No CrossRef data available.
Article contents
How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample
Published online by Cambridge University Press: 19 April 2024
Abstract
Background
The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown.
Methods
The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR−) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR− < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings.
Results
Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR− values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR− values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties.
Conclusions
The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.
- Type
- Original Article
- Information
- Copyright
- Copyright © The Author(s), 2024. Published by Cambridge University Press
References
Altman, D. G., & Bland, J. M. (1994). Statistics notes: Diagnostic tests 1: Sensitivity and specificity. BMJ, 308(6943), 1552–1552. doi:10.1136/bmj.308.6943.1552CrossRefGoogle Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Amorim, P. (2000). Mini international neuropsychiatric interview (MINI): Mini international neuropsychiatric interview (MINI): Validation of a short structured diagnostic psychiatric interview. Brazilian Journal of Psychiatry, 22(3), 106–115. doi:10.1590/S1516-44462000000300003CrossRefGoogle Scholar
Bartoli, F., Bachi, B., Callovini, T., Palpella, D., Piacenti, S., Morreale, M., … Carrà, G. (2024). Anxious distress in people with major depressive episodes: A cross-sectional analysis of clinical correlates. CNS Spectrums, 29(1), 49–53. doi:10.1017/S1092852923002377CrossRefGoogle ScholarPubMed
Bastiaens, L., & Galus, J. (2018). The DSM-5 self-rated Level 1 cross-cutting symptom measure as a screening tool. Psychiatric Quarterly, 89(1), 111–115. https://doi.org/10.1007/s11126-017-9518-7CrossRefGoogle ScholarPubMed
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale. Journal of Psychosomatic Research, 52(2), 69–77. doi:10.1016/S0022-3999(01)00296-3CrossRefGoogle ScholarPubMed
Bossuyt, P. M., Reitsma, J. B., Bruns, D. E., Gatsonis, C. A., Glasziou, P. P., Irwig, L., … Cohen, J. F. (2015). STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. BMJ, 351, h5527. doi:10.1136/bmj.h5527CrossRefGoogle ScholarPubMed
Collett, D. (2002). Modelling binary data (2nd ed.). New York, NY: Chapman and Hall/CRC. doi:10.1201/b16654CrossRefGoogle Scholar
Doss, R. A., & Lowmaster, S. E. (2022). Validation of the DSM-5 Level 1 cross-cutting symptom measure in a community sample. Psychiatry Research, 318, 114935. doi:10.1016/j.psychres.2022.114935CrossRefGoogle Scholar
Eaton, N. R., Bringmann, L. F., Elmer, T., Fried, E. I., Forbes, M. K., Greene, A. L., … Waszczuk, M. A. (2023). A review of approaches and models in psychopathology conceptualization research. Nature Reviews Psychology, 2, 622–636. doi:10.1038/s44159-023-00218-4CrossRefGoogle Scholar
Forbes, M. K., Neo, B., Nezami, O. M., Fried, E. I., Faure, K., Michelsen, B., … Dras, M. (2024). Elemental psychopathology: Distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5. Psychological Medicine, 54(5), 886–894. doi:10.1017/S0033291723002544CrossRefGoogle ScholarPubMed
Forbes, M. K., Tackett, J. L., Markon, K. E., & Krueger, R. F. (2016). Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span. Development and Psychopathology, 28(4pt1), 971–986. doi:10.1017/S0954579416000651CrossRefGoogle Scholar
