CAGE Questionnaire Research Articles

A Reliability Induction and Reliability Generalization Study of the Cage Questionnaire

The CAGE is a commonly used alcohol screening instrument. Although considerable work has been done on the validity of CAGE scores, relatively little information is available on their reliability. Reliability induction and generalization studies were performed for the CAGE. Of the 259 studies available for analysis, only 19 (7.3%) contained reliability information for the sample scores. Thirteen (5.0%) and 227 (87.6%) articles made what are designated as reliability induction by report and reliability induction by omission. The median internal consistency reliability across 22 samples was .74, with a range of .52 to .90. Sample age was the only identified sample characteristic that demonstrated a statistically significant relationship with CAGE score reliability.

The psychosocial work environment and alcohol dependence: a prospective study

Aims: To examine whether a stressful psychosocial work environment predicts alcohol dependence. Methods: Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985–88) was...

Asking about quantity and frequency of alcohol consumption before asking the CAGE questions produces lower ratings on the CAGE test

Background: We tested whether asking about alcohol consumption before asking the CAGE questions modified the answers to the CAGE test. Methods: Randomized trial on a smoking cessation website, in English, in 2003. Half the participants began by answering questions on quantity and frequency of alcohol consumption and then, on a second web page, answered the CAGE questionnaire (format A). The other half answered first the CAGE and then questions on quantity and frequency (format B). Results: The survey was answered by 1213 people. Fewer people gave positive answers to three of the four CAGE questions in format A than in format B. Cut-down, 32% versus 38% ( P=0.01); annoyed, 13% versus 18% ( P=0.02); eye-opener, 5% versus 8% ( P=0.02). Fewer people had a CAGE score ≥2, indicating possible alcoholism, in format A than in format B (26% versus 32%, P=0.04). This effect was stronger in men (CAGE≥2, format A, 29%; format B, 39%; P=0.03), and it was not statistically significant in women (CAGE≥2, format A, 25%; format B, 28%; P=0.4). Conclusion: In an internet survey, asking questions about the quantity and frequency of alcohol consumption before asking the CAGE questionnaire produced fewer positive answers to the CAGE. This effect was observed only in men.

Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire.

The HIV epidemic has been consistently associated with injection drug use and crack cocaine, but alcohol problems in HIV-infected persons are less well described. Our objectives were 2-fold: (1) to assess the prevalence of alcohol problems in HIV-infected patients initiating medical care; and (2) to determine the positive predictive value of the CAGE questionnaire for alcohol abuse or dependence in HIV-infected patients. Between July 1997 and October 2000, we assessed a consecutive series of patients who were establishing primary care for HIV infection (clinic sample), using an established alcohol screening test, the CAGE questionnaire. In addition, we enrolled other HIV-infected patients, including some of the clinic sample, who had two or more positive responses to the CAGE questionnaire into a longitudinal cohort (cohort sample), performed a diagnostic interview for lifetime history of alcohol abuse and dependence, and determined the positive predictive value of CAGE for alcohol diagnoses. In the clinic sample (n = 664), 42% (276 of 664) had two or more positive responses to the four CAGE questions. In the cohort sample (n = 141), 95% (134 of 141) met DSM-IV criteria for diagnosis of lifetime alcohol abuse or dependence. For patients initiating HIV primary care, a history of alcohol problems is very common. The CAGE questionnaire identifies a lifetime history of alcohol abuse or dependence in HIV-infected patients. Routine screening for alcohol problems should be performed in all patients entering HIV medical care and the CAGE questions are useful in this setting.

Comparison of Short Questionnaires on Alcohol Drinking Behavior in a Nonclinical Population of 36-Year-Old Men and Women

