Alcohol problems in women; Gender characteristics relevant for identification in clinical and health screening settings

Abstract: This thesis presents data relating to gender differences of problem drinking. The aim was to increase the knowledge of characteristics of female problem drinking to enhance identification efficiency. Alcoholic patients, 214 women and 420 men, and subjects from the general population, 2939 women and 1880 men, in Malmö, Sweden were studied between 1983-1995. Lifetime prevalence rates of problem drinking in 42-year old Malmö residents were 4.6% in women and 15.5% in men out of which 2.1% and 8.6%, respectively, were already registered as patients at the Department of Alcohol Diseases (DAD). Sex ratios argued against hidden drinking being an exclusively female phenomenon. Convergence was dismissed. The response style to the revised Mm-MAST indicated gender differences. Reliability was poorer in the females than males (alphas 0.58 vs 0.69). Gamma-glutamyl-transferase was a blunt identification instrument in women; 2% were test positive of which 27% were problem drinkers. Elderly newly admitted patients at the DAD were clinically similar. However, women were significantly more often late onset problem drinkers compared to men. Sex ratios indicated a significant convergence of female patients to that of males during 1988-1992 compared to one decade earlier (1:3.4 and 1:7.8). Correlates of regular benzodiazepine use in 55-year old female Malmö residents were related to psychiatric symptoms rather than problem drinking and teetotalism. The immigrant women were more likely to endorse regular BZD use, early retirement, and multiple psychiatric symptoms. A new female oriented screening questionnaire, including four "female" items and the four CAGE items, was constructed based on the response style in a patient sample. The validation results from a health screening population indicate promising properties of the new scale, the AVI4+CAGE, although further development is required.