder; a promising finding gave the high rates of comorbidity in clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Alcohol intake was measured using the Alcohol Use Disorders Identification Test (AUDIT) (Saunders et al., 1993) and was reported as alcohol score and alcohol risk category. AUDIT has shown high reliability and validity in general population previously (Dybek et al., 2006). Physical activity, reported as PA score and PA status, was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) which is a valid and reliable instrument used in adults from a variety of settings (Craig et al., 2003). ...
Article
Aim: Nursing students experience high levels of stress, anxiety and depression. This study examined associations between health behaviors and stress, anxiety and depression in Australian nursing students. Design: this was a cross-sectional study. Methods: Participants completed an online survey providing demographic information and responses to the 21-item Depression Anxiety Stress Scale, Fagerström Test for Nicotine Dependence, short Food Frequency Questionnaire, Alcohol Use Disorders Identification Test, International Physical Activity Questionnaire and Workforce Sitting Questionnaire. Associations were evaluated using multivariate linear regression. Results: Mild to extremely severe stress (46.6%), anxiety (52.8%) and depression (42.2%) were prevalent. Intake of snack-foods was associated with higher depression (β = 8.66, p < 0.05) and stress (β = 3.92, p = 0.055) scores. More time spent sitting was associated with higher depression (β = 0.48, p < 0.001) and stress (β = 0.28, p < 0.05) scores. Skipping meals correlated with higher stress, anxiety and depression scores. Conclusion: More support must be provided to nursing students to manage psychological distress and mental health during university study.
... Secondary outcome parameters will be the change in disorder-specific symptoms as measured using the German versions of the major depressive, 46 generalised anxiety, 47 panic and somatoform modules of the PHQ, 48 the SSD-12 49-51 and the AUDIT. 52 We will analyse disorderspecific response (at least 50% symptom reduction at 6 months on the disorder-specific screening instruments) and remission (obtaining a value below the respective clinical cut-off value of the disorder-specific screening instruments at 6 months) for these outcome measures. ...
Article
Die Versorgung psychischer Störungen stellt eine große Herausforderung für das deutsche Gesundheitssystem dar. Wenn Mehrfachdiagnosen vorliegen, leiden die Betroffenen unter einer besonders hohen Krankheitslast. Innovative Behandlungsmodelle für eine integrierte und gestufte Versorgung (Collaborative Care und Stepped Care) sind bisher nur hinsichtlich ihrer Wirksamkeit für singuläre Störungsbilder untersucht worden. Das Projekt „Integrierte und gestufte Versorgung psychischer Erkrankungen durch Überwindung sektoraler Behandlungsbarrieren“ (COMET), welches vom Hamburger Netzwerk für Versorgungsforschung (HAM-NET) von 2017 bis 2020 durchgeführt wird, untersucht ein innovatives, leitlinienorientiertes Versorgungsmodell zur Verbesserung der Versorgung von Menschen mit psychischen Störungen unter Einbezug möglicher Komorbiditäten. Dieses neue Stepped- und Collaborative-Care-Modell für Patienten der Primärversorgung, das Hausärzte, Psychiater und Psychotherapeuten sowie Kliniken vernetzt, wird im vorliegenden Beitrag vorgestellt. Zur Implementierung und Förderung des Modells wurden leitliniengerechte Behandlungspfade, ein tabletgestütztes Programm für Screening, Diagnostik und leitliniengerechte Behandlungsempfehlungen sowie eine webbasierte Terminvergabeplattform entwickelt. Die aus dem Projekt gewonnenen Erkenntnisse zur Effektivität und Effizienz des Modells können die Entscheidung, ob das Modell zukünftig in die Gesundheitsversorgung übertragen wird, unterstützen. Damit könnte ein entscheidender Fortschritt im Hinblick auf eine stärker integrierte und sektorenübergreifende Versorgung von Patienten mit psychischen Störungen gelingen.