Little is known on the diagnostic characteristics of brief questionnaires on alcohol drinking behaviors. This report investigates the determinants of three short alcohol questionnaires and investigates their diagnostic utility as screening tools for alcohol-related problems in a general population from The Netherlands. This report uses cross-sectional data obtained in the year 2000 from 36-year-old healthy male (N = 166) and female (N = 165) volunteers who reported to drink alcohol at least occasionally. Since they were 13-years-old these volunteers have been members of the Amsterdam Growth And Health Longitudinal Study, which started as a school-based study in 1977. Among many other variables, quantity–frequency questions (QF), the CAGE questionnaire, and a question on the highest number of alcoholic units consumed on one occasion during the previous month (MAX) were asked. The sensitivity, specificity, Cohen's kappa, and diagnostic odds ratio of QF, CAGE, MAX, and combinations of these three brief questionnaires were calculated using a 7-item questionnaire on alcohol-related problems as reference. Both in women and men, the prevalence of most alcohol-related problems and of a high QF, CAGE, and MAX was low. QF, CAGE, and MAX, as well as all possible combinations of the three questionnaires, were poor in detecting last-year alcohol-related problems. The CAGE appeared to perform worse than the even shorter and easier-to-interpret QF and MAX. In this healthy population of 36-year-old men and women, using the QF, MAX, and especially the CAGE questionnaire as screening instruments for alcohol-related problems resulted in many false positive and false negative classifications.

Prevalence of alcohol use in Istanbul.

The current research assessed the prevalence of alcohol use in Istanbul, Turkey along with characteristics and severity of related problems. The data were collected from structured interviews including the CAGE Questionnaire to eliminate the severity of alcohol-related problems of 1,550 residents (743 women, 807 men) of Istanbul, ages 12 to 65 years. Current alcohol use was 25.6% (397 persons, 118 women and 279 men), including 15.9% of the women and 34.5% of the men. 67% reported never having used alcohol. The rate of alcohol use was highest in the 40- to 49-yr. age group: the onset of use was reported as most common for the 16- to 19-yr.-olds. Prevalence of risky drinking was 6.8% (106 persons). Men were more likely to have an earlier initiation to alcohol use, to consume more [5.2 standard drinks (SD=3.4) vs 3.6 standard drinks (SD=2.5)] and be problem drinkers (31.5% vs 15.2%) than women. Prevalence of alcohol use seems to be relatively low in Istanbul. Data on characteristics of alcohol use are important in estimating groups at risk for problems and in planning prevention strategies.

Detección de problemas relacionados con el alcohol en la familia a través de los hijos

The Children of Alcoholics Screening Test, CAST (Jones, 1981), has showed their utility as an instrument to detect problems related to alcohol abuse in family through the children. Moreover, it has been used to assess the feelings, behaviors and experiences related to the use that the parents make of the alcohol intake. This study has been designed to evaluate the utility of the CAST as a alcohol consumption screening instrument in a representative sample of children from Seville (n=3345; age range: 9 to 20 years). The children were selected from 32 primary, secondary, and polytechnic schools located in one of the 16 districts of the city. We also applied the CAGE questionnaire to their parents. The results show a positive relationship between both instruments, and their utility to discard the presence of problems related to the alcohol abuse in the family. Nevertheless, the predictive validity of the CAST is low in order to confirm the existence of abuse alcohol problems.

Joint use of clinical parameters, biological markers and CAGE questionnaire for the identification of heavy drinkers in a large population-based sample.

Alcohol consumption in France is one of the highest in the world. Factors associated with excessive alcohol drinking are numerous. However, taken separately, none of the existing clinical or biological markers of excessive alcohol intake enables an adequate identification of heavy drinkers. The aim of this cross-sectional survey was to identify socio-demographic, clinical and biological factors associated with excessive alcohol drinking, to develop a model and to assess its reliability, thus enabling the detection of heavy drinkers. Subjects were 1619 men and 1559 women, aged 35-64 years, living in three French areas (Lille, Strasbourg and Toulouse) and randomly selected from polling lists. Socio-demographic status, lifestyle, reported alcohol intake and answers to the CAGE questionnaire (alcohol dependence) were obtained by questionnaire. A blood sample was taken for quantification of biological parameters. Men who drank 60 g of ethanol a day (g/day) or above and women who drank 30 g/day or above were classified as heavy drinkers. The reference class (RC) gathered non-drinkers and moderate drinkers together. The sample was divided into two sub-samples: the first was used to estimate the parameters of a logistic regression model (heavy drinkers vs others), and the second to assess the accuracy of this model for the identification of heavy drinkers, using receiver operating characteristic (ROC) curves. A specific analysis was performed for each gender. Fourteen per cent of men and 40.8% of women were non-drinkers. Nine per cent of women and 14.4% of men were heavy drinkers. Wine was the most consumed alcoholic beverage. In the univariate analyses, differences were observed between the two groups of alcohol consumers for most of the socio-demographic, clinical and biological variables considered. In the multivariate analyses, low educational level, smoking, apoprotein B, high density lipoprotein cholesterol, mean corpuscular volume (MCV), gamma-glutamyl-transferase (GGT) and the CAGE score for men, and living area, age, MCV, GGT and the CAGE score for women remained independently and significantly associated with heavy drinking. In the validation sub-sample, these models combining different types of markers enabled a good discrimination between heavy drinkers and the RC, with an area under the ROC curve of 82% for men and of 79% for women. In this study, socio-demographic, clinical and biological factors and the CAGE score were independently related to excessive alcohol drinking and their joint utilization in a screening model enabled a good recognition of heavy drinkers.