Gibbons, A. B., Farmer, C., Shaw, J. S., & Chung, J. Y. (2023). Examining the factor structure of the DSM-5 Level 1 cross-cutting symptom measure. International Journal of Methods in Psychiatric Research, 32(2), e1953. doi:10.1002/mpr.1953CrossRefGoogle ScholarPubMed
Gonçalves, H., Wehrmeister, F. C., Assunção, M. C. F., Tovo-Rodrigues, L., de Oliveira, I. O., Murray, J., … Menezes, A. M. B. (2018). Cohort profile update: The 1993 Pelotas (Brazil) birth cohort follow-up at 22 years. International Journal of Epidemiology, 47(5), 1389–1390e. doi:10.1093/ije/dyx249CrossRefGoogle ScholarPubMed
Gong, J., Zhang, Y., Yang, Z., Huang, Y., Feng, J., & Zhang, W. (2013). The framing effect in medical decision-making: A review of the literature. Psychology, Health & Medicine, 18(6), 645–653. doi:10.1080/13548506.2013.766352CrossRefGoogle ScholarPubMed
Griffith, J. W., Zinbarg, R. E., Craske, M. G., Mineka, S., Rose, R. D., Waters, A. M., & Sutton, J. M. (2010). Neuroticism as a common dimension in the internalizing disorders. Psychological Medicine, 40(7), 1125–1136. doi:10.1017/S0033291709991449CrossRefGoogle ScholarPubMed
Grimes, D. A., & Schulz, K. F. (2005). Refining clinical diagnosis with likelihood ratios. The Lancet, 365(9469), 1500–1505. doi:10.1016/S0140-6736(05)66422-7CrossRefGoogle ScholarPubMed
Gryczynski, J., Kelly, S. M., Mitchell, S. G., Kirk, A., O'Grady, K. E., & Schwartz, R. P. (2015). Validation and performance of the alcohol, smoking and substance involvement screening test (ASSIST) among adolescent primary care patients. Addiction, 110(2), 240–247. doi:10.1111/add.12767CrossRefGoogle ScholarPubMed
Jaeschke, R., Guyatt, G. H., & Sackett, D. L. (1994). Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The evidence-based medicine working group. JAMA, 271(9), 703–707. doi:10.1001/jama.271.9.703CrossRefGoogle Scholar
Jami, E. S., Hammerschlag, A. R., Ip, H. F., Allegrini, A. G., Benyamin, B., Border, R., … Middeldorp, C. M. (2022). Genome-wide association meta-analysis of childhood and adolescent internalizing symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 61(7), 934–945. doi:10.1016/j.jaac.2021.11.035CrossRefGoogle ScholarPubMed
Kassambara, A. (2021). Package ‘rstatix’ – pipe-friendly framework for basic statistical tests. https://CRAN.R-project.org/package=rstatixGoogle Scholar
Krabbe, J., & Forkmann, T. (2014). Frequency vs. intensity: Framing effects on patients’ use of verbal rating scale anchors. Comprehensive Psychiatry, 55(8), 1928–1936. doi:10.1016/j.comppsych.2014.06.010CrossRefGoogle ScholarPubMed
Krishnakumar, A., Scopel Hoffmann, M., Schoeller, F., Clucas, J. C., Son, J., Müller-Naendrup, L., … Klein, A. (2021). Framing mental health questions using context better predicts disability than does frequency. PsyArXiv [Preprint]. doi:10.31234/osf.io/jm9kcGoogle Scholar
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The patient health questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292. doi:10.1097/01.MLR.0000093487.78664.3CCrossRefGoogle ScholarPubMed
Levin, I. P., Schneider, S. L., & Gaeth, G. J. (1998). All frames are not created equal: A typology and critical analysis of framing effects. Organizational Behavior and Human Decision Processes, 76(2), 149–188. doi:10.1006/obhd.1998.2804CrossRefGoogle Scholar
Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58(2), 163–171. doi:10.1016/j.jpsychores.2004.09.006CrossRefGoogle ScholarPubMed
Löwe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld, K., … Brähler, E. (2010). A 4-item measure of depression and anxiety: Validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders, 122(1–2), 86–95. doi:10.1016/j.jad.2009.06.019CrossRefGoogle ScholarPubMed
