臨床中程度のエビデンス

DSM-5 Cross-Cutting Symptom Model

Narrow, W. E.; Clarke, D. E.; Regier, D. A. · 2013

別名: DSM-5 Level 1 · DSM-5 Cross-Cutting Symptom Measures

The DSM-5 Cross-Cutting Symptom Model introduces a dimensional, transdiagnostic assessment approach to psychiatric diagnosis. The Level 1 measure is a 23-item self-report screener covering 13 symptom domains (depression, anxiety, anger, mania, somatic symptoms, suicidal ideation, psychosis, sleep, memory, repetitive behaviors, dissociation, personality functioning, substance use) that cut across categorical diagnoses. It was developed as part of the DSM-5 field trials to supplement traditional categorical diagnosis with dimensional severity ratings.

Transdiagnostic symptom domains (depression, anxiety, stress-related distress, etc.) used by DSM-5-aligned screening instruments such as DASS-21 and PHQ-9.

出典:: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
デジタルオブジェクト識別子 — ジャーナル記事への直接リンク。:: 10.1176/appi.ajp.2012.12071000

エビデンス概要

実証的サポート: 中程度のエビデンス
再現性: 部分的に再現
異文化: 異文化間で未検証
メタ分析: 索引なし

研究領域臨床精神医学的アセスメントトランスダイアグノスティック

これらの評価は、理論に関する公開文献を要約したもので、それに基づいて構築された個々のテストの品質ではありません。以下に記載された出典に基づく編集判断であり、エビデンスが蓄積されるにつれて変化します。

歴史的背景

Developed during the DSM-5 revision process (2007-2013) in response to decades of criticism that categorical diagnosis fails to capture the dimensional nature of psychopathology and high rates of comorbidity. The cross-cutting measures were field-tested across 11 academic medical centers in the US and Canada as part of the official DSM-5 Field Trials, representing the APA's first systematic attempt to integrate dimensional assessment into the diagnostic manual.

構成概念

抑うつ

In the DSM-5 cross-cutting symptom framework, depression is assessed as a transdiagnostic symptom dimension that screens for the presence and severity of depressed mood and diminished interest or pleasure across psychiatric disorders, regardless of primary diagnosis (APA, 2013). As a dimensional measure, it captures the frequency of depressive symptoms over a two-week period to supplement categorical diagnosis and inform clinical decision-making about co-occurring symptomatology.

不安

In the DSM-5 cross-cutting symptom framework, anxiety is assessed as a transdiagnostic symptom dimension that screens for the presence and severity of worry, nervousness, and anxious apprehension across psychiatric disorders, regardless of primary diagnosis (APA, 2013). It captures the frequency of anxiety-related symptoms to identify clinically relevant anxious distress that may co-occur with any primary condition and warrant further evaluation.

ストレス

In the DSM-5 cross-cutting symptom framework, stress-related distress is assessed as a transdiagnostic symptom dimension capturing perceived psychological burden, tension, and difficulty coping, screened alongside other domains to provide a comprehensive picture of psychiatric symptomatology beyond the primary diagnosis (APA, 2013). This dimensional approach recognizes that clinically significant stress responses frequently co-occur with and modulate the course of diverse mental disorders.

機器

まだこの理論に基づく機器がありません。

この理論に基づくテスト

まだこの理論に基づくテストがありません。

実践的応用

The Level 1 measure serves as a clinical screening tool to identify psychiatric symptom domains that may need further assessment, helping clinicians detect comorbidities and track symptom change over time. It is freely available from the APA and can be administered in routine clinical settings as a brief triage instrument. The Level 2 measures provide deeper assessment of specific domains flagged by Level 1 screening.

測定方法

The DSM-5 field trials used a test-retest reliability design across 11 academic medical centers (7 adult, 4 pediatric sites) in the US and Canada, with generally good-to-excellent intraclass correlation coefficients for most domains.

批評と制限事項

The latent factor structure remains under-investigated in real-world psychiatric populations, with only a handful of published factor-analytic studies and no consensus on dimensionality. Recommended thresholds show strong sensitivity but low specificity (0.60-0.73 range), limiting diagnostic precision. Adoption in clinical practice has been slow, with limited cross-cultural validation outside Western settings and no published meta-analyses of the measure's psychometric properties.

主要文献

Narrow, W. E., Clarke, D. E., Kuramoto, S. J., Kraemer, H. C., Kupfer, D. J., Greiner, L., & Regier, D. A.. (2013). DSM-5 field trials in the United States and Canada, Part III: Development and reliability testing of a cross-cutting symptom assessment for DSM-5. 10.1176/appi.ajp.2012.12071000
Clarke, D. E., Narrow, W. E., Regier, D. A., Kuramoto, S. J., Kupfer, D. J., Kuhl, E. A., Greiner, L., & Kraemer, H. C.. (2013). DSM-5 field trials in the United States and Canada, Part I: Study design, sampling strategy, implementation, and analytic approaches. 10.1176/appi.ajp.2012.12070998
Clarke, D. E. & Kuhl, E. A.. (2014). DSM-5 cross-cutting symptom measures: A step towards the future of psychiatric care?. 10.1002/wps.20154
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. 10.1002/mpr.1953