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Title: Subthreshold DSM-IV alcohol dependence: Exploring the general health and well being of 'diagnostic orphans' in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
Author: McBride, OrIa
ISNI:       0000 0001 3622 5998
Awarding Body: University of Ulster
Current Institution: Ulster University
Date of Award: 2008
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A 'diagnostic orphan' experiences one or two criteria ofalcohol dependence but fails to meet the diagnostic threshold for a DSM-IV alcohol use disorder (AUD). Few epidemiologic studies to date have explored the clinical significance of this subthreshold psychiatric condition. Research investigations of other subthreshold disorders, however, suggest that diagnostic orphans are likely to be prevalent in the general population. Moreover, diagnostic orphans may experience significant psychosocial impairment and diminished levels ofhealth-related quality oflife (HRQoL). This thesis explored these issues by using a variety of sophisticated statistical techniques to analyze data from the 2001-2002 NESARC. Individuals experiencing one-criterion ofalcohol dependence (one-criterion orphans) were three times more common than those experiencing two-criteria (two-criterion orphans). Collectively, diagnostic orphans were nearly twice as prevalent as individuals with AUDs. Analysis ofretrospective lifetime data suggested that diagnostic orphan status might be a prodromal phase to an AUD. One-criterion orphans experienced poorer HRQoL and higher levels ofpsychosocial impairment compared to those with no-AUD or alcohol abuse. Two-criterion orphans had higher estimates ofheavy and binge drinking compared to their one-criterion counterparts. The alcohol dependence group and two-criterion orphans had poorer mental health compared to one-criterion orphans. One-criterion orphans were more likely to report wanting to cut down on or stop drinking, whereas two-criterion orphans frequently endorsed symptoms relating to withdrawal. This thesis highlighted the importance ofexploring an entire spectrum of alcohol use problems. Many questions relating to the long-term course of diagnostic orphan status in the general population have been raised. Longitudinal research is needed to identify specific characteristics that differentiate those diagnostic orphans who remit from their subthreshold symptoms from those who progress to AUDs. Subsequently, the development of cost-effective intervention strategies, designed to lower the proportion ofdiagnostic orphans progressing to more severe alcohol problems, may be appropriate.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available