Mahoney, M. R., Farmer, C., Sinclair, S., Sung, S., Dehaut, K., & Chung, J. Y. (2020). Utilization of the DSM-5 self-rated Level 1 cross-cutting symptom measure-adult to screen healthy volunteers for research studies. Psychiatry Research, 286, 112822. doi:10.1016/j.psychres.2020.112822CrossRefGoogle ScholarPubMed
Manfro, P. H., Belem da Silva, C. T., Anselmi, L., Barros, F., Eaton, W. W., Gonçalves, H., … Kieling, C. (2021). Depression in a youth population-based sample from Brazil: Prevalence and symptom structure. Journal of Affective Disorders, 292, 633–641. doi:10.1016/j.jad.2021.05.073CrossRefGoogle Scholar
Matte, B., Anselmi, L., Salum, G. A., Kieling, C., Gonçalves, H., Menezes, A., … Rohde, L. A. (2015). ADHD in DSM-5: A field trial in a large, representative sample of 18- to 19-year-old adults. Psychological Medicine, 45(2), 361–373. doi:10.1017/S0033291714001470CrossRefGoogle Scholar
McNeely, J., Wu, L.-T., Subramaniam, G., Sharma, G., Cathers, L. A., Svikis, D., … Schwartz, R. P. (2016). Performance of the tobacco, alcohol, prescription medication, and other substance use (TAPS) tool for substance use screening in primary care patients. Annals of Internal Medicine, 165(10), 690. doi:10.7326/M16-0317CrossRefGoogle ScholarPubMed
Means-Christensen, A. J., Arnau, R. C., Tonidandel, A. M., Bramson, R., & Meagher, M. W. (2005). An efficient method of identifying major depression and panic disorder in primary care. Journal of Behavioral Medicine, 28(6), 565–572. doi:10.1007/s10865-005-9023-6CrossRefGoogle ScholarPubMed
Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., Hallak, J. E., Trzesniak, C., de Azevedo Marques, J. M., … Crippa, J. A. (2010). Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcoholism, clinical and experimental research, 34(8), 1417–1424. doi:10.1111/j.1530-0277.2010.01225.xCrossRefGoogle ScholarPubMed
Mitchell, A. J., Yadegarfar, M., Gill, J., & Stubbs, B. (2016). Case finding and screening clinical utility of the patient health questionnaire (PHQ-9 and PHQ-2) for depression in primary care: A diagnostic meta-analysis of 40 studies. BJPsych Open, 2(2), 127–138. doi:10.1192/bjpo.bp.115.001685CrossRefGoogle ScholarPubMed
Mulvaney-Day, N., Marshall, T., Downey Piscopo, K., Korsen, N., Lynch, S., Karnell, L. H., … Ghose, S. S. (2018). Screening for behavioral health conditions in primary care settings: A systematic review of the literature. Journal of General Internal Medicine, 33(3), 335–346. doi:10.1007/s11606-017-4181-0CrossRefGoogle ScholarPubMed
Negeri, Z. F., Levis, B., Sun, Y., He, C., Krishnan, A., Wu, Y., … Thombs, B. D. (2021). Accuracy of the patient health questionnaire-9 for screening to detect major depression: Updated systematic review and individual participant data meta-analysis. BMJ, 375, n2183. doi:10.1136/bmj.n2183CrossRefGoogle ScholarPubMed
Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment. Frontiers in Psychiatry, 11, 76. doi:10.3389/fpsyt.2020.00076CrossRefGoogle ScholarPubMed
Plana-Ripoll, O., Pedersen, C. B., Holtz, Y., Benros, M. E., Dalsgaard, S., de Jonge, P., … McGrath, J. J. (2019). Exploring comorbidity within mental disorders among a Danish national population. JAMA Psychiatry, 76(3), 259. https://doi.org/10.1001/jamapsychiatry.2018.3658CrossRefGoogle ScholarPubMed
Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic meta-analysis. General Hospital Psychiatry, 39, 24–31. doi:10.1016/j.genhosppsych.2015.11.005CrossRefGoogle Scholar
