Axis IV: A reliable and valid measure of psychosocial stressors?

Interrater Agreement Among Psychiatrists in Psychiatric Emergency Assessments

“…Use of structured instruments has been shown to lead to high interrater reliability (12,13,19). Variability due to different "mental models" would be eliminated because the instrument standardizes the combining and weighting of information.…”

“…Several studies have investigated the reliability of psychiatric diagnosis (8)(9)(10)(11)(12)(13)(14); many of these reported low interrater reliability. As an example, Hjortso et al (9) created 24 vignettes based on clinical records and asked seven experienced psychiatrists to make diagnostic judgments.…”

Developing Classification in Psychiatry - Implications of 50 Years of Progress in Psychopharmacological Therapeutics

“…[22][23][24][25][26][27] For example, the recording of physical disorders and life events in DSM-IV could be replaced by scales that record, in a standardised fashion, risk assessment, and/or by summarising the time course/chronicity of the disorder. Both of these approaches might make helpful contributions to clinical patient management plan development and set the stage for a changed axis one of DSM-IV to achieve a greater degree of complementarity between neuropsychopharmalogical developments and psychiatric classifications.…”

The Life and Death of Axis IV

“…Among the points made in support of axis IV was Skodol's (1991) report of the shift from stressor severity in DSM-III (with only modest reliability) to identification of psychosocial stressors in DSM-IV (greater clinical usefulness), indication of improvement in the conceptualization and utility of axis IV over time (Mezzich, 2005). Put simply, axis IV had gotten better.…”