... Der AuditC ist ein validierter Kurzfragebogen zur Erhe bung der Alkoholkonsumgewohnheiten und zur Identifi zierung von Personen mit einem Risikogebrauch[34][35][36]. Zur Erfassung des Tabakkonsums ist der FTND internati onal gebräuchlich[37,38].Er erfasst mit sechs Fragen zum Rauchverhalten wichtige Dimensionen der Tabak abhängigkeit. ...
Article
Sexual Dysfunction in Primary Health Care Abstract. In primary health care, sexual dysfunctions are usually only insufficiently recorded. At the same time, these disorders are relatively common and often remain untreated. This study investigated sexual dysfunction and how it is influenced by lifestyle in patients in a general practitioner's practice (HP). Methods: A sample of HP patients was asked about their sexuality, psychosocial situation and lifestyle, using validated questionnaires. Results: The sample consisted of 30 women and 37 men. Of these, about two thirds have never spoken to a physician about their sex life and more than four fifths have never been asked about it by a phyisican. In 75 % of the sample there was no evidence of sexual dysfunction. Men with questionnaire values indicating sexual dysfunction showed significantly higher psychological stress than those with inconspicuous values. Conclusion: Despite an inconspicuous anamnesis regarding risk factors of sexual dysfunction, about a quarter of the sample found evidence of sexual dysfunction. An inconspicuous anamnesis in the areas of alcohol/tobacco consumption and depression does not make a targeted questioning about sexual dysfunction superfluous. Particularly for men, acute psychological stress should be a sufficient reason to address the topic of sexuality and to deepen it if necessary.
... Sensitivity and specificity proved to be good (Reinert & Allen, 2002). In addition, test-retest reliability was high (Dybek et al., 2006). High values refer to higher alcohol consumption. ...
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Background and aims: Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample. Methods: A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses. Results: The analyses showed a significant negative correlation between the subscales “Adjusting” and “Tolerating” and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies “Adjusting” [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91–0.99] and “Tolerating” [COR = 0.95, CI = 0.92–99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only “Tolerating” turned out to be significant [COR = 0.96, CI = 0.93–0.99]. Discussion and conclusions: For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptancefocused strategies, should be considered in prevention and psychotherapy. Keywords: pathological gambling, problematic gambling, emotion regulation strategies, risk factor, proactive recruitment, unselected sample
Article
Although pain reduction after alcohol administration has repeatedly been demonstrated, alcohol effects on advanced and clinically relevant dynamic pain paradigms are still unknown. As such, temporal summation of pain (TSP) and conditioned pain modulation (CPM) indicate mechanisms of endogenous pain modulation and involve certain neurotransmitter systems crucially influenced by alcohol. Our study is the first to investigate acute alcohol effects on TSP and CPM. We investigated 39 healthy subjects in a placebo-controlled within-subject design and targeted alcohol levels of 0.06% (dose 1) and 0.08% (dose 2). Pain threshold, TSP, and CPM were evaluated before and after an alcoholic or placebo drink. Temporal summation of pain was assessed as enhanced pain response to 5 repetitive contact heat stimuli (threshold +3°C). Conditioned pain modulation was tested as pain inhibition when a conditioning stimulus (46°C hot water) was applied concurrently to a test stimulus (contact heat; threshold + 3°C). Both alcohol doses boosted CPM, with a greater effect size for the higher dose. Conditioning stimulus ratings increased after alcohol intake but were not correlated with CPM, suggesting independence of these effects. Temporal summation of pain was not affected by alcohol, and alcohol effects on pain threshold were small and limited to the higher dose. Our findings suggest that analgesic alcohol effects might be mainly driven by an enhancement of endogenous pain inhibition. The frequent use of alcohol as self-medication in chronic pain might be motivated by alcohol temporarily restoring deficient CPM, thus leading to pain relief in the short run and alcohol-related problems in the long run.
