BACKGROUND AND AIMS The focus of this paper is on the improvement of substance use disorder (SUD) screening and measurement. Using a multi-dimensional item response theory model, the bifactor model, we provide a psychometric harmonization between SUD, depression, anxiety, trauma, social isolation, functional impairment and risk-taking behavior symptom domains, providing a more balanced view of SUD. The aims are to (1) develop the item-bank, (2) calibrate the item-bank using a bifactor model that includes a primary dimension and symptom-specific subdomains, (3) administer using computerized adaptive testing (CAT) and (4) validate the CAT-SUD in Spanish and English in the United States and Spain. DESIGN Item bank construction, item calibration phase, CAT-SUD validation phase. SETTING Primary care, community clinics, emergency departments and patient-to-patient referrals in Spain (Barcelona and Madrid) and the United States (Boston and Los Angeles). PARTICIPANTS/CASES Calibration phase: the CAT-SUD was developed via simulation from complete item responses in 513 participants. Validation phase: 297 participants received the Composite International Diagnostic Interview (CIDI) and the CAT-SUD. MEASUREMENTS A total of 252 items from five subdomains: (1) SUD, (2) psychological disorders, (3) risky behavior, (4) functional impairment and (5) social support. CAT-SUD scale scores and CIDI SUD diagnosis. FINDINGS Calibration: the bifactor model provided excellent fit to the multi-dimensional item bank; 168 items had high loadings (> 0.4 with the majority > 0.6) on the primary SUD dimension. Using an average of 11 items (four to 26), which represents a 94% reduction in respondent burden (average administration time of approximately 2 minutes), we found a correlation of 0.91 with the 168-item scale (precision of 5 points on a 100-point scale). VALIDATION strong agreement was found between the primary CAT-SUD dimension estimate and the results of a structured clinical interview. There was a 20-fold increase in the likelihood of a CIDI SUD diagnosis across the range of the CAT-SUD (AUC = 0.85). CONCLUSIONS We have developed a new approach for the screening and measurement of SUD and related severity based on multi-dimensional item response theory. The bifactor model harmonized information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD. The CAT-SUD is highly predictive of a current SUD diagnosis based on a structured clinical interview, and may be predictive of the development of SUD in the future.

中文翻译：

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用于筛选和测量的计算机化自适应物质使用障碍量表的开发：CAT-SUD

背景和目的 本文的重点是改进物质使用障碍 (SUD) 筛查和测量。使用多维项目反应理论模型，即双因素模型，我们提供了 SUD、抑郁、焦虑、创伤、社会孤立、功能障碍和冒险行为症状领域之间的心理测量协调，提供了对 SUD 的更平衡的看法。目标是 (1) 开发项目库，(2) 使用包括主要维度和症状特定子域的双因素模型校准项目库，(3) 使用计算机化自适应测试 (CAT) 进行管理，以及 (4 ) 在美国和西班牙验证西班牙语和英语的 CAT-SUD。设计项目库构建、项目校准阶段、CAT-SUD 验证阶段。设置 初级保健、社区诊所、西班牙（巴塞罗那和马德里）和美国（波士顿和洛杉矶）的急诊科和患者转诊。参与者/案例 校准阶段：CAT-SUD 是通过模拟 513 名参与者的完整项目响应而开发的。验证阶段：297 名参与者接受了综合国际诊断访谈 (CIDI) 和 CAT-SUD。测量 共有来自五个子域的 252 个项目：(1) SUD，(2) 心理障碍，(3) 危险行为，(4) 功能障碍和 (5) 社会支持。CAT-SUD 量表评分和 CIDI SUD 诊断。调查结果 校准：双因子模型非常适合多维项目库；168 个项目在主要 SUD 维度上具有高负载（> 0.4，大多数 > 0.6）。平均使用 11 个项目（4 到 26），这代表受访者负担减少了 94%（平均管理时间约为 2 分钟），我们发现与 168 项量表的相关性为 0.91（在 100 分制量表上精度为 5 分）。验证 在主要 CAT-SUD 维度估计和结构化临床访谈的结果之间发现了强烈的一致性。在 CAT-SUD（AUC = 0.85）范围内，CIDI SUD 诊断的可能性增加了 20 倍。结论 我们基于多维项目反应理论开发了一种筛查和测量 SUD 及相关严重程度的新方法。双因素模型协调了来自心理健康、创伤、社会支持和传统 SUD 项目的信息，以提供更完整的 SUD 特征。