Power, M., Fell, G., & Wright, M. (2013). Principles for high-quality, high-value testing. Evidence Based Medicine, 18(1), 5–10. doi:10.1136/eb-2012-100645CrossRefGoogle ScholarPubMed
Simel, D. L., Samsa, G. P., & Matchar, D. B. (1991). Likelihood ratios with confidence: Sample size estimation for diagnostic test studies. Journal of Clinical Epidemiology, 44(8), 763–770. doi:10.1016/0895-4356(91)90128-VCrossRefGoogle ScholarPubMed
Smith, P. C., Schmidt, S. M., Allensworth-Davies, D., & Saitz, R. (2009). Primary care validation of a single-question alcohol screening test. Journal of General Internal Medicine, 24(7), 783–788. doi:10.1007/s11606-009-0928-6CrossRefGoogle ScholarPubMed
Stevenson, M., Sergeant, E., Heuer, C., Nunes, T., Heuer, C., Marshall, J., … Rabiee, A. (2020). Package ‘epiR’ – tools for the analysis of epidemiological data. https://CRAN.R-project.org/package=epiRGoogle Scholar
US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Chelmow, D., Coker, T. R., … Wong, J. B. (2023b). Screening for depression and suicide risk in adults: US preventive services task force recommendation statement. JAMA, 329(23), 2057–2067. doi:10.1001/jama.2023.9297Google ScholarPubMed
US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Coker, T. R., Davidson, K. W., … Wong, J. B. (2023a). Screening for anxiety disorders in adults: US preventive services task force recommendation statement. JAMA, 329(24), 2163–2170. doi:10.1001/jama.2023.9301Google ScholarPubMed
US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., … Wong, J. B. (2018). Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US preventive services task force recommendation statement. JAMA, 320(18), 1899–1909. doi:10.1001/jama.2018.16789Google ScholarPubMed
US Preventive Services Task Force, Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., … Wong, J. B. (2020). Screening for unhealthy drug use: US preventive services task force recommendation statement. JAMA, 323(22), 2301–2309. doi:10.1001/jama.2020.8020Google ScholarPubMed
Victora, C. G., Araújo, C. L. P., Menezes, A. M. B., Hallal, P. C., Vieira, M. d. F., Neutzling, M. B., … Barros, F. C. (2006). Methodological aspects of the 1993 Pelotas (Brazil) birth cohort study. Revista de Saúde Pública, 40(1), 39–46. doi:10.1590/S0034-89102006000100008CrossRefGoogle ScholarPubMed
Victora, C. G., Hallal, P. C., Araujo, C. L., Menezes, A. M., Wells, J. C., & Barros, F. C. (2008). Cohort profile: The 1993 Pelotas (Brazil) birth cohort study. International Journal of Epidemiology, 37(4), 704–709. doi:10.1093/ije/dym177CrossRefGoogle ScholarPubMed
Vilagut, G., Forero, C. G., Barbaglia, G., & Alonso, J. (2016). Screening for depression in the general population with the center for epidemiologic studies depression (CES-D): A systematic review with meta-analysis. PLoS One, 11(5), e0155431. doi:10.1371/journal.pone.0155431CrossRefGoogle Scholar
Waszczuk, M. A., Zimmerman, M., Ruggero, C., Li, K., MacNamara, A., Weinberg, A., … Kotov, R. (2017). What do clinicians treat: Diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns. Comprehensive Psychiatry, 79, 80–88. doi:10.1016/j.comppsych.2017.04.004CrossRefGoogle ScholarPubMed
Xie, C., Xiang, S., Shen, C., Peng, X., Kang, J., Li, Y., … ZIB Consortium. (2023). A shared neural basis underlying psychiatric comorbidity. Nature Medicine, 29(5), 1232–1242. doi:10.1038/s41591-023-02317-4CrossRefGoogle ScholarPubMed
Gonçalves Pacheco et al. supplementary material
Gonçalves Pacheco et al. supplementary material
File
1.2 MB