Prevalence of alcohol dependence in a town in Nepal as assessed by the CAGE questionnaire.

In spite of a perception that alcohol use is rampant in Nepal, there has been no survey to assess the extent of alcohol dependence in the country. (i) To assess prevalence of alcohol dependence in the community of Dharan and (ii) to correlate this with various socio-demographic characteristics. The CAGE questionnaire was administered to all adult individuals in houses selected randomly in the township of Dharan. Among 2344 adults assessed, the prevalence of alcohol dependence was found to be 25.8%. The prevalence of alcohol dependence increased with age to peak in the age group 45-54 years and was more than twice as common in men as in women. Also, alcohol dependence was more common among those with lower level of education, widowers and divorcees and those belonging to the Matwali community. The extent of dependence was influenced by socio-cultural sanctions. The prevalence of alcohol dependence is too high for comfort in Dharan, a town in eastern Nepal. There is an urgent need to formulate a policy for substance abuse in the country taking into account the findings of this study.

General Practitioners and Alcohol Use Disorders: Quantity Without Quality

Background: General medical practitioners are essential for the prevention, diagnosis, and management of alcohol use disorders. Studies to examine medical practice in this field, however, are very rare. Method: A cross-sectional study involving 2010 patients seen by a sample of 145 general practitioners in the Auvergne region of central France was conducted on a given day in May 1998. The purpose of the study was to evaluate the prevalence of alcohol use disorders (using the DSM-IV diagnostic criteria for alcohol abuse or dependence and the CAGE questionnaire) and so to estimate the proportion of nonsomatic alcohol-related care dispensed. Results: Sixteen percent of patients consulting their general practitioner had an alcohol problem, 27% of men and 5% of women. On average, a quarter of these patients had not been previously identified by the physician. Diagnosis seemed particularly difficult in women: 11% of women aged between 36 and 45 had an alcohol-related problem that went unidentified in 60% of cases. Care for alcohol-related health problems was therefore seriously inadequate. In one third of cases, patients with a diagnosed alcohol-related problem were not followed up by the physician for that problem. Two thirds received no medication, and in more than 80% of cases the physician did not refer to a specialist or prescribe admission to a specialized hospital ward. Conclusions: These results underline the diagnostic and therapeutic difficulties experienced by general practitioners. This study has led to the establishment of a pilot health care network for patients suffering from alcohol use disorders. This network involves voluntary doctors who have been trained and are better paid for their services. Care protocols have been established to which these practitioners have to adhere.

