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Dual Diagnosis Screening Interview to Identify Psychiatric Comorbidity in Substance Users: Development and Validation of a Brief Instrument

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Dual Diagnosis Screening Interview to Identify Psychiatric Comorbidity in Substance Users: Development and Validation of a Brief Instrument Research Report European Addiction Eur Addict Res 2014;20:41–48 Received: October 16, 2012 Research DOI: 10.1159/000351519 Accepted: April 15, 2013 Published online: August 1, 2013 Dual Diagnosis Screening Interview to Identify Psychiatric Comorbidity in Substance Users: Development and Validation of a Brief Instrument a a, b a, c, d Joan Ignasi Mestre-Pintó Antònia Domingo-Salvany Rocío Martín-Santos a, e, f Marta Torrens The PsyCoBarcelona Group (see Appendix) a b c Hospital del Mar Medical Research Institute (IMIM), CIBERESP, Department of Psychiatry, Hospital Clinic, IDIBAPS, d e f CIBERSAM, University of Barcelona, Institute of Neuropsychiatry and Addictions, Hospital del Mar, and Universitat Autònoma de Barcelona, Barcelona , Spain Key Words administration was 16.8 ± 2.5 min. Conclusion: The DDSI is a Psychopathology · Dual diagnosis · Screening · valid and easy-to-administer screening tool to detect possi- Dual Diagnosis Screening Instrument ble psychiatric comorbidity among substance users. Copyright © 2013 S. Karger AG, Basel Abstract Aim: The objective of this study was to develop and validate Introduction a brief tool, the Dual Diagnosis Screening Instrument (DDSI), to screen psychiatric disorders in substance users in treat- To identify psychiatric comorbidity among individu- ment and nontreatment-seeking samples. Methods: A total als with substance use disorders (SUDs) is an area of of 827 substance users (66.5% male, mean age 28.6 ± 9.9 great clinical and public health interest. Drug users with years) recruited in treatment (in- and outpatient) and non- other psychiatric comorbid disorders have more emer- treatment (substance user volunteers in university research gency admissions, higher prevalence of suicide, medical studies) settings were assessed by trained interviewers using conditions (e.g. HIV and HCV infection) and social the DDSI and the Psychiatric Research Interview for Sub- problems than those who have only SUDs or other psy- stance and Mental Disorders (PRISM) as the criterion stan- chiatric diagnoses [1] . Moreover, the treatment of SUD dard. Both instruments were administered blind to the re- patients with comorbid psychiatric disorders is consid- sults of the other. Disorders obtained with the DDSI were ered more complex and with poorer prognosis [2] . Thus, compared to lifetime diagnoses obtained with the PRISM. the correct detection of other psychiatric conditions Sensitivity, specificity, negative, and positive predictive val- among substance users is crucial to adequately manage ues were estimated. Also test-retest reliability of the DDSI was these patients. assessed. Results: The DDSI showed a high sensitivity ( ≥ 80%) Among others (e.g. Semi-Structured Assessment for for identifying lifetime depression, mania, psychosis, panic, Drug Dependence and Alcoholism (SSADDA) [3] ), the social phobia, and specific phobia disorders. Specificity was Psychiatric Research Interview for Substance and Mental ≥ 82% for those diagnoses. Test-retest κ showed excellent Disorders (PRISM) is an interview specifically designed agreement (range 81–95%). The mean duration of the DDSI to evaluate psychiatric comorbidity among substance us- © 2013 S. Karger AG, Basel Marta Torrens 1022–6877/14/0201–0041$39.50/0 Institute of Neuropsychiatry and Addiction Hospital del Mar Passeig Marítim 25–29 E-Mail [email protected] ES–08003 Barcelona (Spain) www.karger.com/ear E-Mail mtorrens @ imim.es Downloaded by: T. Marta - 177062 193.144.6.107 - 8/6/2013 11:32:28 AM ers that has shown good psychometric properties in terms Table 1. Correspondence between PRISM diagnoses and DDSI of validity [4] and reliability [5, 6] . Although the PRISM disorders could be considered as a gold standard to evaluate psychi- PRISM DDSI atric comorbidity among substance users, its use is pri- marily meant for research purposes. Its administration in Depression Depression routine practice in community health facilities is often Induced depression not feasible, due to its length and the need of a trained Dysthymia Dysthymia professional to administer it. Furthermore, in the context of new scenarios, beside traditional out- and inpatient fa- Manic episode Mania Bipolar I disorder cilities, where substance users are managed, there is a Hypomanic episode need of valid screening instruments to detect co-occur- ring psychiatric disorders among people with SUDs [7] . Schizophrenia Psychosis Schizophreniform disorder At present different screening instruments for psychi- Schizoaffective disorder atric diagnoses are available, but few have been developed Delusional disorder and