Meta‐analysis of self‐reported substance use compared with laboratory substance assay in general adult mental health settings

International Journal of Methods in Psychiatric Research - Tập 21 Số 2 - Trang 134-148 - 2012
Matthew Large1, Glen Smith2, Grant Sara3,4, Michael Paton5, Karina Karolina De Santis6, Olav Nielssen7
1School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
2The Northside Clinic Greenwich NSW Australia
3InforMH, Mental Health and Drug and Alcohol Office NSW Health North Ryde NSW Australia
4Northern Clinical School; Sydney University; Sydney NSW Australia
5Area Mental Health Drug and Alcohol Service, Northern Sydney Central Coast Area Health Service Macquarie Hospital North Ryde Sydney NSW Australia
6School of Humanities and Social Sciences, Jacobs University Bremen, Bremen, Germany
7Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia

Tóm tắt

AbstractAn accurate assessment of substance use is necessary to make a correct psychiatric diagnosis and to provide appropriate treatment. This study uses meta‐analysis to establish the strength of the association between self‐reported substance use and the results of laboratory substance assay including the testing for specific substances and screening for any substance use in psychiatric hospitals and in community mental health settings.A systematic search for published studies was supplemented by additional data required for meta‐analysis provided by several researchers in this field. Using random‐effects meta‐analysis, we calculated the pooled estimate of the odds ratio of a positive substance assay in patients reporting use or non‐use of substances and estimated the sensitivity, specificity, positive predictive value and negative predictive value.Twenty‐six studies met the inclusion criteria. Very strong associations were found between self‐reported use and positive tests for cannabis [N = 11 studies, odds ratio (OR) = 22.3; 95% confidence interval (CI) = 10.1–49.1], amphetamines (N = 8, OR = 26.6; 95% CI = 7.9–88.9), cocaine (N = 8, OR = 39.7; 95% CI = 16.2–97.2) and opiates (N = 7, OR = 83.5; 95% CI = 26.7–260.7). Strong associations were found between self‐reported use of any substance and positive substance screening (N = 15, OR = 7.2, 95% CI = 3.6–14.1) and tests for alcohol use (N = 5, OR = 8.5; 95% CI = 2.5–28.4). Screening for any substance use had a sensitivity of 61% and a specificity of 66%. Testing for individual substances was specific but lacked sensitivity.Screening has the potential to detect clinically relevant substances that would not be reported by the patient, whereas testing for a specific substance has little advantage over self‐report. The sensitivity of the substance assay might be improved by obtaining a sample at the earliest opportunity. Consideration should be given to the increased use of substance screening in general adult mental health settings because it could improve the accuracy of psychiatric diagnosis and increase the likelihood of patients receiving treatment for substance use disorders. Copyright © 2012 John Wiley & Sons, Ltd.

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10.1176/ajp.151.7.1077

10.1176/appi.books.9780890423349

10.1016/S0140-6736(87)92620-1

10.1097/00005053-199503000-00011

10.1373/clinchem.2008.122341

10.1136/bmj.327.7418.783

10.1192/bjp.bp.106.024448

Bertolín‐Guillén J.M., 1999, Sensitiveness and specificity of psychotropic drugs analysis for the diagnosis of mental disorders, Adicciones, 11, 107

10.1016/j.addbeh.2005.08.008

10.1176/ajp.146.10.1349b

10.3109/00952999109001598

10.1080/15504260903176039

10.1176/ps.48.3.353

10.1080/15504260802084425

10.1001/archpsyc.1974.01760070005001

10.1186/1471‐227X‐8‐17

10.1016/j.eurpsy.2007.05.001

10.1016/0022-3956(94)90010-8

Elangovan N., 1993, Substance abuse among patients presenting at an inner‐city psychiatric emergency room, Hospital & Community Psychiatry, 44, 782

Ellinwood E.H., 1968, Amphetamine psychosis. II. Theoretical implications, International Journal of Neuropsychiatry, 4, 45

10.1001/jama.2009.675

10.1080/08039480802294787

10.1093/oxfordjournals.schbul.a033339

10.1093/jat/33.9.569

Galletly C.A., 1993, Urine drug screening of patients admitted to a state psychiatric hospital, Hospital & Community Psychiatry, 44, 587

10.1176/ps.49.6.825

10.1001/archpsyc.61.8.807

10.3109/00952997709007003

Helseth V., 2005, Drug screening among patients aged 17–40 admitted with psychosis, Tidsskrift for den Norske Lægeforening, 125, 1178

10.1300/j374v01n01_05

Katz G., 2008, Substance abuse in hospitalized psychiatric patients, The Israel Medical Association Journal: IMAJ, 10, 672

10.4088/JCP.v63n1007

10.1176/ps.47.10.1104

10.1192/pb.26.7.248

10.1023/A:1015391323164

10.1186/1745‐0179‐2‐4

10.1007/BF03033068

10.4088/JCP.v69n0114

10.1053/ajem.2001.20003

10.1192/bjp.116.535.643

10.1300/J079v21n04_02

10.1176/appi.ps.51.4.474

10.1111/j.1440‐1614.2006.01906.x

10.1016/S0924-977X(01)00129-8

10.1046/j.1440-1614.1999.00588.x

10.1093/oxfordjournals.schbul.a033386

10.1176/ajp.150.5.758

10.1001/archpsyc.63.5.490

10.1176/appi.ps.54.6.891

10.1097/01.nmd.0000202575.79453.6e

10.1016/0740‐5472(84)90005‐9

10.1080/0004867090297090

10.1093/schbul/15.3.465

10.1192/bjp.bp.105.017236

Wilkins J.N., 1991, Discrepancies between patient report, clinical assessment, and urine analysis in psychiatric patients during inpatient admission, Psychopharmacology Bulletin, 27, 149

World Health Organization(2010)International Classification of Diseases.http://www.who.int/classifications/icd/en/[17 November 2010].

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International Journal of Methods in Psychiatric Research

Tập 21 Số 2

134-148

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