Need for Brief Interventions for Marijuana and Alcohol Use Related to Injuries

Academic Emergency MedicineVolume 10, Issue 1 p. 62-64 Free Access Need for Brief Interventions for Marijuana and Alcohol Use Related to Injuries Linda C. Degutis DrPH, Corresponding Author Linda C. Degutis DrPH Section of Emergency Medicine, Yale University, New Haven, CT*(linda.degutis@yale.edu)Search for more papers by this author Linda C. Degutis DrPH, Corresponding Author Linda C. Degutis DrPH Section of Emergency Medicine, Yale University, New Haven, CT*(linda.degutis@yale.edu)Search for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/aemj.10.1.62Citations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References Woolard, R, Nirenberg, TD, Becker, B, et al. Marijuana use and prior injury among injured problem drinkers. Acad Emerg Med. 2003; 10: 43– 51. Substance Abuse and Mental Health Services Administration. 2001 National Household Survey on Drug Abuse. Website: http://www.samhsa.govoasnhsda2k1nhsdavol1chapter1.htm1.1. Accessed September 2002. Substance Abuse and Mental Health Services Administration. 2000 National Household Survey on Drug Abuse. Website: http://www.samsha.govoas2k2alcNS.htm. Accessed September 2002. Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Emergency Department Trends from the Drug Abuse Warning Network, Preliminary Estimates January—June 2001 with Revised Estimates 1994-2000. Website: http://www.samhsa.govoasdawnTrndED2001TextTrndEDtxt.PDF. Accessed September 2002. Levy, RS, Herbert, CK, Munn, BG, Barrack, RL. Drug and alcohol use in orthopedic trauma patients: a prospective study. J Orthop Trauma Surg. 1996; 10(3): 21– 7. Braun, BJ, Tekawa, IS, Gerberich, SG, Sidney, S. Marijuana use and medically attended injury events. Ann Emerg Med. 1998; 32: 353– 60. Soderstrom, CA, Trifillis, AL, Shankar, BS, Clark, WE, Cowley, RA. Marijuana and alcohol use among 1023 trauma patients: a prospective study. Arch Surg. 1988; 123: 733– 7. Connecticut General Statutes, P.A 98-201. An Act Concerning Substance Abuse Emergency Room Screening and Training and Education for Health Care Professionals. 1998. Ewing, J. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984; 252: 1905– 7. Degutis, LC. Screening for alcohol problems in emergency department patients with minor injury: results and recommendations for practice and policy. Contemp Drug Probl 1998; 25: 463– 75. El-Guebaly, N, Armstrong, SJ, Hodgins, DC. Substance abuse and the emergency room: programmatic implications. J Addict Dis. 1998; 17(2): 21– 40. Cherpitel, CJ. Alcohol and injuries: a review of international emergency room studies. Addiction. 1993; 88: 923– 37. Cherpitel, CJ. Drinking patterns and problems associated with injury status in emergency room admissions. Alcohol Clin Exp Res. 1988; 12: 105– 10. Grisso, JA, Schwarz, DF, Hirschinger, N, et al. Violent injuries among women in an urban area. N Engl J Med. 1999; 341: 1899– 905. Rivara, FP, Koepsell, TD, Jurkovish, GJ, Gregory, J, Gurney, JG, Soderberg, R. The effects of alcohol abuse on readmission for trauma. JAMA. 1993; 270: 1962– 4. Connecticut Law Revision Commission. The Drug Policy Reports: Part I Drug policy in Connecticut and Strategy Options; Part II Drug Policy in Connecticut. 1997. D'Onofrio, G, Degutis, LC. Screening and brief intervention for alcohol problems in the emergency department. Acad Emerg Med. 2002; 9: 627– 38. D'Onofrio, G, Bernstein, E, Bernstein, J, et al. Patients with alcohol problems in the emergency department, part 1: improving detection. Acad Emerg Med. 1998; 5: 1200– 9. D'Onofrio, G, Bernstein, E, Bernstein, J, et al. Patients with alcohol problems in the emergency department, part 2: intervention and referral. Acad Emerg Med. 1998; 5: 1210– 7. D'Onofrio, G, Nadel, ES, Degutis, LC, et al. Improving emergency medicine residents' approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med. 2002; 40: 50– 62. Citing Literature Volume10, Issue1January 2003Pages 62-64 ReferencesRelatedInformation

Alcohol Misuse Among Elderly Psychiatric Patients: A Pilot Study

The aim of this pilot study was to ascertain the frequency of alcohol misuse among the elderly (>65) psychiatric referrals. Consecutive referrals to a suburban elderly psychiatric team were screened for alcohol misuse by using the CAGE questionnaire as a part of psychiatric assessment. Gamma-glutanyl transpeptidase (GGT) was measured in those showing evidence of alcohol misuse. Frequency of alcohol misuse in the elderly was found to be low. Alcohol misuse was associated with raised GGT, depression, being divorced/ widowed and living alone.

