Supplementary Material for: Identification of Latent Alcohol Use Groups and Transitions over Time Using a 9-Year Follow-Up Study in the Adult General Population

Introduction: Studies investigating latent alcohol use groups and transitions of these groups over time are scarce, while such knowledge could facilitate efficient use of screening and preventive interventions for groups with a high risk of problematic alcohol use. Therefore, the present study examines the characteristics, transitions, and long-term stability of adult alcohol use groups and explores some of the possible predictors of the transitions. Methods: Data were used from the baseline, 3-, 6-, and 9-year follow-up waves of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a representative study of Dutch adults aged 18–64 at baseline (N = 6,646; number of data points: 20,574). Alcohol consumption, alcohol use disorder (AUD), and mental disorders were assessed with the Composite International Diagnostic Interview 3.0. Latent Markov Modelling was used to identify latent groups based on high average alcohol consumption (HAAC) and AUD and to determine transition patterns of people between groups over time (stayers vs. movers). Results: The best fitting model resulted in four latent groups: one nonproblematic group (91%): no HAAC, no AUD; and three problematic alcohol use groups (9%): HAAC, no AUD (5%); no HAAC, often AUD (3%); and HAAC and AUD (1%). HAAC, no AUD was associated with a high mean age (55 years) and low educational level (41%), and no HAAC, often AUD with high proportions of males (78%) and people with high educational level (46%). Eighty-seven percent of all respondents – mostly people with no HAAC, no AUD – stayed in their original group during the whole 9-year period. Among movers, people in a problematic alcohol use group (HAAC and/or AUD) mostly transitioned to another problematic alcohol use group and not to the nonproblematic alcohol use group (no HAAC, no AUD). Explorative analyses suggested that lack of physical activity possibly plays a role in transitions both from and to problematic alcohol use groups over time. Conclusion: The detection of three problematic alcohol use groups – with transitions mostly between the different problematic alcohol use groups and not to the group without alcohol problems – points to the need to explicitly address both alcohol consumption and alcohol-related problems (AUD criteria) in screening measures and interventions in order not to miss and to adequately treat all problematic alcohol users. Moreover, explorative findings suggest that prevention measures should also include physical activity.

引言：关于潜在酒精使用群体及其随时间推移的过渡的研究为数不多，而此类知识能够促进对高风险问题酒精使用群体的筛查和预防干预的有效利用。因此，本研究旨在探讨成年酒精使用群体的特征、过渡及长期稳定性，并探索一些可能的过渡预测因素。研究方法：本研究利用了荷兰心理健康调查与发病率研究-2（NEMESIS-2）的基线、3年、6年和9年随访波次数据，该研究是对18至64岁荷兰成年人的代表性研究（基线N=6,646；数据点数量：20,574）。通过综合国际诊断访谈3.0（CIDI 3.0）对酒精消费、酒精使用障碍（AUD）和心理健康状况进行评估。利用潜在马尔可夫模型（LMM）根据高平均酒精消费（HAAC）和AUD识别潜在群体，并确定人们在群体间随时间推移的过渡模式（留守者与流动者）。结果：最佳拟合模型产生了四个潜在群体：一个非问题群体（91%）：无HAAC，无AUD；以及三个问题酒精使用群体（9%）：HAAC，无AUD（5%）；无HAAC，经常AUD（3%）；以及HAAC和AUD（1%）。HAAC，无AUD与较高的平均年龄（55岁）和较低的教育水平（41%）相关，而无HAAC，经常AUD则男性比例较高（78%）以及高教育水平人群比例较高（46%）。在整个9年期间，87%的受访者——主要是无HAAC、无AUD的人群——保持在他们的原始群体中。在流动者中，问题酒精使用群体（HAAC和/或AUD）的人大多过渡到另一个问题酒精使用群体，而非非问题酒精使用群体（无HAAC，无AUD）。探索性分析表明，缺乏体育锻炼可能在人们从问题酒精使用群体过渡到非问题酒精使用群体，以及从非问题酒精使用群体过渡到问题酒精使用群体的过程中发挥作用。结论：检测到三个问题酒精使用群体——过渡主要发生在不同的问题酒精使用群体之间，而非过渡到无酒精问题群体——指出，在筛查措施和干预措施中，需要明确处理酒精消费和与酒精相关的问题（AUD标准），以避免遗漏并充分治疗所有问题酒精使用者。此外，探索性发现表明，预防措施还应包括体育锻炼。