Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network.
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2011-11
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BACKGROUND:This study applied item response theory (IRT) and latent class analysis (LCA) procedures to examine the dimensionality and heterogeneity of comorbid substance use disorders (SUDs) and explored their utility for standard clinical assessments, including the Addiction Severity Index (ASI), HIV Risk Behavior Scale (HRBS), and SF-36 quality-of-life measures. METHODS:The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the U.S. National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from inpatient and outpatient addiction treatment settings at 12 programs. Data were analyzed by factor analysis, IRT, LCA, and latent regression procedures. RESULTS:A two-class LCA model fit dichotomous SUD data empirically better than one-parameter and two-parameter IRT models. LCA distinguished 10% of severe comorbid opioid-dependent individuals who had high rates of all SUDs examined-especially amphetamine and sedative abuse/dependence-from the remaining 90% who had SUDs other than amphetamine and sedative abuse/dependence (entropy=0.99). Item-level results from both one-parameter and two-parameter IRT models also found that amphetamine and sedative abuse/dependence tapped the more severe end of the latent poly-SUD trait. Regardless of whether SUDs were defined as a continuous trait or categorically, individuals characterized by a high level of poly-SUD demonstrated more psychiatric problems and HIV risk behaviors. CONCLUSIONS:A combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.
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Wu, Li-Tzy, Walter Ling, Bruce Burchett, Dan G Blazer, Chongming Yang, Jeng-Jong Pan, Bryce B Reeve, George E Woody, et al. (2011). Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network. Drug and alcohol dependence, 118(2-3). pp. 186–193. 10.1016/j.drugalcdep.2011.03.018 Retrieved from https://hdl.handle.net/10161/19984.
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Scholars@Duke
Li-Tzy Wu
Education/Training:
Pre- and post-doctoral training in mental health service research, psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns Hopkins University School of Public Health
Fellow of the NIH Summer Institute on the Design and Conduct of Randomized Clinical Trials
Daniel German Blazer
I am currently semi-retired. Most of my recent work has been focused on roles with the National Academy of Medicine (former Institute of Medicine). I have chaired three committees during the past four years, one on the mental health and substance use workforce, one on cognitive aging, and one on hearing loss in adults. I currently also chair the Board on the Health of Select Populations for the National Academies.
In the past I have been PI on a number of research projects, including the Epidemiologic Catchment Area Study, and the Clinical Research Center for Late Life Depression. More recently I have been involved with five research projects. The first, the Established Populations for Epidemiologic Study of the Elderly (EPESE), included a study demonstrating that sleep complaints are more frequent in white compared to blacks, even when relevant demographic variables are controlled. In a second study, day-time napping was a significant predictor of mortality. A third study in the Piedmont of North Carolina revealed no difference in utilization or satisfaction with health services when urban elders were compared with rural elders. In a fourth study, self-rated health was not as strong a predictor of mortality, as has been found in previous studies, especially when controlling for important covariates.
A second research endeavor has been with the National Comorbidity Study. I led investigators who demonstrated that the prevalence of major depression is higher than previously estimated in national samples of persons between the ages of eighteen and fifty-five in the community and discussed the methodological issues that may contribute to this differing estimate. The risk-factor profile of pure major depression was compared with comorbid major depression. I will continue in this research during 1994/95 to look at Seasonal Affective Disorders (SAD).
I have also worked with my colleague Litzy Wu ScD in the study of substance use disorders and have published a number of papers related to substance use in the elderly. I also work closely with my colleague Celia Hybels, PhD looking at trajectories of depressive symptoms in older adults over time.
I spent considerable time during 1994/97 working on four books. I co-edited the second edition of Geriatric Psychiatry, to be published in the late winter of 1994 or early spring of 1995. I am working on a single author book, Freud vs. God: The End of the Debate/How Psychiatry Lost Its Soul and Christianity Lost Its Mind and on a research methods textbook for clinical psychiatry research. I have produced a second edition of Emotional Problems in Later Life. Since then our Textbook of Geriatric Psychiatry has gone through three additional editions and I published (based on my work during a sabbatical at the Center for Advanced Studies of Behavioral Sciences at Stanford) The Age of Melancholy (for which I received the Oscar Pfister Award from the American Psychiatric Association).
Bryce B. Reeve
Dr. Bryce Reeve is a Professor of Population Health Sciences and Professor of Pediatrics at Duke University School of Medicine. He also serves as Director of the Center for Health Measurement since 2017. Trained in psychometric methods, Dr. Reeve’s work focuses on assessing the impact of disease and treatments on the lives of patients and their caregivers. This includes the development of clinical outcome assessments using both qualitative and quantitative methods, and the integration of patient-centered data in research and healthcare delivery settings to inform decision-making. From 2000 to 2010, Dr. Reeve served as Program Director for the U.S. National Cancer Institute and oversaw a portfolio of health-related quality of life research in cancer patients. From 2010 to 2017, he served as Professor of Health Policy and Management at the University of North Carolina. From 2011-2013, Dr. Reeve served as President of the International Society for Quality of Life Research (ISOQOL). In 2015, he received the John Ware and Alvin Tarlov Career Achievement Prize in Patient-Reported Outcomes Measures. In 2017, 2018, 2019, 2021, 2022, and 2023, he was ranked in the top 1% most-cited in his respective field over the past 11-year period.
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