An epidemiological survey of alcohol use disorders in a Tibetan population

Abstract

We performed an epidemiological survey in order to detect the prevalence of alcohol use disorders in a sub-group of the population of Tibet. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire, the Severity of Alcohol Dependence Questionnaire (SADQ), and a 12-item version of the General Health Questionnaire (GHQ12) were used to obtain epidemiological data on alcohol use disorders and to assess the severity of ‘problem drinking’ and general mental health status. The AUDIT is a reliable and valid screening tool for both alcohol abuse and dependence in the Tibetan population to identify individuals with alcohol use problems. The cut-off points were set to be 10 and 13 of the AUDIT scores as a diagnostic discriminator of alcohol abuse and alcohol dependence, respectively, with both sensitivity and specificity > 0.84. The prevalence of alcohol abuse, was 2.7% (female: 2.0%; male: 6.2%), alcohol dependence 13.5% (female: 7.6%; male: 25.4%) and alcohol use disorders 16.2% (female: 9.6%; male: 31.6%). Age and sex were the main factors affecting an individual's alcohol use and general mental health status. The epidemiological data on alcohol use disorders documented in this project may be helpful in future work seeking more valid causal inferences or interpretations related to this prevalent health problem in Tibet.

Introduction

Half of all Tibetans live in the Tibet Autonomous Region, which has a population of 2.77 million. There were no epidemiological surveys of mental disorders in this population until very recently. In 2004, the first ever epidemiological survey of mental disorders in the Tibet Autonomous Region was carried out and determined that alcohol use disorders diagnosed with DSM-IV criteria were the most prevalent mental problems, with point prevalence of over 4% in Tibet. This was followed by anxiety disorders (1.94%), affective disorders (0.47%) and schizophrenia (0.37%) (Wei and Liu, 2004). However, alcohol-related disorders, which have serious psychological, physical and social disadvantages, have been under-recognized in Tibet. The reasons for this include: i) based on historical, regional and cultural factors, the general attitude is one of tolerance toward alcohol consumption in the local population. As such, it may limit the recognition of high levels of alcohol consumption as a potential health risk. ii) Historically, there are inadequate mental health services in the Tibet Autonomous Region, where there are few psychiatrists with modern psychiatric training and local health workers lack the essential training and knowledge to recognize this problem. Therefore, obtaining accurate and reliable epidemiological data is an essential first step towards the identification of aetiological factors and the implementation of public health measures related to alcohol consumption in the region. Obtaining these data will facilitate informed decisions regarding health care planning for the prevention and early treatment of alcohol-related problems.

Selecting effective and simple tools to screen for these disorders, tools that can be used by non-psychiatric professional investigators, is essential for epidemiological studies in Tibet, as a large proportion of the population, especially those living in the rural areas, have had poor educational opportunities and cannot read or write in either Chinese Han or Tibetan. Among the many screening instruments for alcohol-related problems, the Alcohol Use Disorders Identification Test (AUDIT) has been demonstrated to be one of the most useful since it is easy to administer and has been shown to effectively identify alcohol use disorders a variety of countries and cultural groups (Babor et al., 2001, Lapham et al., 1998, Lima et al., 2005, Ronald et al., 2006, Volk et al., 1997, Adewuya, 2005, Ivis et al., 2000, Cherpitel, 1995, Conigrave et al., 1995, Steinbauer et al., 1998, Gache et al., 2005, Giang et al., 2005), and to be a reliable and valid screening measure for indigenous people (Babor et al., 1992, Sharon and Richard, 1997, Saunders et al., 1993a). The AUDIT was developed under the auspices of the World Health Organization (WHO) (Saunders et al., 1993b) and was introduced into China in 1996 and has been widely used in subsequent studies (He et al., 1997, Li et al., 2003a, Li et al., 2003b, Zhou et al., 2005, Meng and Ge, 2005, Gu et al., 2004). It has been shown to be a reliable and valid measure applicable to the study of Chinese cultures as demonstrated by studies in mainland China (He et al., 1997, Li et al., 2003a) and in Hong Kong (Leung and Arthur, 2000). However, there are no studies examining the reliability and validity of the AUDIT among minority nationality groups living in China.

As part of a larger genetic epidemiological study on alcohol use disorders in a native Tibetan population in China, we evaluated the reliability and validity of the Chinese interview version of the AUDIT, and used it as the screening tool to obtain epidemiological data on alcohol use disorders in this setting. We also used the Severity of Alcohol Dependence Questionnaire (SADQ) and a 12-item version of the General Health Questionnaire (GHQ12) to assess the severity of ‘problem drinking’ and general mental health status.