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Background: Just as substance use disorders (SUD), gambling disorder (GD) is characterized by an increase in cue-dependent decision-making (Pavlovian-to-instrumental transfer, PIT). PIT, as studied in SUDs and healthy subjects, is associated with altered communication between Nucleus Accumbens (NAcc), amygdala, and orbitofrontal cortex (OFC). However, these neural differences are poorly understood. For example, it is unclear whether they are due to the physiological effects of substance abuse, or rather related to learning processes and/or other etiological factors like innate traits associated with addiction. We have thus investigated whether network activation patterns during a PIT task are also altered in GD, an addictive disorder not involving substance abuse. We have specifically studied which neural PIT patterns were best at distinguishing GD from healthy control (HC) subjects, all to improve our understanding of the neural signatures of GD and of addiction-related PIT in general. Methods: 30 GD and 30 HC subjects completed an affective decision-making task in a functional magnetic resonance imaging (fMRI) scanner. Gambling associated and other emotional cues were shown in the background during the task, allowing us to record multivariate neural PIT signatures focusing on a network of NAcc, amygdala and OFC. We built and tested a classifier based on these multivariate neural PIT signatures using cross-validated elastic net regression. Results and Discussion: As expected, GD subjects showed stronger PIT than HC subjects because they showed stronger increase in gamble acceptance when gambling cues were presented in the background. Classification based on neural PIT signatures yielded a significant AUC-ROC (0.70, p = 0.013). When inspecting the features of the classifier, we observed that GD showed stronger PIT-related functional connectivity between nucleus accumbens (NAcc) and amygdala elicited by gambling background cues, as well as between amygdala and orbito-frontal cortex (OFC) elicited by negative and positive cues. Conclusion: We propose that GD and HC subjects are distinguishable by PIT-related neural signatures including amygdala-NAcc-OFC functional connectivity. Our findings suggest that neural PIT alterations in addictive disorders might not depend on the physiological effect of a substance of abuse, but on related learning processes or even innate neural traits, also found in behavioral addictions.
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Bislang liegen keine allgemeingültigen Vorgaben für die Durchführung der psychosozialen/psychosomatischen Evaluation vor Adipositaschirurgie vor. Die präoperative Untersuchung durch einen in der Adipositasbehandlung erfahrenen Mental Health Professional sollte in jedem Fall ein klinisches Interview, die Diagnostik psychischer Symptome anhand standardisierter Fragebögen und die Sichtung bisheriger Befunde beinhalten. In diesem Kapitel werden Empfehlungen für die präoperative psychosoziale/psychosomatische Evaluation vor Adipositaschirurgie zusammengefasst, die sich an der bisherigen Forschungsliteratur und an der aktuellen S3-Leitlinie Chirurgie der Adipositas und metabolischer Erkrankungen der AWMF orientieren. Außerdem wird auf Aspekte der postoperativen Evaluation psychischer Probleme eingegangen.
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Purpose of Review The playing of videogames has become an everyday occurrence among many adolescents and emerging adults. However, gaming can be problematic and potentially addictive and problematic gamers can experience co-occurring behavioral or substance use-related problems. The aims of the present review were to (i) determine the co-occurrence of potentially addictive behaviors with problematic and disordered gaming, and (ii) elucidate the potential risk factors in the development and maintenance of co-occurrence within disordered gaming. Recent Findings The main findings demonstrated that there are few empirical studies (N = 20) examining (i) co-occurrence of gaming disorder with other addictive behaviors; (ii) longitudinal risk of disordered gaming with co-occurring addictive behaviors; and (iii) mechanisms of co-occurrence in disordered gaming with co-occurring potentially addictive behaviors. Results suggest that disordered gaming can co-occur with a variety of other addictive behaviors (e.g., alcohol use disorder or addictive use of social media), and that research into the co-occurrence of addictive behaviors and substance use is increasing. Summary Based on this systematic review, findings suggest that gamers engage in a number of potentially addictive behaviors and substance use which can have detrimental effects on health and wellbeing. While a majority of the reviewed studies consider prevalence rates from a range of geographical locations, there are fewer papers which investigate individual and environmental risk factors.
