Assessment of the validity and clinical utility of AUDIT-C versus RAPS-4 alcohol screeners among active-duty US Army soldiers.
High rates of alcohol-related problems have been reported among US service members (SMs). Screening questions on drinking and related behaviors can help identify individuals at-risk for alcohol-related problems. However, brief alcohol screeners, such as the alcohol use disorders identification test-consumption (AUDIT-C) and the 4-item rapid alcohol problems screening (RAPS-4), have not been adequately and concurrently validated among active-duty SMs.
From October to December 2021, 19,465 active-duty soldiers (including activated reserve soldiers) completed anonymous command-directed e-surveys (response rate= 31%); two random samples were drawn and sex-stratified. The AUDIT-C, RAPS-4, depression (PHQ2), anxiety (GAD2), and suicidal thoughts (2-item CSSRS) were analyzed to assess convergent validity and clinical utility of the AUDIT-C versus RAPS-4.
Findings indicate fair-to-moderate (φ = 0.310-0.399) convergence between screeners among males and weak-to-fair (φ = 0.227-0.391) convergence among female soldiers. Among male soldiers, the best level of agreement between screeners, albeit fair in concordance, was AUDIT-C ≥ 6 (weighted kappa = 0.381-0.399). Among female soldiers, AUDIT-C ≥ 4 or 5 demonstrated the best concordance with RAPS-4 (weighted kappa = 0.384-0.380, respectively). Importantly, however, less than one-third of soldiers screened positive by both AUDIT-C and RAPS-4; over two-thirds had discordant screening results. Although both screeners were independently and positively associated with risk for suicidal thoughts, depression, and/or anxiety, the RAPS-4 demonstrated stronger association with suicidal thoughts than AUDIT-C.
The AUDIT-C and RAPS-4 each capture unique but interrelated aspects of drinking behaviors. The RAPS-4 appears advantageous by including clinically oriented questions that have shown to strongly correlate with AUD risk, and in this study demonstrated strong correlations with risk for other mental health conditions. In contrast, the AUDIT-C is only limited to consumption-focused items. While the AUDIT-C is currently mandated primary alcohol screener in military settings, the stronger correlation of RAPS-4 with related behavioral health outcomes warrants further research and consideration as a preferable primary screener among SMs.
From October to December 2021, 19,465 active-duty soldiers (including activated reserve soldiers) completed anonymous command-directed e-surveys (response rate= 31%); two random samples were drawn and sex-stratified. The AUDIT-C, RAPS-4, depression (PHQ2), anxiety (GAD2), and suicidal thoughts (2-item CSSRS) were analyzed to assess convergent validity and clinical utility of the AUDIT-C versus RAPS-4.
Findings indicate fair-to-moderate (φ = 0.310-0.399) convergence between screeners among males and weak-to-fair (φ = 0.227-0.391) convergence among female soldiers. Among male soldiers, the best level of agreement between screeners, albeit fair in concordance, was AUDIT-C ≥ 6 (weighted kappa = 0.381-0.399). Among female soldiers, AUDIT-C ≥ 4 or 5 demonstrated the best concordance with RAPS-4 (weighted kappa = 0.384-0.380, respectively). Importantly, however, less than one-third of soldiers screened positive by both AUDIT-C and RAPS-4; over two-thirds had discordant screening results. Although both screeners were independently and positively associated with risk for suicidal thoughts, depression, and/or anxiety, the RAPS-4 demonstrated stronger association with suicidal thoughts than AUDIT-C.
The AUDIT-C and RAPS-4 each capture unique but interrelated aspects of drinking behaviors. The RAPS-4 appears advantageous by including clinically oriented questions that have shown to strongly correlate with AUD risk, and in this study demonstrated strong correlations with risk for other mental health conditions. In contrast, the AUDIT-C is only limited to consumption-focused items. While the AUDIT-C is currently mandated primary alcohol screener in military settings, the stronger correlation of RAPS-4 with related behavioral health outcomes warrants further research and consideration as a preferable primary screener among SMs.
Authors
Duffy Duffy, Hoge Hoge, Gomez Gomez, Beymer Beymer, Bricault Bricault, Carrasquillo Carrasquillo, Wilk Wilk, Bell Bell, Quartana Quartana
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