validated to evaluate psychiatric comorbidities among Brief psychotic disorder subjects with SUDs. The Mini-International Neuropsy- Psychotic disorder not chiatric Interview (MINI) and its short version [8] the Pri- otherwise specified mary Care Evaluation of Mental Disorders (PRIME-MD) Induced psychosis [9] , and the SDDS-PC [10] have not been validated in sub- Panic disorder with/without stance-abusing populations. Moreover, the performance agoraphobia Panic disorder of the Psychiatric Diagnostic Screening Questionnaire Agoraphobia Agoraphobia (PDSQ) [11] was assessed among a sample of 1,000 psy- Simple phobia Simple phobia chiatric outpatients but only 13% of them had a SUD, mostly alcohol-use disorders. Later the PDSQ was vali- Social phobia Social phobia dated in different samples of substance users with contro- Generalized anxiety disorder Generalized anxiety disorder versial results [12–14] . The Boston Consortium of Servic- Posttraumatic stress disorder Posttraumatic stress disorder es for Families in Recovery (BCSFR) instrument [15] was tested only in female substance abusers and was found to Attention deficit hyperactivity Attention deficit hyperactivity disorder disorder be a useful screening instrument for detecting posttrau- matic stress disorder (PTSD) in women beginning treat- ment, but not for detecting other mental illnesses. The Pa- tient Health Questionnaire (PHQ) [16] has only been val- idated for depression in substance users [17] . Others like cluding Spanish. In a preliminary study, we assessed the the Mental Health Screening Form (MHSF-III) have lim- validity of the Spanish version of the S-CIDI for detect- ited validation [18] or have been validated in prison sub- ing lifetime psychiatric disorders in substance abusers, stance-abuse treatment programs, as the Co-Occur- using the DSM-IV-TR diagnoses obtained by the PRISM ring Disorders Screening Instruments (CODSI-MD and ( table 1 ) as the criterion standard. The sensitivity of the CODSI-SMD) [19] . S-CIDI interview ranged from 50% (psychosis) to 100% In such a context, we decided to study the validity of (depression, panic disorder, and simple phobia) and the the screening section of the World Health Organization’s specificity ranged from 11% (depression) to 74% (psy- Composite International Diagnostic Interview (S-CIDI). chosis) [21] . Such poor results did not support the use of This instrument was used in the European Study on Epi- S-CIDI as a screening instrument to detect psychiatric demiology of Mental Disorders (ESEMeD), which is part disorders among substance users. To improve the psy- of the World Mental Health (WMH) study [20] . A posi- chometric properties of S-CIDI, a number of modifica- tive response to any of the screening questions leads to tions were introduced, leading to the development of the the completion of the CIDI section for the specific disor- Dual Diagnosis Screening Instrument (DDSI) presented der prompted by that question. The S-CIDI was first de- in this paper. veloped in English and underwent a rigorous process of The purpose of the present study was to develop and adaptation in order to obtain conceptually and cross-cul- determine the validity of the DDSI to detect lifetime psy- turally comparable versions in different languages, in- chiatric disorders among a wide range of substance users, 42 Eur Addict Res 2014;20:41–48 Mestre-Pintó et al. DOI: 10.1159/000351519 Downloaded by: T. Marta - 177062 193.144.6.107 - 8/6/2013 11:32:28 AM both in treatment (in- and outpatients) and nontreat- duced disorders, and primary disorders. Interviewers received an ment settings (substance user volunteers in university re- intensive training course of approximately 60 h, of which 20 h were on-site. search studies), compared with DSM-IV-TR diagnoses assessed by the PRISM as the criterion standard. Development of the DSSI The DDSI was developed from an adaptation of the S-CIDI. The original interview S-CIDI was progressively modified by intro- M e t h o d s ducing, removing and changing some questions and the subsequent adaptation of diagnostic algorithms. Changes were conducted to tighten the assessment criteria while attempting to maintain its The study was approved by the Ethical Committee of Clinical brevity and quick administration. These modifications reached a Research of the Institution (No. 2005/2148/I). All subjects who consensus in periodical multidisciplinary meetings, where the pre- participated signed their informed consent to participate after re- liminary results were evaluated taking into account DSM-IV-TR ceiving oral and written information about the study. criteria and the expertise of the group members. Subsequent ver- sions (S-CIDI-Tox v1 to S-CIDI-Tox v4 and DDSI) were adminis- Participants tered in succession during the 5-year duration of the study. For ex- A total of 827 substance users subsequently recruited for oth- ample, to achieve better results for psychosis
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