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Since March 2017, the prescription of medical cannabis at the expense of the statutory health insurance is possible after approval by the respective medical services. Chronic pain is the most common indication, as health claims data and the accompanying survey show. From the point of view of the law, a prescription is indicated in cases of serious illness, missing or not indicated established therapeutic approaches and a not entirely remote prospect of improvement of the illness or its symptoms. This describes a broader indication spectrum than can currently be based on randomised controlled clinical trials. There is weak evidence of low efficacy for neuropathic pain. For pain related to spasticity and cancer-related pain there is evidence of improvements in quality of life, but effects on pain are of little relevance. For all other indications, only an individual therapeutic trial can be justified based on the available external evidence. However, this usually corresponds to the demand of "a not entirely remote prospect" of a noticeably positive effect of medical cannabis. It is also problematic that almost no long-term studies for the application and efficacy of flowers and extracts are available.Current knowledge on the use of cannabis-based drugs and, more clearly, medical cannabis for chronic pain is insufficient. The increase in the number of countries with marketing authorisations or exemptions for medicinal cannabis or cannabis-based drugs for chronic pain will also pave the way for larger empirical and population-based studies that will further improve the evidence base of research and clinical use.
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Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters and gardeners (SVLFG ) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual (TAU+ ).Methods: In a two-armed, pragmatic randomized controlled trial (N=312) with follow-ups at post-treatment (6 months), 12 months and 18 months, insured farmers, foresters and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or TAU+. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25 to 50 minutes delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-) effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level.
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Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25–50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.
Article
Background and aims Evidence for analgesic effects of oral alcohol consumption on heat pain has recently been documented in a placebo-controlled, randomized and double-blind design. We aimed at further investigating these effects and now set the focus on pain threshold and the ratings of supra-threshold pain to cover most of the pain range. Moreover, we now firstly evaluated sex differences in these effects. Methods We investigated 41 healthy participants (22 females) in a randomized, double-blind and placebo-controlled design and targeted two different moderate breath-alcohol levels of 0.06% and 0.08%. Before and after an alcoholic or placebo drink, contact heat was applied at the forearm. Subjects evaluated pain threshold (method of adjustment) and rated pain intensity and pain unpleasantness of supra-threshold stimuli (intensity: threshold +3 °C; duration: 5 s). Results Analgesic effects taking the form of increased pain thresholds were found after both alcohol doses, surprisingly with more pronounced effects for the lower dose. While the high alcohol dose exerted small analgesic effects on pain intensity ratings (i.e. decrease), slightly increased ratings of pain intensity and pain unpleasantness after the low alcohol dose rather suggest pain enhancement. Alcohol did not affect intensity vs. unpleasantness ratings differentially. We found no evidence for sex differences in any of these effects. Conclusions Overall, acute alcohol effects on pain were subtle. Our findings suggest that while low alcohol doses already exert analgesic effects on pain threshold, stronger doses are required for pain reduction on supra-threshold pain levels. Furthermore, sex differences could not be detected within our experimental paradigm but should be further explored in future research. Implications Analgesic effects of sub-toxic alcohol doses – as normally occurring during social drinking – might be weak; however, susceptibility to pain relieving effects of alcohol might be a risk factor for the use of alcohol as self-medication in acute pain states.
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Introduction Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. Methods and analysis The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. Ethics and dissemination Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request. NCT03496948 ( www.clinicaltrials.gov ), Pre-results.
