Validation of the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in acute psychiatric inpatients. / Validación de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) en pacientes con trastorno psiquiátrico ingresados en una unidad de agudos.

The aims of this study were to examine the psychometric properties of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in psychiatric inpatients, due to the scarcity of screening instruments validated in this population. Patients from Hospital Clínic's psychiatric ward (n = 202) completed: ASSIST, Addiction Severity Index (ASI), MINI-International Neuropsychiatric Interview (MINI), Alcohol Use Disorders Identification Test (AUDIT), Fagerström Test for Nicotine Dependence (FTND), Severity of Dependence Scale (SDS), and Drug Abuse Screening Test (DAST). Reliability and validity evidences based on internal structure (Exploratory and Confirmatory Factor Analyses) and on the relation to other variables were obtained. Excellent internal consistency was found for Total Substance Involvement (TSI) (α = .92 and ω = .93) and for Specific Substance Involvement (SSI) scores (α = .88 - .96 and ω = .89 - .95). Analysis of internal structure for tobacco, alcohol and cannabis subscales resulted in unidimensional models with adequate goodness-of-fit indices. ASSIST scores were significantly correlated with those of ASI (r = .795 to r = .953), AUDIT (r = .864), FTND (r = .808), DAST (r = .831), SDS (r = .519) and with "number of diagnoses of abuse/dependence" in MINI-Plus (TSI: r = .857 to r = .862; SSI: r = .646 to r = .834). Receiver operating characteristic analysis (ROC) and Mann-Whitney's U test found good discriminative validity evidences. ASSIST scores showed good reliability and there were validity evidences that support its use for identifying risk levels of tobacco, alcohol and other substance use in psychiatric patients.

Los objetivos fueron examinar las propiedades psicométricas de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) en pacientes con trastorno psiquiátrico. Un total de 202 pacientes ingresados en psiquiatría del Hospital Clínic completaron: ASSIST, Índice de gravedad de la adicción (ASI), MINI-Entrevista Neuropsiquiátrica Internacional (MINI), cuestionario de identificación de los trastornos debidos al consumo de alcohol (AUDIT), Test de Fagerström (FTND), Escala de gravedad de la dependencia (SDS) y Prueba de detección de abuso de drogas (DAST). Se obtuvieron la fiabilidad y evidencia de validez de la estructura interna (análisis factorial exploratorio/confirmatorio) y de la relación con otras variables. Se encontró excelente consistencia interna en puntuaciones de riesgo total (TSI) (α = ,92 y ω = ,93) y de cada sustancia (SSI) (α = ,88 - ,96 y ω = ,89 - ,95). La estructura interna de tabaco, alcohol y cannabis resultó en modelos unidimensionales con índices de bondad de ajuste adecuados. Las puntuaciones del ASSIST correlacionaron significativamente con: ASI (r = ,795 a r = ,953), AUDIT (r = ,864), FTND (r = ,808), DAST (r = ,831), SDS (r = ,519) y «número de diagnósticos de abuso/dependencia¼ en MINI-Plus (TSI: r = ,857 - ,862; SSI: r = ,646 - ,834). El análisis de curva ROC y U de Mann-Whitney mostraron evidencias de validez discriminativa. Las puntuaciones del ASSIST tienen buena fiabilidad y existen evidencias de validez para su uso en la detección del nivel de riesgo de consumo de tabaco, alcohol y sustancias en pacientes con trastorno psiquiátrico.

Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation in the Spanish population.

BACKGROUND: Psychosocial risk factors influence the course of transplantation. Psychosocial evaluation is an important part of pre-transplantation evaluation processes, yet there are no standardized instruments in Spanish. OBJECTIVE: To translate, adapt, and test the reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in organ and cell transplantation patients in the Spanish context. METHOD: A Spanish version was developed and adapted using WHO's guidelines. The first 30 candidates' SIPAT interviews were recorded and scored by four independent examiners to test the inter-rater reliability. The internal consistency of the SIPAT items was calculated with a sample of 150 heart, liver, and allogeneic haematopoietic stem cell transplant candidates. Evaluations were conducted by SIPAT-trained and transplantation-experienced clinical psychologists and psychiatrists. RESULTS: Stanford Integrated Psychosocial Assessment for Transplantation achieved excellent intra-class correlation reliability coefficients between investigators (ICC = 0.93 for the general score and from 0.77 to 0.94 for domain scores). Good internal consistency was found with Cronbach's alpha of 0.84 (from 0.69-0.71 for domains). DISCUSSION: This study presents the translated and adapted version of SIPAT. It has been found to have strong inter-rater reliability and good internal consistency. Further research is needed to confirm reliability (eg, test-retest) and establish its validity (eg, concurrent, predictive).

Active Smoking Before Liver Transplantation in Patients with Alcohol Use Disorder: Risk Factors and Outcomes.

Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and after liver transplant (LT). An observational retrospective cohort study with 314 ALD patients undergoing LT from January 2004 to April 2016. Recipients were followed until April 2017 or death. Kaplan-Meier and Cox proportional hazards regression analyses were used to assess risk of mortality according to smoking status before LT. Smokers had a 79% higher risk of dying than those who had never smoked or quit smoking before LT. Ex-smokers had a greater survival probability (96.2%, 93.8%, 86.9%, and 83.1% at 1, 3, 5, and 10 years after LT) than active smokers until LT (96.0%, 85.6%, 80.0%, and 70.4%). Active smokers before LT with poor toxicity awareness had more than a twofold higher risk of mortality (Cox HR = 2.20, 95% CI: 1.05-4.58, p = 0.04) than ex-smokers. Younger age (OR = 94), higher Model for End-Stage Liver Disease (MELD) (OR = 1.06), and comorbid substance use disorder (OR = 2.35) were predictors of smoking until LT. Six months or less of alcohol abstinence (OR = 3.23), and comorbid substance use disorder (OR = 4.87) were predictors of active smoking after LT. Quitting smoking before transplantation improved survival. Evidence based smoking cessation interventions should be offered before and after LT.

Validación de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) en pacientes con trastorno psiquiátrico ingresados en una unidad de agudos / Validation of the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in acute psychiatric inpatients

Los objetivos fueron examinar las propiedades psicométricasde la prueba de detección de consumo de alcohol, tabaco ysustancias (ASSIST) en pacientes con trastorno psiquiátrico. Untotal de 202 pacientes ingresados en psiquiatría del Hospital Clíniccompletaron: ASSIST, Índice de gravedad de la adicción (ASI), MINIEntrevista Neuropsiquiátrica Internacional (MINI), cuestionariode identificación de los trastornos debidos al consumo de alcohol(AUDIT), Test de Fagerström (FTND), Escala de gravedad de ladependencia (SDS) y Prueba de detección de abuso de drogas(DAST). Se obtuvieron la fiabilidad y evidencia de validez de laestructura interna (análisis factorial exploratorio/confirmatorio) yde la relación con otras variables. Se encontró excelente consistenciainterna en puntuaciones de riesgo total (TSI) (α = ,92 y ω = ,93) y decada sustancia (SSI) (α = ,88 - ,96 y ω = ,89 - ,95). La estructura internade tabaco, alcohol y cannabis resultó en modelos unidimensionalescon índices de bondad de ajuste adecuados. Las puntuaciones delASSIST correlacionaron significativamente con: ASI (r = ,795 a r =,953), AUDIT (r = ,864), FTND (r = ,808), DAST (r = ,831), SDS (r =,519) y «número de diagnósticos de abuso/dependencia» en MINIPlus (TSI: r = ,857 - ,862; SSI: r = ,646 - ,834). El análisis de curva ROCy U de Mann-Whitney mostraron evidencias de validez discriminativa.Las puntuaciones del ASSIST tienen buena fiabilidad y existenevidencias de validez para su uso en la detección del nivel de riesgode consumo de tabaco, alcohol y sustancias en pacientes con trastornopsiquiátrico. (AU)

The aims of this study were to examine the psychometric propertiesof The Alcohol, Smoking and Substance Involvement Screening Test(ASSIST) in psychiatric inpatients, due to the scarcity of screeninginstruments validated in this population. Patients from HospitalClínic’s psychiatric ward (n = 202) completed: ASSIST, AddictionSeverity Index (ASI), MINI-International Neuropsychiatric Interview(MINI), Alcohol Use Disorders Identification Test (AUDIT),Fagerström Test for Nicotine Dependence (FTND), Severity ofDependence Scale (SDS), and Drug Abuse Screening Test (DAST).Reliability and validity evidences based on internal structure(Exploratory and Confirmatory Factor Analyses) and on the relationto other variables were obtained. Excellent internal consistency wasfound for Total Substance Involvement (TSI) (α = .92 and ω = .93)and for Specific Substance Involvement (SSI) scores (α = .88 - .96 andω = .89 - .95). Analysis of internal structure for tobacco, alcohol andcannabis subscales resulted in unidimensional models with adequategoodness-of-fit indices. ASSIST scores were significantly correlatedwith those of ASI (r = .795 to r = .953), AUDIT (r = .864), FTND (r =.808), DAST (r = .831), SDS (r = .519) and with “number of diagnosesof abuse/dependence” in MINI-Plus (TSI: r = .857 to r = .862; SSI: r =.646 to r = .834). Receiver operating characteristic analysis (ROC) andMann-Whitney’s U test found good discriminative validity evidences.ASSIST scores showed good reliability and there were validityevidences that support its use for identifying risk levels of tobacco,alcohol and other substance use in psychiatric patients. (AU)