The performance of the Alcohol Use Disorder Identification Test (AUDIT) in detecting alcohol abuse and dependence in a population of depressed or anxious persons

BACKGROUND: Alcohol use disorders are highly prevalent but often remain unrecognized among depressed and/or anxious persons. This study examines the performance of the Alcohol Use Disorder Identification Test (AUDIT) in detecting alcohol abuse and dependence in this high-risk group and compares it to that in healthy controls.

METHODS: Data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 1756 persons with a past-year depressive and/or anxiety disorder and 648 persons without a lifetime depressive and anxiety disorder. The performance of the AUDIT was compared against the gold standard of a CIDI-based diagnosis of past-year alcohol abuse or dependence by means of sensitivity, specificity and areas under receiver operating characteristic curves (AUCs).

RESULTS: The AUDIT accurately detected alcohol dependence in depressed and/or anxious men (AUC=0.89) and women (AUC==0.88), with detected cut-off points of ≥9 and ≥6, respectively, comparable to that in healthy controls (men: AUC=0.89; women: AUC=0.94). However, the overall accuracy in detecting alcohol abuse was limited in depressed/anxious men (AUC=0.74) and women (AUC=0.78) and no adequate cut-off points with both acceptable sensitivity and specificity could be identified.

LIMITATIONS: Persons with a primary diagnosis of an addiction disorder were excluded and therefore the sample may not be fully representative of the most severely addicted patients.

CONCLUSIONS: These findings confirm the accuracy of the AUDIT in detecting alcohol dependence, but not alcohol abuse, in depressed and/or anxious persons. Screening for alcohol dependence in this high-risk group could improve identification of persons suffering from this impairing comorbid condition.