临床中等证据支持

DSM-5跨诊断症状模型

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

也被称为: DSM-5 Level 1 · DSM-5 Cross-Cutting Symptom Measures

DSM-5跨诊断症状模型为精神病学诊断引入了一种维度化、跨诊断的评估方法。第一级测量工具是一份包含23个条目的自评筛查量表,涵盖13个跨越分类诊断的症状域(抑郁、焦虑、愤怒、躁狂、躯体症状、自杀意念、精神病性症状、睡眠、记忆、重复行为、分离症状、人格功能、物质使用)。该工具是作为DSM-5现场试验的一部分开发的,旨在用维度化的严重程度评定来补充传统的分类诊断。

与DSM-5相符的筛查工具(如DASS-21和PHQ-9)所使用的跨诊断症状域(抑郁、焦虑、应激相关困扰等)。

来源:: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
DOI:: 10.1176/appi.ajp.2012.12071000

证据概览

实证支持: 中等证据支持
重复验证: 部分重复验证
跨文化性: 尚未进行跨文化验证
綜合分析(统合分析): 尚无收录

研究領域臨床精神科评估跨診斷

这些评等总结了关於该理論已发表的文獻,而非以此理論建构的任何单一测验的品质。它们是根据下方所列来源所作的編輯判斷,並會隨著证据累积而變化。

历史背景

该模型在DSM-5修订过程中(2007-2013年)开发,以回应数十年来关于分类诊断无法捕捉精神病理学的维度性质及高共病率的批评。作为APA正式DSM-5现场试验的一部分,跨诊断测量工具在美国和加拿大的11个学术医疗中心进行了现场测试,这是APA首次系统性地尝试将维度评估纳入诊断手册。

构念

抑郁

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.

焦虑

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.

压力

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.

工具

尚无基于此理论的工具。

基于此理论的测试

尚无基于此理论的测试。

实际应用

第一级测量工具作为临床筛查工具,用于识别可能需要进一步评估的精神症状域,帮助临床医生发现共病情况并跟踪症状随时间的变化。该工具由APA免费提供,可作为简短的分诊工具在常规临床环境中使用。第二级测量工具则针对第一级筛查所标记出的特定领域提供更深入的评估。

如何测量

DSM-5现场试验在美国和加拿大的11个学术医疗中心(7个成人中心,4个儿科中心)采用了重测信度设计,大多数领域的组内相关系数总体上达到良好至优秀水平。

批评与局限

该潜在因素结构在真实精神科人群中仍缺乏深入研究,已发表的因素分析研究为数不多,且在维度性方面尚未达成共识。推荐的临界值显示出较强的敏感性但特异性较低(0.60-0.73范围),限制了诊断精确度。该测量工具在临床实践中的采纳一直较为缓慢,在西方以外环境中的跨文化验证有限,且尚无关于该测量工具心理测量特性的已发表元分析。

重要文献

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