Patterns of alcohol dependence in Thai drinkers: A differential item functioning analysis of gender and age bias
Highlights
► Little is known about the patterns of alcohol dependence in women and adolescents. ► Drinking despite physical/mental problems is more common in Thai women. ► Thai adolescents and men may endorse alcohol dependence criteria in the same way. ► Time spent drinking is common in Thai drinkers with severe alcohol dependence.
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.
Section snippets
Materials and methods
The protocol of 2008 Thai-NMH survey was approved by the Ethics Committee of the Department of Mental Health, Ministry of Public Health. Written informed consent was obtained from participants after the procedure had been fully explained.
Results
The 1-year prevalence rates of alcohol dependence were 1.4% in women and 13.7% in men. The prevalence rates were high in the age ranges of 25–34 years old (8.4%), 35–44 years old (7.4%) and 15–24 years old (5.9%).
Discussion
Compared with the direct comparison of item endorsement between groups (e.g., all criteria endorsed less frequently by women), the DIF analytic findings (e.g., some criteria endorsed more frequently by women) would be more reliable because the overall disease severity has been controlled. The study findings suggest that most alcohol dependence criteria are applicable across gender and age groups. However, Thai women but not Thai adolescents might endorse some criteria differently from their
Role of funding sources
The Department of Mental Health, Ministry of Public Health conducted the 2008 Thai-NMH survey. This study was supported by grant 54-03-011 form the Integrated Management for Alcohol Intervention Program (I-MAP), Thai Health Promotion Foundation. These agencies played no direct role in the design or conduct of the study, analysis and interpretation of the data, and did not review or approve this manuscript.
Contributors
All authors designed the protocol. MS had full access to all of the data in the study and takes responsibility for integrity of the data and accuracy of the data analysis. MS drafted the manuscript. All authors provided text revisions of the manuscript and have approved the final manuscript.
Conflict of interest
None.
Acknowledgments
Thank you to the survey team of the Department of Mental Health for collecting the data. Many thanks to Patraporn Tungpunkom for providing assistance with the confirmatory factor analysis.
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