Patterns of alcohol dependence in Thai drinkers: A differential item functioning analysis of gender and age bias

Abstract

In Caucasians, the patterns of alcohol use disorders in women and adolescents are likely to be different from those in men and adults, respectively. The authors examined these differences in a Southeast Asian sample of Thai people living in communities. A two-parameter logistic model of the IRT log-likelihood-ratio (IRTLR) test for differential item functioning (DIF) procedure was used. Participants were a subsample of 3718 current drinkers participating in the 2008 Thai National Mental Health Survey (n = 17,140). The 1-year prevalence rates of alcohol dependence were 1.4% in women and 13.7% in men. Based on the Mini International Neuropsychiatric Interview (MINI), alcohol dependence and abuse module, all current drinkers were interviewed for a yes/no response to each of seven alcohol dependence criteria. Confirmatory factor analysis suggested a single-factor model of alcohol dependence criteria (χ2 = 211.51, RMSEA = 0.06, SRMR = 0.03 and CFI = 0.96). Compared with 3174 men, 544 women had a significantly higher threshold estimate for quit/control problems and a lower threshold value for drinking despite physical/mental problems (b parameter difference of 0.25 and − 0.30, respectively). Thai adolescents (n = 272) and Thai adults (n = 3446) had no statistically significant DIF on any criterion. The criterion of time spent drinking had significantly high discrimination estimates in women, men, adolescent and adults (a parameters of 2.50, 2.08, 2.33 and 2.16, respectively). Gender bias on alcohol dependence criteria can be found in Thai drinkers. Time spent drinking may be the most useful criterion for discriminating the severity of alcohol dependence across age and gender groups of Thai drinkers.

Introduction

The Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) criteria for alcohol use disorders are widely accepted in medical practice, epidemiological studies and clinical research. Although these criteria base on the conceptual framework of Edwards and Gross proposing 30 years ago, they are still supported by advances in biological and behavioral sciences (Edwards and Gross, 1976, Li et al., 2007).

Alcohol use and problems in women are likely to be different from those in men. Women may carry a lower genetic risk for alcohol use disorders and tend to suffer more negative biological effects from drinking as compared with men (Nolen-Hoeksema & Hilt, 2006). Men are more likely than women to have certain psychosocial risk factors for alcohol use and problems, e.g., fewer perceived social sanctions for drinking, positive expectancies for alcohol use (Nolen-Hoeksema & Hilt, 2006). These findings have helped to explain some gender differences in alcohol use disorders, for example, the much higher rate of alcohol use disorders among men as compared with women.

The pattern of alcohol use disorders in adolescents may be different from that in adults. Some of those are (i) a low prevalence rate of alcohol dependence; (ii) common problem of tolerance and larger/longer drinking than intended and (iii) a relatively uncommon symptom of withdrawal (Clark, 2004). Some findings also suggest that the criteria of tolerance and larger/longer drinking than intended may not be valid in this subpopulation (Hasin et al., 2003).

Several lines of evidence have shown that gender and age may affect the symptom patterns of alcohol use disorders. In a study, women were found to endorse a criterion of hazardous use less frequently than men (Harford, Yi, Faden, & Chen, 2009). In the same study, adolescent men were most likely to report tolerance but least likely to have quit/control problems. In a study of female drinkers, adolescents endorsed hazardous use less frequently but reported larger/longer drinking than intended more often than emerging adults (Duncan et al., 2011). Such evidence suggests that most criteria of alcohol use disorders are applicable across subpopulations, but some of them should be used with caution in women and adolescents.

Studies of alcohol use disorders in Asian women and adolescents should be a priority area of research. Together with the Americas, South-East Asia and Western Pacific regions are areas with highest prevalence of alcohol use disorders in the world (Rehm et al., 2009). Recent alcohol studies also showed a rapid growth in the number of drinking females, the greater severity of alcohol damage in women and the need of gender-targeted interventions (Mancinelli, Binetti, & Ceccanti, 2007). Compared with many traditional risk factors (e.g., tobacco, cholesterol, hypertension), the age profile of alcohol-attributable disease burden is shifted toward younger population (Rehm et al., 2009). While the evidence of alcohol use disorders in Caucasian women and adolescents is limited, this problem is even worse in Asian subpopulations.

Previous findings suggest that there may be gender and age differences in drinking patterns and drinking consequences in Thai people (Assanangkornchai, Sam-Angsri, Rerngpongpan, & Lertnakorn, 2010). While continual drinking is a common pattern of alcohol dependence in Thai men (Assanangkornchai, Saunders, & Conigrave, 2000), little has been known about the drinking patterns in Thai women and adolescents. In this study, we proposed to use a DIF approach to differentiate the criterion patterns of alcohol dependence in this South-East Asian sample. The subsamples being compared were: i) Thai women and Thai men and ii) Thai adolescents (aged between 15 and 17 years) and Thai adults (aged between 18 and 59 years). This cut-point was applied because the minimum legal drinking age for Thais is 18 years old.