The Validity of Using BASIS-24 to Assess Substance Use and Co-occurring Symptoms among Psychiatric Inpatients

Thomas Idiculla, PhD

McLean Hospital
The Validity of Using BASIS-24 to Assess Substance Use and Co-occurring Symptoms among Psychiatric Inpatients

Scientific Abstract

Background: A reliable measure of co-occurring psychiatric symptoms can be useful for screening, assessment, and treatment of dual diagnosis patients. BASIS-24 as a comprehensive 24-item self-reported assessment tool that identifies specific areas of difficulty and cuts across all diagnostic groups using six composite subscales that quantify severity: Psychosis, Depression/Functioning, Alcohol/Drug Use, Emotional Lability, Relationships, and Self-Harm. This project examined the validity of the BASIS-24 Alcohol/Drug Use subscale for patients with substance use and co-occurring symptoms with discharge diagnosis.

Methods: The study used data from 5083 adult psychiatric inpatients spanning 3 years. Patients completed BASIS-24 at admission and discharge. 20.9% (N=1056) had primary ICD-10 discharge diagnosis in the substance use category; 15.5% (N=786) had dual diagnosis with a primary diagnosis in the substance abuse category and a psychiatric diagnosis; 40% (N=2049) had substance use and psychiatric diagnoses in any order. BASIS-24 Alcohol/Drug Use subscale contains 4 items that ask patients about the urge to drink alcohol/take drugs, being talked to about their drinking/drug use, hiding their drinking/drug use, and problems related to their drinking/drug use on a 5-point scale ranging from “Never” at 0 to “Always” at 5. This study used ROC analysis to examine the predictability of Alcohol/Drug Use score and discharge diagnosis.

Results: The average BASIS-24 Alcohol/Drug Use weighted score at admission for Group #1: primary substance use diagnosis: 2.83 (S.D.= 0.86); Group #2: dual diagnosis with primary substance use: 2.85 (S.D.= 0.85). For Group #1 area under the curve (AUC) was 91.8%; Group #2 AUC was 89.5%.

Conclusion: ROC analysis shows excellent predictability for dual diagnosis inpatients. For patients with primary diagnosis of substance use, 92% of the time, the discharge diagnosis complements the self-reported symptoms. This study confirms that BASIS-24 has the potential to be an assessment and screening tool in the dual diagnosis population. Further research with substance use measures is needed to examine this subscale’s severity scores.

SoundCloud Transcript

A reliable measure of substance use and co-occurring psychiatric symptoms can be useful for screening, assessment, and treatment of dual diagnosis patients. BASIS-24 is a comprehensive 24-item self-reported assessment tool. It identifies specific areas of difficulty that cuts across all diagnostic groups using six subscales that quantify severity: Depression, Relationships, Emotional Lability, Psychosis, Self-Harm, and   Alcohol and Drug Use.

This study examined the validity of the BASIS-24 Alcohol and Drug Use subscale for patients with a diagnosis of substance use and co-occurring symptoms. The study sample consists of 5083 adult psychiatric inpatients spanning 3 years. Patients completed BASIS-24 at admission and discharge. 21% of the patients – that is one thousand and fifty-six had substance use as primary diagnosis. Among that Seven hundred and eighty-six patients (16%) had dual diagnosis – with a primary diagnosis in the substance use category and a psychiatric diagnosis. BASIS-24 Alcohol/Drug Use subscale contains 4 items. These items ask patients about the urge to drink alcohol/take drugs, being talked to about their drinking or drug use, hiding their drinking or drug use, and problems related to their drinking or drug use. The items are on a 5-point scale ranging from 0 meaning “Never” 0 to 4 meaning “Always”. This study used ROC analysis to examine the predictability of BASIS-24 Alcohol or Drug Use score with a diagnosis of substance abuse and dual diagnosis.

The results of the study show that the BASIS-24 Alcohol/Drug Use score at admission for the primary substance use group had a mean score of 2.83, with a standard deviation of 0.86, on a 5-point scale. ROC analysis shows excellent predictability for substance use diagnosis, using BASIS-24 Alcohol and Drug Use Subscale, and the area under the curve, AUC was 92%, with a Sensitivity of 87%, and Specificity of 86%.For the dual diagnosis group with primary substance use and psychiatric diagnosis, the area under the curve (AUC) was 90%; with a sensitivity of 87% and specificity of 82%. BASIS-24 Alcohol and Drug Use Subscale has excellent predictability for dual diagnosis among psychiatric inpatients. For patients with primary diagnosis of substance use, 92% of the time, a clinician’s diagnosis complements the patient self-reported symptoms, and a similar strength was found with dual diagnosis at 89.5%.

This study confirms that BASIS-24 has the potential to be an assessment and screening tool in the dual diagnosis population. Further research with substance use measures is needed to examine this subscale’s severity scores.

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research Areas

Authors

Thomas Idiculla, PhD, Jason Berkowitz, BA, Karen Hildebrand, BS

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