Psychometric performance of DSM-IV alcohol use disorders in young adulthood: evidence from an Australian general...

The current study investigates the performance of alcohol use disorders in young adults using item response theory and differential item functioning (DIF).

The 1997 National Survey of Mental Health and Wellbeing (Australia) sample was based on a stratified, multistage area probability sample of people ages 18 years and older in the Australian population. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol use disorders were assessed in all current alcohol users (N = 7,746; 44.2% female). The psychometric properties of the DSM-IV alcohol use disorder criteria in young adults were assessed using item response theory. Age-based DIF was also assessed in each of the DSM-IV criteria for alcohol use disorders. The presence of age-based DIF in subgroups defined by sex and consumption was also examined.

Overall, problems were identified in the use in hazardous situations, persistent desire/inability to quit/cut down, and tolerance criteria in young adults. However, the DIF identified at the criterion level had little impact on total information provided by the criteria across the two age groups. Subgroup analyses indicated that for the female-only and non-heavy using subgroups, DIF was no longer detected in the use in hazardous situations criterion. The alcohol use disorder criteria were found to provide maximum information about moderate to severe pathology among young adults. There was little evidence for the DSM-IV abuse/dependence distinction in young adulthood.

Some of the DSM-IV alcohol use disorder criteria appear problematic when applied to young adults, and future research needs to focus on clarifying young adults' understanding of these problematic criteria. Although DIF was identified in three of the alcohol use disorder criteria, the total information provided by these criteria was largely the same among younger and older age groups.