Validity of the revised Diagnostic and Statistical Manual of Mental Disorders-5 cross-cutting symptom measure as implemented in community mental health settings

J Affect Disord. 2024 Jan 1:344:662-673. doi: 10.1016/j.jad.2023.10.077. Epub 2023 Oct 14.

Abstract

Background: The purpose of this study was to validate the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) Cross-Cutting Symptom Measure (CCSM) as a screening tool for a wide variety of disorders within busy community outpatient mental health settings.

Method: Participants (N = 851) were referred for coordinated specialty care services (mean age = 20.26 years (SD = 2.97); 82.5 % Caucasian, 7.5 % African American, 0.7 % Native American, 0.7 % Pacific Islander, 0.8 % Asian, 7.8 % Multiracial; 15.1 % Latinx; 53.1 % female, 45.5 % male, 1.4 % other gender).

Results: At optimal cut-score, specificity ranged from 57 to 77 % for depression, anxiety, substance use and psychosis domains; sensitivity ranged from 63 to 72 %. Scores for depression, anxiety, substance use and psychosis domains differed significantly by groups with and without diagnoses. Correlations among domains were larger where expected (r = 0.52, depression-suicidal ideation), and relatively smaller where expected (r = 0.28, suicidal ideation-inattention). Depression, anxiety, substance use and psychosis domains evidenced incremental validity for their respective diagnoses (change in explained variance, 3-15 %). Psychometric features of CCSM were broadly supported.

Limitations: Criterion measures did not have inter-rater reliabilities as this is generally prohibitive in clinic settings.

Conclusion: The CCSM could provide a first step in screening for multiple disorders; however, it cannot replace structured interviews for making diagnoses related to these conditions.

Keywords: Cross-cutting symptom measure; DSM-5; Psychopathology; Reliability; Validity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Mental Disorders* / diagnosis
  • Mental Disorders* / psychology
  • Mental Health
  • Psychometrics
  • Psychotic Disorders*
  • Reproducibility of Results
  • Substance-Related Disorders* / diagnosis
  • Young Adult