Usefulness of the "CAGE" in Malaysia

This study examines the usefulness of the "CAGE", (which is an acronym for "cut down", "annoyed", "guilty" and "eye-opener"), a 4-question screening test to identify excessive drinkers among Malaysian inpatients. The CAGE questionnaire after translation and back translation was administered to all inpatients in the General Hospital, Kuala Lumpur. The author interviewed 'blindly' all who score positive on the CAGE score and 10% of all negatives using the DSM III interview schedule for alcohol abuse dependence. The results show that the CAGE performs best at a cut-off point of 2 and above, with a sensitivity of 92%, specificity of 62%, positive predictive values of 38% and Kappa (K) of 0.37 with a DSM III R diagnosis for alcohol abuse/dependence. The poor agreement with a DSM III diagnosis indicates that the CAGE is not useful in the Malaysian population. Reasons suggested for this are: cultural factors in the Malaysian population resulting in the overrating of the question of 'guilt' by Muslims and translations into the local languages which are only the closest approximations.