Gender Differences in the Use of Alcohol and Psychotropics in a Brazilian Population

This cross-sectional, interview-based survey aimed to assess the use of licit substances in terms of gender and sociodemographic factors in the city of Pelotas, southern Brazil. Subjects aged 15 years and over and living in urban areas were eligible and a total of 1277 subjects were interviewed. The prevalence of alcohol consumption was 54.2%; 11.9% (21.7% of men and 4.1% of women) reported potentially harmful levels of alcohol use (“at-risk alcohol intake”); 4.2% were classified as manifesting alcohol dependence by CAGE questionnaire. At-risk alcohol intake and subjects with a positive CAGE score were more common among males aged 35–54 yrs. Among the youngest age group, the prevalence of CAGE positive score was similar for males and females, while subjects with lower educational levels showed a higher prevalence. Women were more likely than men to report the use of psychotropic drugs (15% vs. 7%). These results highlight the importance of substance use in Brazil, and suggest that gender differences must to be taken into consideration when planning intervention programs in developing countries.

General Practitioners and Alcohol Use Disorders: Quantity Without Quality

Background: General medical practitioners are essential for the prevention, diagnosis, and management of alcohol use disorders. Studies to examine medical practice in this field, however, are very rare.Method: A cross‐sectional study involving 2010 patients seen by a sample of 145 general practitioners in the Auvergne region of central France was conducted on a given day in May 1998. The purpose of the study was to evaluate the prevalence of alcohol use disorders (using the DSM‐IV diagnostic criteria for alcohol abuse or dependence and the CAGE questionnaire) and so to estimate the proportion of nonsomatic alcohol‐related care dispensed.Results: Sixteen percent of patients consulting their general practitioner had an alcohol problem, 27% of men and 5% of women. On average, a quarter of these patients had not been previously identified by the physician. Diagnosis seemed particularly difficult in women: 11% of women aged between 36 and 45 had an alcohol‐related problem that went unidentified in 60% of cases. Care for alcohol‐related health problems was therefore seriously inadequate. In one third of cases, patients with a diagnosed alcohol‐related problem were not followed up by the physician for that problem. Two thirds received no medication, and in more than 80% of cases the physician did not refer to a specialist or prescribe admission to a specialized hospital ward.Conclusions: These results underline the diagnostic and therapeutic difficulties experienced by general practitioners. This study has led to the establishment of a pilot health care network for patients suffering from alcohol use disorders. This network involves voluntary doctors who have been trained and are better paid for their services. Care protocols have been established to which these practitioners have to adhere.

V. Adopting Healthful Lifestyle Habits to Lower LDL Cholesterol andReduce CHD Risk

V. Adopting Healthful Lifestyle Habits to Lower LDL Cholesterol andReduce CHD Risk

The Natural History of Gambling and Drinking Problems Among Casino Employees

From an eligible population of 9,943 casino employees, 6,067 volunteered to participate in this study. Of this sample, 1,176 provided data at 3 observation points approximately 12 months apart. Using the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987) and the CAGE (J. A. Ewing, 1984) questionnaire, the authors prospectively examined the prevalence and patterns of alcohol and gambling problems among those employees. Among the casino employees with gambling and drinking problems, a segment displayed the capacity to diminish those problems even when the difficulties had reached disordered levels. The authors also examined the comorbidity of gambling and drinking as well as the relationships among changes in SOGS scores and CAGE scores and changes in demographic and biological variables. The women were more likely to decrease their problem-drinking scores, but not their gambling scores, when compared with the men. In addition, 2 key variables (i.e., disabling depression and dissatisfaction with one's personal life) emerged as predictors of transitions to healthier levels of disordered gambling. The authors cautiously suggest, in light of the results taken together, that more fluctuation is associated with gambling and drinking problems than previously thought and that the conventional wisdom about disordered gambling as “always progressive” needs reconsideration.

Preoperative Evaluation of Chronic Alcoholics Assessed for Surgery of the Upper Digestive Tract