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Aims Information provided on glass labels may be an effective method to reduce alcohol consumption. The aim of this study was to assess the impact of glass labels conveying unit information and a health warning in reducing ad libitum alcohol consumption. Methods A cluster randomised experimental study was conducted to measure the efficacy of a labelled glass in reducing alcohol consumption in a semi‐naturalistic bar‐laboratory setting, in a sample of 81 pairs (n = 162) of UK young adult drinkers. Pairs were randomised to receive two 340 ml glasses of beer or wine: labelled or plain (control). Alcohol consumption was assessed in an ad libitum drinking period and urge to drink was measured at baseline and post drinking period. Focus groups (n = 2) were conducted and thematic analysis was used to gain an insight into the acceptability and the perceived effectiveness of the glasses. Results Mean unit consumption was 1.62 (SD ± 0.83) units in the labelled glass condition and 1.69 (SD ± 0.82) units in the non‐labelled glass condition. There were no significant effects of the labelled glasses on ad libitum alcohol consumption (95% CI ‐0.25 to 0.37, p = 0.35), despite participants (85%) noticing the information. Qualitative analysis of focus groups indicated that although participants perceived the glasses as a useful tool for increasing awareness of units and guidelines, they were viewed as limited in their potential to change drinking behaviour due to the unappealing design of the glass and a view that unit guidelines were not relevant to drinking patterns or contexts. Conclusions Labelled glasses did not change alcohol consumption in the current study, potentially due to ineffectiveness of this type of message in a young adult population. The information on the glasses was attended to, highlighting that glasses could be a feasible tool for providing information.
Article
Objectives: People with alcohol use disorders (AUD) are at a higher risk for physical co-morbidities. Consequently, their daily life functioning needs to be reliably assessed and followed-up. We examined the reliability of the 6-min walk test (6MWT) in a cohort of inpatients with AUD. Secondary aims were to assess minimal detectable changes (MDC95 ), practice effects and associations of the 6MWT with demographical and clinical variables. Methods: Two 6MWTs were administered within 3 days to 45 (32♂) inpatients with a DSM-5 diagnosis of AUD. Physical complaints before and after the 6MWT were recorded. Patients performed a standing broad jump to assess muscle strength and completed the International Physical Activity Questionnaire, the Positive Affect and Negative Affect Schedule (PANAS) and Alcohol Use Disorders Identification Test. Results: Patients walked 636.3 ± 82.3 meters and 638.1 ± 77.6 meters at the first and second test. The intraclass correlation coefficient was 0.94 (95% confidence interval 0.90-0.97). The MDC95 was 15 meters for men and 9 meters for women. No practice effect was detected. The presence of feet or ankle problems or pain before the test, dyspnea after the test, impaired muscle strength and lower PANAS positive affect scores were independently related to shorter 6MWT distance accounting for 67.3% of the variance. Conclusion: The 6MWT is a reliable tool for evaluating the functional exercise capacity in inpatients with AUD. Health care professionals should consider musculoskeletal and respiratory symptoms when interpreting fitness test outcomes in this vulnerable population.
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Background: Refugee populations are at substantial risk of developing substance use disorder (SUD) and other mental health disorders. At the same time, refugee populations face numerous barriers to accessing mental health services. Digital interventions can address some of these issues, as emerging evidence indicates that digital interventions offer an effective, low-cost alternative with high accessibility and similar efficacy as standard SUD prevention programs. As an add-on to traditional services, they further present a viable approach to the lack of personnel available for foreign language communication in preventive and therapeutic settings. In the present study, we thus aim to develop and evaluate a digital health intervention (DHI) for the reduction of substance use for young refugees with problematic use of alcohol and/or cannabis. The intervention will be implemented in a smartphone app, translated into Arabic, English, Farsi, German, and Pashto, and is to be used stand-alone. It is based on methods from cognitive behavioral therapy, contains culturally adapted elements, provides practical information on how to deal safely with alcohol and cannabis, and motivates behavior change through increased self-reflection and behavioral, cognitive, and emotional skills-training in interactive exercises. Methods: We conduct a single-armed feasibility trial among 150 young refugees with problematic use of alcohol and/or cannabis. Participants will receive a digital screening and digital health intervention (DHI) for the reduction of problematic substance use, carried out over a 4-week time frame. The primary outcomes are the intervention's feasibility and the target population's acceptance of the intervention. The secondary outcome is a change in substance use post-intervention from baseline. Measurements are taken pre-intervention (baseline), post-intervention (after 4 weeks), and at 3- and 6-month follow-ups. We expect the intervention to be feasible and accepted by the target group. Discussion: The present study will establish to what degree the digital intervention (the “BePrepared App”) is feasible and accepted by the target group. The evaluation of an easily accessible, feasible, and accepted intervention may impact refugees' mental health and health-related consequences. It aims at overcoming barriers to preventive health care in the substance use field for underserved refugee populations as a tool within a larger set of urgently needed interventions. Trial Registration: DRKS00021095 at the “German Clinical Trials Register” (30.03.2020).
