The 12-Item Self-Rating Questionnaire for Depressive Mixed State (DMX-12) for Screening of Mixed Depression and Mixed Features

Abstract

For simultaneous screening of mixed features (MF) by DSM-5 and mixed depression (MD) by Benazzi, useful symptoms were extracted from our 12-item dimensional scale for depressive mixed state (DMX-12). Subjects were 190 consecutive cases with major depressive episode (MDE) who visited our clinic. Associations between symptomatological combinations of the DMX-12 and MF or MD were analyzed using receiver operating characteristic (ROC). The rate of MF was 4.2% while that of MD was 22.6%. Eight symptoms (overreactivity, inner tension, racing/crowded thought, impulsivity, irritability, aggression, risk-taking behavior, and dysphoria) with their AUC > 0.6 for ROC curves were specially focused on distinguishing patients with MF or MD from non-mixed patients. By using these 8 symptoms, 40.5% of the overall patients were screened as positive at the same cut-off value (≥13) for both MD and MF. The AUC of ROC curve and sensitivity/specificity were well balanced together with sufficient negative predictive values. The abovementioned 8 symptoms seem to be helpful for primary screening and negative check of DMX with considerable severity during MDE.

Depressive mixed state and anxious distress as risk factors for suicidality during major depressive episodes

“…[27][28][29] This was also supported by our previous finding that the rate of mixed features by DSM-5 was only 4.2% while that of DMX was 22.6% using the same samples with MDE. [16] AD has also been suggested to be associated with suicidality in several previous studies. [17,18] A 2-year longitudinal cohort study compared clinical outcomes of MDD (severity and chronicity of the disease, functional impairment, presence of comorbid anxiety disorders, and prevalence of suicidality) between MDD with and without AD.…”

“…Categorical screening as DMX was determined by a cutoff score of ≥ 13 for the eight DMXspecific symptoms from DMX-8 (over-reactivity, inner tension, racing thoughts, impulsivity, irritability, aggression, risk-taking behavior, and dysphoria). [16] Patients meeting this criterion were designated as DMX (+).…”

“…[14] To address these issues, we developed the self-administered 12-item questionnaire for DMX (DMX-12) [15] to assess DMX, from which we extracted the eight most effective items (DMX-8) for screening purposes, and clarified that the DMX-8 can distinguish not only mixed features [12] but also DMX with considerable severity. [16] Meanwhile, AD was introduced in DSM-5 as a specifier of MDD, emphasizing the clinical significance of anxiety in depressed patients. [17] The DSM-5 criterion for the AD specifier is the presence of at least: (1) feeling keyed up or tense, (2) feeling unusually restless, (3) difficulty concentrating because of worry, (4) fear that something awful might happen, and (5) feeling that the individual might lose control of himself or herself.…”

Elevated Brain-Derived Neurotrophic Factor Levels During Depressive Mixed States

“…Categorical screening as DMX-positive was determined by a cutoff score of <13 for the eight DMX-specific symptoms (over-reactivity, inner tension, racing thoughts, impulsivity, irritability, aggression, risk-taking behavior, and dysphoria). 20 We used these scores to group the participants into DMXnegative (n=82) and DMX-positive (n=54) groups.…”