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Axis IV - psychosocial and environmental problems - in the DSM-IV
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2013 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 20, no 9, 768-775 p.Article in journal (Refereed) Published
Abstract [en]

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.

Abstract

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.

Place, publisher, year, edition, pages
2013. Vol. 20, no 9, 768-775 p.
Keyword [en]
assessment, axis IV, concurrent validity, DSM-IV, psychosocial stress, young adults
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-151493DOI: 10.1111/jpm.12009ISI: 000325371100002OAI: oai:DiVA.org:uu-151493DiVA: diva2:410140
Available from: 2011-04-12 Created: 2011-04-12 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Young Adults in General Psychiatry
Open this publication in new window or tab >>Young Adults in General Psychiatry
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mental illness is common, and usually starts early in life. However, the majority of those affected never seek mental health care. The overall aim of this thesis was to increase knowledge about help-seeking young adults with mental illness in order to improve diagnostic procedures in clinical psychiatry.

A group of young adult psychiatric out-patients (n=217) were consecutively invited to participate in the study between October 2002 and September 2003. Altogether 200 (92%) agreed to participate. Among them, there were 161 (80%) women and 39 (20%) men. Participants’ mean age was 22.4±1.9 years. All participants were carefully and comprehensively assessed with respect to axes I, II, IV and V in the DSM-IV. Psychiatric disorders and personality disorders were assessed using the Structured Clinical Interview for DSM-IV for axis I disorders and the Structured Clinical Interview for DSM-IV for axis II disorders. Psychosocial and environmental problems (axis IV) were evaluated through structured interviewing by a social worker and by self-assessment with a questionnaire. Professional and patient ratings on the Global Assessment of Functioning scale were compared before and after treatment. Patients also reported on the Swedish universities Scales of Personality, the Child and Adolescent Psychiatric Screening Inventory-Retrospect and the Coddington’s life event scale.

Taken together, the young adult, psychiatric outpatients were characterized by an early onset of their mental disorders, by co-morbidity, by being female and by having mood or anxiety disorders. There were no significant differences between self-referred and those referred by medical professionals according to either number of current or lifetime diagnoses. Childhood onset of depression was associated with more severe symptoms, more psychosocial risk factors, and more childhood developmental delays. Axis IV psychosocial stress categories were related to the presence of axis I disorders, personality disorders, co-morbidity, and impaired functioning. Agreement between patients’ and professionals’ ratings on the GAF scale was good before treatment and excellent after treatment.

In summary, the findings suggest that direct self-referral to specialized psychiatric care does not seem to be associated with overutilization of such care. Childhood onset of depression is associated with a more complex illness. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability. And finally, the results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 48 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 671
Keyword
Young adults, multi-axial diagnostics, self-referred, help seeking, axis IV, axis V
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-151504 (URN)978-91-554-8070-7 (ISBN)
Public defence
2011-05-28, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-05 Created: 2011-04-12 Last updated: 2011-07-01Bibliographically approved

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Ramirez, AdrianaEkselius, LisaRamklint, Mia

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