Article
Die Wiedereingliederung ins Erwerbsleben stellt für arbeitslose, alkoholabhängige Rehabilitandinnen nach einer Entwöhnungsbehandlung eine besondere Herausforderung dar. Je weiter die Versicherten vom Arbeitsleben entfernt sind, desto schwieriger gestaltet sich die Wiedereingliederung. Welchen Einfluss hat die Arbeitslosigkeit eines Versicherten bei Aufnahme der Entwöhnungsbehandlung auf die Erwerbstätigkeit vier Jahre nach der Entwöhnungsbehandlung und wie unterscheiden sich hinsichtlich der Aufnahme einer sozialversicherungspflichtigen Tätigkeit erfolgreiche arbeitslose und nicht erfolgreiche arbeitslose Patientinnen nach der stationären Entwöhnungsbehandlung? In die Untersuchung wurden 661 Versicherte der DRV Braunschweig-Hannover einbezogen, die sich im Jahr 2015 einer stationären Entwöhnungsbehandlung wegen einer Alkoholabhängigkeit unterzogen haben. Für den Vergleich bei Aufnahme arbeitsloser und nicht arbeitsloser Patienten wurden Daten aus dem Versicherungskonto, insbesondere die Beitragszeiten aus versicherungspflichtiger Beschäftigung aus dem Jahr vor und den Jahren nach der Entwöhnungsbehandlung, Daten aus dem Entlassungsbericht sowie das Antragsverhalten einbezogen. Es wurden chi2-, t-Tests berechnet. Zur Vorhersage der Erwerbstätigkeit vier Jahre nach Entlassung wurde eine Regressionsanalyse durchgeführt. Die Nachhaltigkeit der beruflichen Reintegration vier Jahre nach Entlassung war von der Nähe zum Arbeitsmarkt vor der Entwöhnungsbehandlung abhängig. Ebenso entscheidend war, dass die berufliche Wiedereingliederung innerhalb des ersten Jahres gelang. Arbeitslose Frauen waren hinsichtlich der beruflichen Wiedereingliederung weniger erfolgreich. In der Nachbetreuung arbeitsloser Alkoholabhängiger muss die Stabilität der Wiedereingliederung vor dem Hintergrund der Abhängigkeitserkrankung und der Persönlichkeit des Patienten länger unterstützt werden.
Article
Background and Objectives: Previous research suggests that rumination acts as a mediating mechanism in the association between depression and drinking motives, particularly drinking to cope, as well as negative alcohol-related consequences. In this study, we tested the connections between depressive symptoms, rumination, drinking motives, alcohol consumption, and alcohol-related problems in a clinically depressed population (N = 209). Methods: Structural equation modeling was used to test the models. Specifications were based on the results of a previously evaluated model in a sample of college students. Results: The complex model showed a significant positive association between depressive symptoms and rumination. Drinking motives (enhancement and coping) were linked to more negative alcohol-related consequences. In a simplified model, pronounced depressive symptoms were associated with both increased ruminative thinking and more negative alcohol-related problems. Rumination was connected with stronger drinking motives (combined in one general factor), which were again associated with alcohol consumption and alcohol-related problems. Limitations: The use of self-report measures to determine diagnostic validity. Conclusions: In a clinically depressed sample, depressive symptoms were linked to increased negative alcohol-related consequences. This association was partially explained by rumination and drinking motives. However, rumination was less relevant than previous studies suggested.