Alcoholics are at risk of developing major complications in the postoperative period. Adequate prophylactic treatment, as well as preoperative abstinence, can significantly decrease the rate of complications. However, the preoperative diagnosis of alcoholism is difficult to establish. The purpose of this study was to assess whether three preoperative visits, an alcohol-related questionnaire (CAGE), and the laboratory markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) would increase the rate of detection of chronic alcoholics. The study included the Departments of ENT, Facial and Maxillofacial Surgery, and General Surgery of a university hospital; 705 male patients were assessed for tumor surgery of the upper digestive tract and were allocated to 5 different groups. All patients were seen three times, and five different strategies were used to detect chronic alcoholics. The gold standard was the diagnosis of alcohol misuse made by an experienced (blinded) investigator according to the DSM-III-R. The main outcome measurements were the detection rates of the different test strategies. By clinical routine alone, only 16% were detected during the first visit and 34% after three visits. If the CAGE questionnaire was added, sensitivity increased to 64%. The further addition of GGT or CDT led to 80 and 85% detections, respectively. A combination of all tests had a sensitivity of 91%. To detect more alcoholic patients at risk for major complications, patients should be seen more often, and additional diagnostic tools such as the CAGE, CDT, and GGT should be used before surgery.

Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study.

This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6-year follow-up period. We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51-61 and their spouses living in the United States in 1992. Five types of health outcomes--mortality, general health, functional status, cognitive status, and mental health--were examined. Drinking categories were based on average drinks per day (0, <1, 1-2, 3-4, 5+), with 5 + defined as 'very heavy drinking'. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline. Over the 6-year follow-up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95%, CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke). Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.

Alcohol abuse: prevalence and detection in a general hospital

Despite a high prevalence of alcohol-related disabilities and the availability of cost-effective interventions, alcohol abuse and dependence commonly go undetected in hospital inpatients. In a university teaching hospital we compared three well validated screening methods for sensitivity and specificity-the Alcohol Use Disorders Identification Test (AUDIT, with various cut-off scores), CAGE (a four-question screening tool), and a 10-question version of the Michigan Alcoholism Screening Test (BMAST). A subset of patients also completed the DSM IV structured clinical interview for diagnosis. 1133 adult patients were randomly selected from all hospital admissions, with exclusion of day cases and patients too ill to be interviewed. Two-thirds of the patients were interviewed, most of the remainder being unavailable at the time. 30% of the men and 8% of the women met the DSM IV criteria for alcohol abuse or dependence. Sensitivities and specificities of the screening tools were as follows: AUDIT (with cut-off score >8) 89% and 91%; CAGE 77% and 99%; BMAST 37% and 100%. 255 case records of patients scoring above the cut-off on one or more questionnaires were subsequently reviewed. The admitting team recognized an alcohol problem in only 46, of whom 17 were referred for appropriate follow up. As in previous hospital surveys, alcohol abuse and dependence was not receiving proper attention. The most efficient screening tool was the CAGE questionnaire.

The Detection and Treatment of Psychiatric Disorders and Substance Use Among Pregnant Women Cared for in Obstetrics

A recent report from California suggests that psychiatric disorders and substance use are significantly underrecorded on hospital delivery records and that these disorders correlate with inadequate prenatal care. Clinicalstudies have validated a primary care screening instrument for psychiatric disorders, the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire. Both maternal psychiatric and substance use problems have the potential to adversely affect mothers and their infants. The present study used the PRIME-MD instrument to assess current psychiatric disorders in 186 women older than 18 years who were under prenatal care at a university-based obstetrics clinic. Antenatal alcohol and drug use was explored using the Alcohol and Drug CAGE questionnaires. Seventy of the women, 38% of the total, screened positive for psychiatric disorder and/or substance use. They were significantly likelier than screen-negative women to report an unexpected pregnancy and to have a history of psychiatric treatment. Educational level, racial background, living with a partner or not, working outside the home, and age could not be related to the risk of a positive screen. Screen-positive women were likelier to receive inadequate or intermediate prenatal care and were more often referred to child protective services, but these associations were not significant. No important differences in obstetrical history or outcomes could be identified. More than half of the screen-positive women had depressive and anxiety symptoms, but relatively few had agitation, behavioral symptoms, or sleep disorder. The likelihood of having mental health evaluated was not a function of age, race, or obstetrical outcome. Treatment for psychiatric disorder or substance use, recorded in 15 of the 70 screen-positive women, was associated with lack of a live-in partner, referral to a child protective service during the index pregnancy, and more spontaneous abortions. The investigators conclude that a substantial number of obstetrical patients have a are psychiatric disorder or substance use problem that goes unrecognized unless screening efforts are undertaken. In view of the potential adverse effects on both maternal and infant outcomes, further work is needed to develop effective interventions.