Axis IV - psychosocial and environmental problems - in the DSM-IV

• Published in: Journal of psychiatric and mental health nursing 2013-11, Vol.20 (9), p.768-775
• Main Authors: Ramirez, A., Ekselius, L., Ramklint, M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; assessment; axis IV; concurrent validity; Cross-Sectional Studies; Diagnostic and Statistical Manual of Mental Disorders; DSM-IV; Female; Humans; Male; Mental Disorders - diagnosis; Mental Disorders - psychology; Nursing; Psychiatric Status Rating Scales; psychosocial stress; Reproducibility of Results; Self-Assessment; Social Environment; Stress, Psychological - diagnosis; Stress, Psychological - etiology; Stress, Psychological - psychology; Sweden; Young Adult; young adults
• ISSN: 1351-0126; 1365-2850; 1365-2850
• DOI: 10.1111/jpm.12009

Accessible summary The aim of this study was to extensively explore the properties of the revised axis IV of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV). Psychosocial and environmental problems, which are believed to exacerbate current mental disorders, were evaluated by using a questionnaire and through clinical interviews. The reliability between self‐assessment and professional assessment was also examined. The results showed that the revised axis IV according to DSM‐IV seems to have concurrent validity, but is still hampered by limited reliability. These findings could be useful for the upcoming DSM‐V revision as well as help clinicians and patients to better identify mental health problems. The aim of this study was to further explore the properties of axis IV in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV). In a naturalistic cross‐sectional design, a group (n = 163) of young (18–25 years old) Swedish psychiatric outpatients was assessed according to DSM‐IV. Psychosocial and environmental problems/axis IV were evaluated through structured interviewing by a social worker and by self‐assessment on a questionnaire. Reliability between professional assessment and self‐assessment of axis IV was examined. Concurrent validity of axis IV was also examined. Reliability between professional and self‐assessed axis IV was fair to almost perfect, 0.31–0.83, according to prevalence and bias‐adjusted kappa. Categories of psychosocial stress and environmental problems were related to the presence of axis I disorders, co‐morbidity, personality disorders and decreasing Global Assessment of Functioning (GAF) values. The revised axis IV according to DSM‐IV seems to have concurrent validity, but is still hampered by limited reliability.