Chapter
Bislang liegen keine allgemeingültigen Vorgaben für die Durchführung der psychosozialen/psychosomatischen Evaluation vor Adipositaschirurgie vor. Die präoperative Untersuchung durch einen in der Adipositasbehandlung erfahrenen Mental Health Professional sollte in jedem Fall ein klinisches Interview, die Diagnostik psychischer Symptome anhand standardisierter Fragebögen und die Sichtung bisheriger Befunde beinhalten. In diesem Kapitel werden Empfehlungen für die präoperative psychosoziale/psychosomatische Evaluation vor Adipositaschirurgie zusammengefasst, die sich an der bisherigen Forschungsliteratur und an der aktuellen S3-Leitlinie Chirurgie der Adipositas und metabolischer Erkrankungen der AWMF orientieren. Außerdem wird auf Aspekte der postoperativen Evaluation psychischer Probleme eingegangen.
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Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems. To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP). A diagnostic cross-sectional study. A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium. Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard. The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients. This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.
Article
After reviewing currently available diagnostic assessment instruments for substance use disorders this paper describes the format and structure of the Munich-Composite International Diagnostic Interview (M-CIDI) substance disorder section. In addition, the test-retest reliability of diagnoses and criteria for nicotine, alcohol, illegal and prescription drugs, is reported. Findings obtained in community sample of adolescents and young adults indicate that the substance section is acceptable for almost all types of respondents, efficient in terms of time and ease of administration as well as reliable in terms of consistency of findings over time. The test-retest reliability over a period of an average of 1 month, as examined by two independent interviewers indicates good-to-excellent kappa values for all substance disorders assessed, with significant kappa values ranging between 0.55 for drug abuse and 0.83 for alcohol abuse. There was also fairly consistently high agreement for the assessment of single DSM-IV diagnostic criteria for abuse and dependence as well as the M-CIDI quantity-frequency and time-related questions. To conclude, although - unlike previous studies - this study was conducted in a community sample and not in patients and used considerably longer time intervals of more than a month between investigations, our M-CIDI reliability findings are at least as high as those from previous studies.
Article
Earlier meta-analyses have not made a distinction between very brief (5- to 20-min) interventions and extended (several visits) brief interventions. Literature searches identified seven publications, comprising 14 data sets, meeting the inclusion criteria: sampling from primary care populations, random allocation to intervention and to control groups, and follow-up time 6-12 months. For very brief interventions, the change in alcohol consumption was not significant among men nor among women. For extended brief interventions, the pooled effect estimate of change in alcohol intake was -51 g of alcohol per week (95% confidence interval -74, -29) among women. Among men the estimate was of similar magnitude, but significant lack of statistical homogeneity implied that the summary estimate was not meaningful. Significant statistical heterogeneity was observed when data on very brief interventions among men and women were pooled. That was the case also for gamma-glutamyltransferase activity. Extended brief interventions were effective among women. Other brief interventions seem to be effective sometimes, but not always, and the average effect cannot be reliably estimated. The reasons for the lack of uniform effectiveness should be explored.
Article
Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta-analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points, and took into account the critical distinction between treatment-seeking and non-treatment-seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non-treatment-seeking samples (n = 34) and those comparing brief interventions with extended treatment in treatment-seeking samples (n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow-up points. At follow-up after > 3-6 months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.
Article
Efficient, inexpensive screening for early stage alcohol problems is important in health care settings. The Alcohol Use Disorders Identification Test (AUDIT) has been studied extensively to establish its value in this regard. A literature search that used EtOH as a database was conducted to identify studies published on the AUDIT through September 2001. Keywords used for the search were "Alcohol Use Disorders Identification Test" and "AUDIT." All studies reporting psychometric properties of the measure were reviewed with particular attention being given to the period 1996 and later. A small number of additional references were located by noting their citation in other studies reviewed. Although more research is needed on non-English versions to establish their psychometric properties, at least in its English edition, the AUDIT demonstrates sensitivities and specificities comparable, and typically superior, to those of other self-report screening measures. Test-retest reliability and internal consistency are also quite favorable. For males, the AUDIT-C, a shortened version of the AUDIT, appears approximately equal in validity to the full scale. Recent research continues to support use of the AUDIT as a means of screening for alcohol use disorders in health care settings in the United States.
