Rasch analysis of alcohol abuse and dependence diagnostic criteria in persons with spinal cord injury

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Study examined the dimensionality and other psychometric characteristics of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria for alcohol use disorders (AUD) in individuals with spinal cord injury (SCI). The objective was to determine whether AUDs should be conceptualized categorically as abuse and dependence as in the DSM-IV or on a single continuum with mild-to-severe category ratings as in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). Data from 379 individuals who sustained SCI either traumatically or non-traumatically after the age of 18 and were at least 1 year post injury. Rasch analyses used the alcohol abuse and dependence modules of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition. Fifty-seven percent of the entire sample endorsed criteria for alcohol abuse, and 25 percent endorsed criteria for alcohol dependence. Fit values were generally acceptable except for one item, suggesting that the items fit the expectation of unidimensionality. Examination of the principal components analysis did not provide support for unidimensionality. The item-person map illustrates poor targeting of items. Alcohol abuse and dependence criterion appear to reflect a unidimensional construct, a finding that supports a single latent construct or factor consistent with the DSM-5 diagnostic model.

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