Article
Most screening questionnaires are developed in clinical settings and there are few data on their performance in the general population. This study provides data on the area under the receiver-operating characteristic (ROC) curve, sensitivity, specificity, and internal consistency of the Alcohol Use Disorders Identification Test (AUDIT), the consumption questions of the AUDIT (AUDIT-C) and the Lübeck Alcohol Dependence and Abuse Screening Test (LAST) among current drinkers (n = 3551) of a general population sample in northern Germany. Alcohol dependence and misuse according to DSM-IV and at-risk drinking served as gold standards to assess sensitivity and specificity and were assessed with the Munich-Composite Diagnostic Interview (M-CIDI). AUDIT and LAST showed insufficient sensitivity for at-risk drinking and alcohol misuse using standard cut-off scores, but satisfactory detection rates for alcohol dependence. The AUDIT-C showed low specificity in all criterion groups with standard cut-off. Adjusted cut-points are recommended. Among a subsample of individuals with previous general hospital admission in the last year, all questionnaires showed higher internal consistency suggesting lower reliability in non-clinical samples. In logistic regression analyses, having had a hospital admission increased the sensitivity in detecting any criterion group of the LAST, and the number of recent general practice visits increased the sensitivity of the AUDIT in detecting alcohol misuse. Women showed lower scores and larger areas under the ROC curves. It is concluded that setting specific instruments (e.g. primary care or general population) or adjusted cut-offs should be used.
Article
The Alcohol Use Disorders Identification Test (AUDIT) was completed by 997 persons randomly selected from the general Swedish population (80% response rate). Eighteen per cent of the men and 5% of the women had hazardous or harmful alcohol use according to the > or =8 score criterion. AUDIT scores decreased with increasing age in both genders. Women are more sensitive to alcohol than men and when the cut-off score was set to > or =6, the female prevalence of hazardous or harmful alcohol use increased to nearly 11%. The 'binge drinking' question explained half of the total AUDIT variance and is thus the best item indicator of hazardous or harmful alcohol use in the test. Confirmatory and exploratory factor analyses revealed two AUDIT basic factors, the first three items defining a 'hazardous consumption' factor and the other seven items an 'alcohol-related problems' factor. Both the internal and test- retest reliability of the Swedish version of AUDIT were satisfactory. A table for converting raw scores to non-normalized T-scores for each combination of gender and three age intervals is presented.
Article
A number of different screening tests are frequently used in alcohol research, but our knowledge about the reliability of many of them is quite limited. Recently, this problem has received more attention. This article examines the test-retest reliability of one of these instruments-the Alcohol Use Disorder Identification Test (AUDIT)-in a general population sample. A general population sample (n = 457) was tested and, after approximately 1 month, was retested by using the AUDIT. Correlation between the two tests has been examined with the intraclass correlation coefficient and the kappa coefficient in analysis of dichotomous variables. Specificity and sensitivity at a number of different cutoff scores have also been analyzed by using the first test as a criterion. On the item level, the correlations ranged between 0.6 and 0.8. The overall reliability of total AUDIT scores was 0.84. When stratified by gender, age, and consumer status, the total score reliability approximated 0.80 for all the categories except low alcohol consumers (0.51). Agreement using the recommended cutoff score of 8+ was also examined. The reliability (kappa) observed in the whole sample was 0.691, which was interpreted as a substantial agreement. By this cutoff, 91% were correctly classified at retest compared with the first test. AUDIT 8+ showed higher reliability for males, young people, and moderate consumers and low reliability among low consumers. In terms of reliability, the most optimal cutoff for women turned out to be 6 or more. According to these results, the test-retest reliability of AUDIT is high. The next step might be to examine to what extent the findings apply within health-care settings, which is what the test originally was designed for.